Select Provider Network Presented by the Employees Group Insurance - - PowerPoint PPT Presentation

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Select Provider Network

Presented by the Employees Group Insurance Department

• Sept. 30, 2015

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Background

• April 9, 2015

— House Bill 1567 was signed into law – Health plans offered by the Office of Management and Enterprise Services “may provide for the application of deductibles and copayment or coinsurance provisions that are based on contract with providers for specific services based on levels of outcomes or cost” – Effective Nov. 1, 2015

• May 2015

— HealthChoice began discussing bundled payment options with interested facilities within the Oklahoma market

• Jan. 1, 2016

— “Select Provider Network” to be introduced by HealthChoice and the Oklahoma Department of Corrections (DOC)

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Select Provider Network

• Select Provider Network

— Network of participating facilities that will offer certain services to members at a bundled price — Available to members of the HealthChoice plans and those in the custody of DOC ‒ Not available to participants in the HealthChoice USA Plan ‒ When applicable, HDHP participants must meet their deductible first ‒ No out-of-pocket costs to members when using Select Network Providers for specified services

• Bundled Price

— Facility will submit one bill for all services associated with the bundled encounter — HealthChoice will make one payment which will incorporate facility and professional components, including anesthesiology

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Select Provider Network

• Provider Participation

— Providers may choose to participate in the Select Provider Network for selected categories or all categories ‒ Example ‒ a provider may choose to be a Select Provider for colonoscopy/sigmoidoscopy services but not for shoulder arthroscopy services, or they may participate in both

• Contracting

— Contract amendment required and available through HealthChoice and DOC Network Management

• Reimbursement

— Allowable Fees will be determined through discussions with provider partners and review of prevailing market ranges — Fee schedules will be available through the secure HealthChoice and DOC websites or from network management

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Select Provider Network

• Communications to HealthChoice Members

— Option Period materials include a description of the program — HealthChoice Member Services will educate members during the annual Option Period — Both the HealthChoice and DOC websites will feature the most current list of participating providers and the select procedures offered

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Select Provider Network

• Jan. 1, 2016

— Colonoscopies and sigmoidoscopies — $100 incentive payment to members in addition to no out-

• f-pocket costs
• Second Quarter of 2016

— Additional services being considered include shoulder arthroscopy and computed tomography of the head

• Remainder of 2016 and Forward

— Input from provider partners and members will be key to identifying additional opportunities for services — Additions to the program may also be identified based on local and national trends and successful Centers for Medicare and Medicaid Services initiatives

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Timeline

• Sept. 30, 2015

— Public hearing

• Oct. 9, 2015

— Written comments on public hearing are due

• Oct. 27, 2015

— Final recommendation posted to the HealthChoice and DOC websites

• Jan. 1, 2016

— Implementation of Select Provider Network

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