Accountable Care Program
Regional Sales Representative
Sterling Self Insurance Administration
800-617-4729, ext. 202
About UC San Diego Health System
As the only academic health system in the San Diego region, UC San Diego Health System offers a wide range of services from primary to specialty care, and uses state-of-the-art technology and telemedicine. It is one of the few health systems in California that is completely paperless, utilizing an electronic health record system in both inpatient and outpatient settings. Because UC San Diego Health System manages the health care of its enrolled members, it is recognized for delivering the highest quality patient-centered health care, while keeping costs low.
Through a unique partnership, UC San Diego Health System and Sterling Self Insurance Administration (SIA) are offering a new Accountable Care Program (ACP). This partnership enables employers to self-insure their medical benefits, giving them control over medical benefits and spending — now, and in years to come.
Within the ACP, UC San Diego Health System serves as the exclusive in-network provider of medical services for employers in the San Diego area. Employers fund their annual expected medical expenses through an arrangement between the employer, UC San Diego Health System and Sterling SIA.
The ACP encourages employees to take responsibility for their health and rewards them for maintaining a healthy lifestyle. We know that by involving employees as empowered decision-makers, they become educated purchasers, which results in decreased health care spending. Employers benefit from a workforce that is incentivized to maintain good health. This change translates into lower medical utilization and costs, and higher productivity.
Rising health care costs, rising health insurance premiums, and the implications of health care reform are forcing employers of all sizes to use creative solutions for providing health care coverage for their employees. And many employers are realizing that managing health care costs works most effectively when employees have built-in incentives for making sound choices when it comes to managing their health care. Self-insurance and the unique benefits of the ACP are right for employers who are:
- Ready to change their benefits plan and funding model to gain cost control.
- Looking for a long-term solution to provide affordable health benefits for employees.
- Savvy about consumer-directed health plans, such as health savings accounts (HSAs) and health reimbursement arrangements (HRAs), and how they benefit the bottom line for employers and employees.
- Looking for ways to avoid many costly aspects of health care reform.
Putting It All Together for Our Clients
To make this a simple transition for employers and employees, the ACP is designed as a single source solution for every aspect of an employer’s self-insured plan, utilizing best-in-class partners with expertise in their respective fields. This combination gives employers health care benefit solutions that are disciplined, sustainable and controllable. Employers can work directly with health insurance brokers and general agents to develop the program, supported by Sterling SIA.
- Employers can choose from Sterling SIA benefit plan designs that include HSAs and/or HRAs to increase employee engagement, save taxes and reduce costs.
- UC San Diego Health System hospitals and physicians represent in-network providers.
Setup, Enrollment and Account Management
- Plan setup and enrollment support are provided by Sterling SIA, a health plan administrator in business since 2004 and highly regarded for its expertise in health insurance and health care financing. Sterling provides enrollment support, expert education for employers and employees, personal service, and integrated, interactive web-based account management and reporting tools.
Claims Management, Pharmacy and Wellness
- Medical, dental and vision claims management is provided through Capitol Administrators.
- Discounted pharmacy benefit management is available through Ventegra® and UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.
- Health Choices wellness program is provided by Viridian Health Management — developer of a model worksite wellness program for the Centers for Disease Control and Prevention (CDC).
Rebates and Rewards
- Pharmacy rebates are passed on to employers and employees, depending upon the deductible phase — a benefit unique to this program.
- A proprietary Sterling HealthAssets™ account is provided for employees to hold pharmacy rebates and financial rewards for wellness programs like weight loss and smoking cessation.