PacifiCare HMO 101 Presentation 9 07

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PacifiCare HMO 101 Presentation 9 07 Powered By Docstoc
					                                                                                     PacifiCare HMO/MCO
                                                                                        101 Presentation
                                                                                                                    2007


Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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         The purpose of this PowerPoint presentation is to provide a
         general overview of what you might want to include in a
         presentation given to either a new group or renewing group
         during enrollment season.


         Please verify that the information in the slides you choose to
         use is applicable to your region. Because there are so many
         different plan offerings and nuances in each market some
         information may not be applicable for your region.


         Please feel free to add or delete slides and/or language as
         needed.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
                   HMO / MCO plans
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                   If cost of coverage is the concern, an HMO / MCO may be the right
                   choice. Care is provided entirely within a single HMO / MCO network,
                   and the out of pocket expenses are general small.

                   •Members select a primary care physician from the health plan’s
                   network of contracted providers to coordinate all of their care
                   •They see a primary care physician for covered services as often as they
                   need and obtain referrals for specialist services
                   • They pay a co-payment for designated services
                   •Little or no paperwork or claim forms are required
                   •There are no pre-existing exclusions
                   •Coverage includes preventive health care, most immunizations and
                   physical examinations at regular intervals



Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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    Who are the Primary Care Physicians (PCP)
                                  • Family Practice

                                  • General Practice

                                  • Internal Medicine

                                  • Pediatrics




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 What benefits are included in the HMO/MCO
 plan?
                      PCP office visits:                                                        at a set copay per visit

                      Specialist visits:                                                        at a set copay per visit –
                                                                                                 sometimes twice the PCP copay

                      Hospitalization:                                                          usually paid at 100% or may
                                                                                                 include a copay

                      Emergency:                                                                at a set copay; (waived if
                                                                                                 admitted)

                      Urgent Care:                                                              at a set copay copay – usually
                                                                                                 the same as the PCP office visit


Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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 What benefits are included in the PacifiCare
 HMO plan cont...?
                 Ambulance:                                                                               Paid at 100% or a copay may
                                                                                                           apply

                Standard Lab & X-Ray :                                                                   a set copay applies per visit –
                                                                                                           waived it provided as part of
                                                                                                           office visit

                Specialized Scanning & Imaging:                                                          a set copay applies per
                                                                                                           procedure

                Rehabilitative Therapy :                                                                 a set copay per therapy
                                                                                                           treatment
                       Physical, Occupational, & Speech Therapy

                       Limited to a specific number of visits per year
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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    Prescription Medication                                                             (If applicable)




             PacifiCare Formulary

              Generic:                                                                      a set copay (30 day supply)

              Brand-Name Drugs:                                                             a set copay copay (30 day supply)

              Non-Formulary Drugs:                                                          [Require Pre-authorization]



              Mail-order prescription service available through Prescription
               Solutions just call 1-800-562-6223



Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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   Health Improvement Programs


                        Pregnancy to Preschool

                        Menopause: “Understanding your Options”

                        24 Hour Information & Nurse Line

                        Taking Charge of Your Heart Health™

                        Taking Charge of DiabetesSM

                        StopSmokingSM




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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 PacifiCare Perks                                                SM*

  *PacifiCare Perks services and/or products are administered through PacifiCare Health Plan Administrators, a subsidiary of PacifiCare Health Systems.




                Exclusive “Members-Only” discount program

                Includes discounts through vendor arrangements

                Family safety products, health clubs, alternative care,
                 vitamins, vision care services, natural body care
                 products and much more!




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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 PacifiCare HealthCreditsSM


 • Value-added program designed to help lower health care costs and
   increase employee productivity
 • Available to all PacifiCare commercial medical members at no
   additional premium cost
 • Encourages and rewards employees who actively participate in:

          PacifiCare’s VirtualHealthClubSM
          Completing a Health Risk Assessment
          Health and disease management programs

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Honors & Recognition
       •    A Fortune Global 500 Company -- PacifiCare ranked 496 in Fortune Magazine's
            annual listing of the 500 largest corporations in the world, July 26, 2004
       •    Innovators Award sponsored by Health Insurance Association of America
       •    Health Financing Innovator Award from the Foundation for Accountability
       •    American Business Awards: Stevie award Finalist, Women’s Health Solutions: Best
            New Product/Service
       •    One of the Best Places to work for Latinos, Hispanic Magazine
       •    10 Best Companies for Asian Americans, Asian Enterprise Magazine
       •    Black Chamber of Commerce 2004 Corporation of the Year
       •    Selected by local providers for being the best performer among HMOs




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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  PHS Quality Pedigree: Quality & Accountability


• NCQA Accreditation

• QUALITY INDEX® Profile hailed by purchasers, regulators, consumers, providers,
  CMS, NCQA, IOM, AHRQ

• HEDIS® - Met or Exceeded Industry Average in 5 HEDIS Effectiveness of Care
  Measures compared to California Health Plan Competitors

• Ranked #1 for Patient Satisfaction Among Network Model HMOs in California
  (Consumer Reports, October 2001)

• AAHP’s 2001 National Exemplary Practice Award for Congestive Heart Failure
  Program (CHF) in Colorado




 Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
PacifiCare of Arizona - Quick Facts
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 • NCQA Status = Excellent (Commercial) and Commendable
   (Medicare+Choice)
 • Rated among the top-five NCQA Accredited plans in Arizona
 • Highest rated health plan in Arizona as reported in NCQA’s Quality
   Compass.
 • AM Best Rating = B++ Very Good




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
PacifiCare of California – Quick Facts
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                • NCQA Status = Excellent (Commercial HMO/POS) and
                  Commendable (Medicare+Choice)
                • Highest rated health plan in California as reported in NCQA’s Quality
                  Compass.
                • Highest average ratings in CAHPS, cardiovascular health, women’s
                  health and rated second in category of young families.
                • AM Best Rating = A- Excellent




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
PacifiCare of Colorado - Quick Facts
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                • NCQA Status = Excellent (both Commercial
                  HMO/POS and Medicare+Choice plans)
                • HEDIS and CAHPS Scores
                • AM Best Rating = B++ Very Good




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
PacifiCare of Nevada - Quick Facts
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                • NCQA Status = Commendable (both Commercial and
                  Medicare+Choice plans)
                • Highest rated health plan in Nevada as reported in NCQA’s
                  Quality Compass.
                • AM Best Rating = B+ Very Good




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
PacifiCare of Oklahoma – Quick Facts
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                • NCQA Status = Excellent (both Commercial and
                  Medicare+Choice plans)
                • Rated among the top-five NCQA Accredited plans
                  in Oklahoma
                • AM Best Rating = B++ Very Good




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
PacifiCare of Oregon - Quick Facts
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 • NCQA Status = Excellent (both Commercial and Medicare+Choice
   plans)
 • HEDIS and CAHPS Scores
 • AM Best Rating = B++ Very Good
 • AHIP’s National Exemplary Practice Award for the Taking Charge of
   Diabetes Program in Oregon & Washington




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
PacifiCare of Texas - Quick Facts
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                • NCQA Status = Excellent (Commercial) and
                  Commendable (Medicare+Choice)
                • Rated among the top-five NCQA Accredited
                  plans in Texas
                • AM Best Rating = B+ Very Good




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
PacifiCare of Washington - Quick Facts
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 • NCQA Status = Excellent (both Commercial and Medicare+Choice
   plans)
 • HEDIS and CAHPS Scores
 • AM Best Rating = B++ Very Good
 • AHIP’s National Exemplary Practice Award for the Taking Charge of
   Diabetes Program in Oregon & Washington




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Customer Service                                                                                                                    21




                • First Call Resolution
                • Expanded hours of operation
                • New Member Welcome Campaign
                • IVR/ASR/CTI
                • Member Satisfaction drivers




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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   PacifiCare Customer Service

                                                               [1-800-347-8600]

                                                        Available
                                           [7 a.m. - 8 p.m.] Monday - Friday

                                               Spanish Speaking Associates
                                                      Also Available



Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
PacifiCare on the Web                                                                                                               23




                www.pacificare.com
                • HMO Provider Directory • PacifiCare Perks

                • Formulary                                                                  • “Contact Us” area
                • Frequently Asked                                                           • Online Member
                  Questions                                                                    Publications
                • Health Improvement
                  Programs




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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   How to Enroll with PacifiCare
   It’s as Easy as 1,2,3!


                        Select a PCP

                        Complete your Enrollment Form

                        Submit your Enrollment Form to your Employer




Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

				
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