EOS SOLUTIONS WITH CUSTOMIZED NETWORKS AND SERVICES
Since 1989, WPPN has provided quality health care network and managed care services in the State of Wisconsin. Together with MultiPlan, one of the oldest and largest provider networks in the nation, we provide our clients with and excellent array of customizable health care products to help you control costs and improve quality. Now marketing our products under the name HealthEOS we are pleased to offer the following networks and services:
PPO Networks- WPPN Partnership Network
- HCN Network (as of 7/1/02)
- MultiPlan National Network of Facilities and Providers
- Dental PPO
Specialty Managed Care Networks
Employer Community Coalition Services
Data Management and Reporting Services
Utilization Review and Utilization Management Services
CareEnginesm
Provider Services
- CareEnginesm Service Recommendations
- Internet Directory Search Print Capabilities
- Professional Application for PPO Membership
- Nominate a Provider
The WPPN Partnership Network is a Wisconsin area network of hospitals and providers. The network maintains contracts with 150 hospitals and more than 15,000 primary care, specialty and ancillary service provider locations in Wisconsin and adjacent areas in Minnesota and Michigan. There is broad geographic coverage throughout Wisconsin, including all the hospitals in the greater Milwaukee area. Contracts are negotiated based on Medicare fee schedules whenever possible. All claims are sent to the HealthEOS (MultiPlan/WPPN) Service Center in De Pere, Wisconsin for repricing.
HCN (HEALTHCARE NETWORK OF WISCONSIN) top
HCN will join the HealthEOS suite of network products by July 1, 2002. This network's primary coverage is in Southeast Wisconsin.
HealthEOS clients can now benefit from PPO rates for dental services in Southeast Wisconsin. The network consists of over 190 dental providers and is expanding rapidly into other parts of the State. General dentistry services, as well as pediatric dentistry, enododontics, periodontics, orthodontics and oral surgery are available from fully credentialed, quality providers.
MULTIPLAN NATIONAL NETWORK OF FACILITIES AND PROVIDERS top
The MultiPlan national network consists of nearly 55,000 facilities, including 3,100 acute care hospitals in all 50 states. Over 25 million Americans access these facilities through the MultiPlan network. MultiPlan networks include 1 in every 10 Americans. MultliPlan also manages a network of approximately 400,000 physicians and other practitioners. This network is expanding to offer nationwide access. The MultiPlan national network can be made available for enrollees traveling outside the area. to HealthEOS clients who are members of the WPPN Partnership Network, the HCN Network and coalition area networks. The national networks are available on a non-risk, contingency fee basis. www.multiplan.com
Because of our unique repricing capabilities and the size and geographic distribution of our Partnership Network, HealthEOS has the ability to partner with a select group of providers and facilities in a concise geographic area. We can establish this select group as an EPO, providing our larger Partnership Network as a second tier in a three-tiered point of service plan. We provide contracting and repricing services and are able to report to providers and health plan sponsors on utilization of the various networks in their plan.
CHIROPRACTIC MANAGED CARE NETWORK top
Quality managed chiropractic care is provided by chiropractors in over 600 Wisconsin locations. These chiropractors have agreed to a discounted fee schedule and to specific practice pattern guidelines. Unique provider profiling identifies high quality, cost effective providers. Service and utilization parameters trigger claim review. A multi-tiered review process is binding on all providers. Claims are repriced and passed on to payors. This is true managed care program that helps health plan sponsors manage utilization and quality in a potentially costly area of specialty care.
COMMUNITY COALITION DEVELOPMENT top
HealthEOS can aid employer sponsors of health plans in banding together as a purchasing group, giving them the bargaining power they individually lack. The result is lower cost for health-related products and services for all coalition members, with no loss in flexibility. Through our efforts, coalition members enjoy the benefit of more control over the cost and quality of their health care. Our experienced professionals guide the development process from initial employer meetings and data analysis to network development, program and plan design development and CareEnginesm Services. Many employers find the value and cost-savings of our CareEnginesm Service alone makes it worthwhile to join a coalition.
COMMUNITY COALITION SUPPORT top
HealthEOS coalition professionals act as a resource for information and research. We utilize state of the art measurement tools to provide our coalition management teams with reports they can use to make decisions, influence behaviors, control costs and improve quality. We can help coalitions interpret health care data and translate that into action plans that make their programs more cost-effective. We keep them aware of new managed care products and services available in the marketplace. Our coalitions can access our statewide networks or we can develop local networks to meet their specific goals.
MULTIPLE PAYOR REPORTING CAPABILITY top
HealthEOS has the unique ability to combine data for employers using multiple payors. This allows cost analysis on a larger universe of data than our competitors. Because we have been repricing all our claims since 1989, we have a database of information on providers, networks, and facilities that allows for comparison. We can also support the CareEnginesm Service.
We provide our network clients reports showing the savings achieved with a variety of measurements, including
From time to time our clients have specific reporting requests. We will attempt to accommodate these needs with customized reporting formats.
PRE-CERTIFICATION, LARGE CASE MANAGEMENT, DISEASE MANAGEMENT top
Our highly skilled and dedicated team will provide a full range of utilization management services. A patient's need for care in the proper setting is initially assessed and treatment plans pre authorized. Large Case Management identifies major cases where more personalized, intensive intervention can result in considerable savings while helping ensure medically appropriate care for critically ill or injured patients. Our disease Management services use the CareEnginesm to identify employees who are at risk for certain medical problems, then make recommendations in keeping with the best evidence-based medical knowledge. This remarkable new tool can help employees stay on the job and add to their productivity.
CAREENGINESM SERVICE RECOMMENDATIONS top
Developed by a team of physicians and information technology experts, the CareEnginesm Service couples patient-specific clinical data (claims, pharmacy etc.) with the body of the most recent literature-based medical knowledge relevant to a particular patient. The CareEnginesm applies a series of clinical rule sets designed to flag cases in which there may be a problem with the current course of treatment, or a medical problem that is not being addressed. The CareEnginesm Service helps to identify problems ranging from potentially disastrous medical errors to instances in which preventive medical tests or treatment protocols are not being delivered. These care concerns are reviewed by an experienced staff of physicians and communicated to treating providers. CareEnginesm Service is a product of ActiveHealth Management, Inc., in New York.
DOCTOR-TO-DOCTOR MESSAGING top
When an issue is identified by the system, it is reviewed by CareEngine'ssm clinical staff and, if warranted, by specialists at some of the nation's leading academic centers. Findings are then shared by a CareEnginesm clinician with the treating physician, along with the context-specific, peer-reviewed clinical literature defining the pertinent established standards of care. CareEnginesm clinicians communicate the care considerations by a doctor-to-doctor phone call, letter or fax, to the treating physician.
This system has the benefit to providers of supplying them with information about their patient from a variety of sources that they might not otherwise have. This process can increase provider's access to the information needed to make the best clinical decisions for their patients. The CareEnginesm system helps providers, and therefore health plans, be more proactive. It combines state of the art clinical medicine with the power of information management technology to enhance patient specific care suggestions and the overall quality of health care, while simultaneously containing overall costs.
DISEASE MANAGEMENT IDENTIFICATION top
The CareEnginesm Service generates lists of patients who would benefit from Disease Management.
INTERNET DIRECTORY SEARCH PRINT CAPABILITIES top
MultiPlan/WPPN is the contracting entity for all HealthEOS networks. One of the ways we market the services of our contracted providers is by listings of facilities and practitioners on the Internet. These directory listings are updated every two weeks. The site includes a custom print feature which allows the user to print all or part of the network directory they have searched.
PROFESSIONAL APPLICATION FOR PPO NETWORK MEMBERSHIP top
If you are a provider interested in joining one of our HealthEOS (MultiPlan/WPPN) networks, please contact our Customer Service Department at 800-279-9776 to obtain the application paperwork. If you are affiliated with a clinic that is already under contract with us, and you wish to apply for membership, you may download the application and submit it to our office.
HealthEOS is responsive to our clients' needs. Complete and submit a "Nominate Your Provider" form to us via fax or mail. HealthEOS contracts under the MultiPlan/WPPN name. We will contact your nominated provider to discuss network membership.
If you have any questions or would like more information about any HealthEOS products or services, please contact HealthEOS (MultiPlan/WPPN) 800-279-9776.