2015 Provider Network Strategy Accessing the Provider Network - - PowerPoint PPT Presentation

2015 Provider Network Strategy

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Accessing the Provider Network Template

Carrier Specific Provider Network Name

C4HCO Shopping Page

Provider Network Overview.PDF

A potential C4HCO client could evaluate the carries Specific Network Template by hitting the carriers network name from the C4HCO shopping page OR Review the Network Template from the Carriers Detail Benefit page under “Plan Documents”

Rocky Mountain Health Plan

Rocky Mountain HMO Colorado Springs Health Partners Provider Network

Carrier Product Type: Health Maintenance Organization

Accessing Care Outside the service area / State: Emergency and Urgent care is provided any where in the United States and traveling abroad. Coverage outside of Colorado? No problem. You have access to a nationwide network of providers and hospitals. Key Provider Network Features: Learning to live with a chronic condition can be difficult. If you are diagnosed with a chronic condition (like asthma, diabetes, COPD, or heart disease), our specially-trained care managers are here to work with you and your doctor to help you get the care you need, understand the health care system, and answer any questions you may have. Hospital Medical Facilities: Childrens Hospital Colorado, Denver Health & Hospitals, Exempla St Josephs Hospital, Kindred Hospital Denver, National Jewish Health, Porter Adventist Hospital, Presbyterian St Luke Medical Center,Rose Medical Center Emergency Care & Urgent Care Facilities: After Ours Inc,Concentra Urgent Care, Green Valley Ranch Urgent Care Center Prof LLC, Guardian Urgent Care, Rocky Mountain Urgent Care Specialty Care Facilities: Select Specialty Hospital, St Anthony Hospital Central Inpatient Rehab Ancillary Providers: Colorado Springs Health Partners Radiology, Diagnostic Health Center of Colorado LP, Healthsouth Diagnostic Center Open MRI, Memorial Health Radiology/Imaging/Nuclear Medicine, Penrad Imaging, Southwest Diagnostic Center of Colorado Springs, Apria Home Infusion, Preferred Homecare Infusion LLC-Colorado Springs Pharmacy Providers: Walgreens Drug Store, Safeway Pharmacy, Sam's Club Pharmacy, Albertsons Pharmacy, Costco Pharmacy, King Soopers Pharmacy, IDGP Pharmacy at the University of Colorado Hospital, City Market Pharmacy

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(Carrier Name)

(Provider Network name) match C4HCO shopping page

Product Type: (HMO, EPO, PPO)

Accessing Care Outside the service area / State:

(provide services for accessing care out side the service area & the state)

Key Provider Network Features: (open text to provide any

key features about your Network)

Hospital Medical Facilities: (List available

hospitals)

Emergency Care & Urgent Care Facilities: (list available

Emergency Care & Urgent Care facilities)

Specialty Care Facilities:

(list Rehabilitative facilities / Behavioral Health Facilities / Substance Abuse Facilities / any additional facilities)

Ancillary Providers: (list Lab / Radiology / DME / Home Health / Hospice

/ Skilled nursing / Dialysis / others)

Pharmacy Providers: ( list participating pharmacies)

Highlights of this Sections:

• Accessing Care Outside the service area / State
• Hospital Medical Facilities
• Emergency Care & Urgent Care Facilities
• Specialty Care Facilities
• Ancillary Providers
• Pharmacy Providers

Section 1: Provider Network Template

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Section 2: Provider Network Template

PRIMARY CARE PHYSICIANS

Selecting a Primary Care Physicians: (insert instructions on how to select a new or changing a PCP, is a PCP required to start accessing care) Key Features: (Open text provided by carrier) Primary Care Physicians by Type and Quantity Family Medicine (Total Count) Pediatrician (Total Count) General Practice (Total Count) Obstetrics & Gynecology (Total Count) Internal Medicine (Total Count) Other (Total Count)

Primary Care Physician Section:

• Selecting a Primary Care Physician – Instructions
• Key Features – Open text for carriers to describe their Primary Care Physician network
• Primary Care Physicians – Total Counts Only
• Family Medicine
• General Practice
• Internal Medicine
• Pediatrician
• Obstetrics & Gynecology
• Other

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SPECIALTY CARE PHYSICIANS

Accessing care from a Specialty Care Physicians: (insert instructions on how to access care from a specialty physician - referral required?, get medical / case management involved? Pre authorization required?) Key Features: (Open text provided by carrier) Specialty Care Physicians by Type and Quantity Addiction & Substance Abuse (Total Count) Ophthalmology (Total Count) Allergy & Immunology (Total Count) Optometry (Total Count) Behavior Health (Total Count) Otolaryngology (Total Count) Cardiovascular Disease (Total Count) Pain Medicine (Total Count) Dermatology (Total Count) Physical Therapy (Total Count)

Specialty Care Physician Section:

• Accessing Care from a Specialty Care Physician
• Key Features – Open text for carriers to describe their Specialty Care Physician network

And / Or include

• Total Counts Only & Customize the list based on carrier preference – Optional

Section 3: Provider Network Template

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Service Area

Insert service area counties / map / description about your service area

Service Area Section:

• This section is dedicated for the carrier to describe their service area

Section 4: Provider Network Template

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Key Features of the Provider Network Template Strategy:

• Carrier would populate ONE Provider Network Template based on

plan and network options (example – PPO plans use network XYZ and their HMO plans use network ABC)

• Customers could to pull up each carriers specific Provider Network Template to compare networks
• Carriers would provide detail descriptions about their Network in varies text fields:
• Product type description
• Accessing care outside their service area and state
• Key provider network features
• List facilities, ancillary providers and pharmacy providers
• How to select and change Primary Care Providers
• Key features on Primary Care Physicians – Open text for carriers to highlight details about their PCP’s
• Accessing care from a Specialty Care Physician
• Key features on Specialty Care Physicians – Open text for carriers to highlight details about their Specialist

(For rural areas a carrier could explain how they access / utilize Specialist from metropolitan areas)

• Description of the carriers service area
• Accessing Provider Network Templates – Customers can hit “network name” from carriers shopping page header

and / or by opening a PDF network template document under the carriers Detail Benefits in the Plan Documents section.

Key Features

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Questions OR Suggestions