HPN (High performance network)

Transcription

1 A brief overview Coventry Health Care HPN (High performance network) For the 2014 benefit year, Coventry Health Care will offer a type of Medicare Advantage plan in several of our markets, commonly referred to as an HPN or High Performance Network plan. This overview document is designed to give you the basics on what an HPN is and how it differs from other types of Medicare Advantage plans. What makes Total Care different? Members can be confident that they have access to the top providers, who work closely together. This new model is statistically proven to lead to better health outcomes, greater patient satisfaction, higher retention, and lower costs. It provides systems that enhance care coordination and includes incentives for primary care physicians to spend more time with patients. It s a great option for improving members health, it s more personal, and it costs less.

2 Coventry High Performance Networks Below is a list of the Coventry markets that will offer an HPN plan in 2014, along with the name of the preferred provider group who will be participating in each plan. Please note that most HPNs are only available in select counties in each market, so be sure to check with your local Coventry plan for details on availability. Coventry Market Preferred Provider or HPN Plan Type Georgia Illinois Iowa Kansas University Health Link / PCP IPA St. Joes/ Candler PHO SouthCoast Medical Group SwedishAmerican Health System UnityPoint Health-Methodist Mercy Medical Center McFarland Clinic Siouxland Medical Doctors, Inc. Alegent Creighton Health Via Christi Stormont Vail Mercy - St. Louis Advantra (PPO/POS/HMO) Advantra Total Care (HMO) Missouri Mercy - Four Rivers (formerly Patients First) SSM Health Care Nebraska Alegent Creighton Health North Carolina CaroMont Cornerstone Healthcare Advantra Gold (PPO) *Make sure to read the PPO section of this document as these plans work differently than what you ve been used to.

3 Coventry High Performance Networks Coventry Market Preferred Provider or HPN Plan Type Oklahoma Integris Health Partners Coventry Freedom (HMO & PPO) South Dakota Avera Health Texas Baptist Health System Advantra HMO and PPO *Make sure to read the PPO section of this document as these plans work differently than what you ve been used to. What is an HPN? HPN, often referred to as narrow networks are part of an ACO (Accountable Care Organization), a network of doctors and hospitals that share responsibility for providing care to patients. Under the new health care reform law, an ACO would agree to manage all of the health care needs of a minimum of five-thousand Medicare beneficiaries for at least three years.

4 Coventry s HPN plans offer a lot of great benefits and services, but may not be a good fit for everyone. For example, your clients may not be interested in an HPN plan if they: Have a specific doctor(s) they want to see who is not the designated provider for the plan Travel frequently or spend time living in other areas so need the flexibility of being about to obtain routine care out-of-network Like having a broad selection of doctors they can see Is an HPN right for your client? On the flipside, an HPN may be right for your client if they: Would appreciate the simplicity of accessing all their care through a single provider Would enjoy a plan that places more emphasis on preventive health care, rather than just being there when they get sick Have complex medical needs and would welcome extra support with coordinating their health care needs It s important that you review the pros and cons of an HPN plan with your clients so they can decide if it s right for them. How does it work? With an HPN, all of a member s care is coordinated by a single, designated team of doctors, or ACO (preferred provider). In each of the markets where Coventry offers HPN plans, we have established a partnership with a reputable health care system that will be responsible for providing all the care to the members enrolled in that plan. These health care systems are financially incentivized to achieve better outcomes for our members. Better outcomes are measured in a variety of ways, but could include reducing hospital admissions, increasing compliance with obtaining recommended preventive health screenings and reducing emergency room visits, to name a few. In other words, doing a good job at keeping people well. As a result, the doctors involved in the HPN have more responsibility and ownership for their patients health and well being. And, patients benefit because they receive highly personalized and coordinated care that is more focused on helping them to be healthy, rather than just taking care of them when they get sick. PPO HPN Plans In 2014,some of Coventry s markets will offer PPO HPNs. With these plans, a member can choose to have all of their care provided by the designated preferred provider or they can see other doctors. If a member chooses the preferred provider, they will receive a higher level of care coordination. Specifically, the member will be able to take advantage of all the positive things an HPN offers, as outlined above.

5 Coventry is here to support you in understanding our HPN plans! Please don t hesitate to call your local plan to get more information and training on this product offering. Coventry Market Contact Name Phone Georgia Tanya Biggers x 6554 Illinois Todd Brooks Iowa Joe Koppin Kansas John Winter Missouri (St. Louis) Gil Reynolds Nebraska Joe Koppin N. Carolina Paul McLeod Oklahoma John Winter South Dakota Joe Koppin Texas Don Hansford