What problem is Holista solving?
Employees often make healthcare decisions with little to no guidance, often leading to suboptimal health outcomes and higher care costs. Traditional health networks fail to differentiate high-performing providers or outcomes, and patients are left with limited details from their doctors. Holista solves this by empowering employees with actionable insights and better care options.
Are there upfront PEPM fees for employers?
No, there are no upfront Per Employee Per Month (PEPM) fees. Payment is included in the fixed episode payment, ensuring there are no additional costs for employers to participate.
When can an employer add Holista to their plan?
Employers can integrate Holista into their plans at any point during the year—it doesn’t need to align with the enrollment cycle. We recommend adding Holista outside the typical enrollment period for a smoother setup and integration.
What is a high-value network, and how does it mitigate risk?
A high-value network ensures that patients are connected with top-performing physicians rather than making healthcare decisions blindly. This focus on quality care reduces risks and improves outcomes.
What is concierge clinical navigation, and how does it work?
Holista provides app and portal access, where clinical teams guide patients through every step of their care journey—from pre-procedure to recovery. This hands-on approach ensures compliance, reduces risks, and supports the best possible clinical outcomes for patients.
How do closed-loop referrals work?
Holista works closely with Direct Primary Care (DPC) providers to ensure a closed-loop referral process. This means patients are referred to the appropriate care and are guided back to their Primary Care Provider (PCP) post-Episode of Care (EOC).
What variation does Holista eliminate?
Holista eliminates the inefficiencies of traditional care by waiving pre-authorization requirements. Instead, we focus on a clear care plan and recovery strategy, providing greater transparency and a better healthcare experience. Moreover, an employer can expect the same cost for each occurrence of an episode of care within their market.
How can a broker get an employer started with Holista?
The process begins with a request for two years’ worth of claims data. From there, Holista creates a missed opportunities report or establishes an ROI baseline, which serves as the foundation for the program when starting.
What actionable reporting and dashboards does Holista provide?
Holista provides brokers and employers with a Missed Opportunities Report or ROI baseline as a starting point. These reports are continually updated to track progress and identify areas of improvement.
Does Holista get involved with Claims processing?
Holista is a fully integrated claims and payment platform and a licensed TPA. Stop Loss carriers have endorsed Holista, leading to lower client Stop Loss premiums.
How does Holista help employers educate employees about its services?
Holista offers ongoing promotion and education support through a variety of pre-developed collateral. Additionally, Holista collaborates with employers to create customized materials that resonate with their teams needs and priorities.
What is Holista’s reporting cadence?
Once the program is established, Holista works with the benefits consultant to determine an appropriate reporting cadence tailored to the employer’s needs.
How does Holista integrate with the Summary Plan Document?
The Summary Plan Document is updated to reflect the addition of Holista’s Episode of Care (EOC) solution, ensuring compliance and transparency for employers and employees alike.
What Episodes of Care are available?
Find all Episodes of Care via the Live Directory at providerdirectory.holistahealth.com