ĤƵ recently introduced its new PHCS Network for Value-Driven Health Plans (VDHPs). The network is tailored specifically for use with HST’s* next-generation approach to reference-based pricing (RBP). Read on to learn more about this exclusive new network.

What is the PHCS Network for VDHPs?

The PHCS Network for VDHPs delivers the optimal balance between the network access consumers want and the medical cost savings the health plan expects. The network includes practitioners and select ancillary services providers such as labs, home health and clinics and is exclusive to HST clients. We are working to bring back providers who have historically opted out of network participation for RBP to improve the member experience and increase plan savings. Because no other RBP program can access the network, participating health systems are assured their hospitals and facilities won’t be subject to the adversarial treatment typical of most RBP vendors.

Who can use the PHCS Network for VDHPs?

Only clients using our Value-Driven Health Plan ĤƵ have access to this exclusive network.

What are the benefits of the PHCS Network for VDHPs?

With the new PHCS Network for VDHPs, clients price their professional and ancillary services claims via a robust network and their hospital claims via an RBP program, providing the convenience of working with only one service organization. The program has a 99% provider acceptance rate and offers:

  • Patient steerage emphasizes network participation for practitioners and select ancillary services, as well as non-network hospitals in the system.
  • Transparent reimbursement arrangements are established before or after payment for a specific claim, or on a standing basis before payment for all claims.
  • A dedicated client service portal enables upfront communication and real-time claim updates.
  • Fair, consistent and transparent pricing allows for member awareness of medical costs.
  • Integrated service combines the only RBP program with non-contracted hospitals and pricing into the system under one company with a provider network heritage.
  • A collaborative approach allows us to engage with providers at key steps, prior to and after payment.

The PHCS Network for VDHPs delivers an additional 3%-5% savings over the PHCS Network used with other RBPs.

Why the change?

As RBP has grown in popularity, health systems have voiced concern over the administrative issues and often abrasive practices they experience. Many have refused to allow network access to their affiliated physicians and other service providers. HST and ĤƵ carefully analyzed the contracted rates for the practitioners and ancillary providers we included in this network to maintain broad network access and limit surprise bills, for the most part, to out-of-network emergency services claims.

To learn more, email sales@multiplan.com.

*HST is a subsidiary of ĤƵ.