Healthcare Solutions’ prospective PPO networks allow treatment protocols to be applied from inception of medical treatment. Network utilization is maximized through soft channeling to specialty networks and the publishing of hospital/physician participants. This results in greater network penetration, improved healthcare outcomes, the application of preferred rates and simplification of administration for adjusters and payers. The Healthcare Solutions network is easily customized to meet individual payer and market needs.
Hospital and Physician PPO Networks
Hospital and physician expenses present the greatest opportunity to achieve savings and combat rising medical costs. Through a combination of national affiliations, as well as regional and proprietary networks, Healthcare Solutions provides seamless access to the country’s strongest providers. This results in greater network penetration at preferred rates and improved outcomes for our workers’ compensation and automobile client base, as well as simplified administration for adjusters and payers.
The Healthcare Solutions network is comprised of participating providers nationwide who are geographically available to claimants, assuring immediate access to qualified providers and maximum penetration rates. Network utilization is maximized by having network directories available through a secure Internet based tool, with client-specific online search features and electronic directories.
Quality network participation is achieved through provider profiling/credentialing. Healthcare Solutions prides itself on its attention to detail throughout the process of credentialing and re-credentialing of network providers. Profiling is accomplished through documenting and measuring provider performance to quality standards in such areas as cost by ICD 9 or duration of disability by ICD 9. Provider performance is consistently documented and measured.
Network discounts are well below fee schedule. Therefore, in order to realize global savings across all bills, Healthcare Solutions offers a non-network negotiation program to work in conjunction with our network savings.
Key benefits of the Healthcare Solutions hospital and physician network include reduction in utilization, positive medical outcomes, accelerated care, reduced medical costs and reduced administrative burden for case managers and adjusters by having a single point of contact.
Designed as a turn-key solution, the hospital and physician network easily integrates into customers’ existing business and technology processes.
Contact a Healthcare Solutions representative to learn more about our Hospital and Physician Network and services.
Specialty PPO Networks
Healthcare Solutions provides ancillary healthcare services to
assist adjusters and case managers in expediting access to care while
simplifying administrative processes. All network providers are
credentialed and board certified within their respective specialties to
ensure the highest quality of care for injured workers and
policyholders. Healthcare Solutions’ national network of over 23,000
providers serves patients who need:
- Durable medical equipment (DME) and medical supplies
- Home healthcare
- Catastrophic care coordination
- Physical medicine
- Diagnostic imaging
- Transportation and language services
- Home/ vehicle / workplace modification services
Contact a Healthcare Solutions representative to learn more about our Specialty Networks and services.
Pharmacy Network
With over 50,000 pharmacy locations in our network, Healthcare Solutions’ retail pharmacy services are designed to be simple and convenient for the patient and the payer. Healthcare Solutions conducts rigorous mail and letter campaigns to convert claimants into our network to ensure clients are not spending more than they should. We consistently achieve over 80% penetration, measured by the percentage of claimants using our retail pharmacy program, which results in a direct and significant reduction in pharmacy expenses.
To complement our retail pharmacy service, we also offer home delivery service. Our home delivery service minimizes administrative tasks for program administrators and adjusters and significantly reduces medication costs.
Program compliance is also critical. Healthcare Solutions drives compliance by developing drug coverage lists customized to address the unique needs of each client’s business. Our system includes over 60 instantaneous edits to prevent claimants from obtaining medications that are not compensable. The system also prohibits early refills, prescription duplications and the processing of prescriptions by unauthorized physicians. The result: our program produces measureable savings that average 35% or more.
Contact a Healthcare Solutions representative to learn more about our Pharmacy Network and Services.
