Your SlideShare is downloading. ×
0
Improving the health of individuals, families and communities
Presbyterian Health Plan
Open Enrollment 2008
Improving the health of individuals, families and communities
Our Purpose
Presbyterian serves to
improve the health of
ind...
Improving the health of individuals, families and communities
Presbyterian Health Plan
 Founded in 1908, Presbyterian Hea...
Improving the health of individuals, families and communities
• Eight hospitals in seven communities
• Nineteen primary ca...
Improving the health of individuals, families and communities
Statewide Network
• Over 1,300 Primary Care Physicians
• Ove...
Improving the health of individuals, families and communities
• M.D. Anderson began providing radiation cancer treatment a...
Improving the health of individuals, families and communities
MultiPlan and PHCS Nationwide Network
Please note:
• The Mul...
Improving the health of individuals, families and communities
MultiPlan and PHCS Nationwide Network
• Over 450,000 Provide...
Improving the health of individuals, families and communities
Las Cruces Network
• Presbyterian is contracted
with 95 % of...
Improving the health of individuals, families and communities
El Paso Network
• Presbyterian is contracted with 96 % of ph...
Improving the health of individuals, families and communities
Plan Highlights
• One of the plans with Lowest
Premium
• Low...
Improving the health of individuals, families and communities
Benefit Highlights
Deductible $50
Office Visit/Gyn Care $10*...
Improving the health of individuals, families and communities
Plan Benefit Example
Billed Allowed You Owe
Preventive $154 ...
Improving the health of individuals, families and communities
Care Coordination and Disease Management
Care Coordination f...
Improving the health of individuals, families and communities
Transition of Care
• Transition of members from previous car...
Improving the health of individuals, families and communities
Helpful Resources
Nurse Advice Line
1-866-221-9679
• Direct ...
Improving the health of individuals, families and communities
Prevention and Wellness
• Member Education
• Web-based preve...
Improving the health of individuals, families and communities
Member Services
Dedicated Member Service Unit
– Welcome call...
Improving the health of individuals, families and communities
www.phs.org
Improving the health of individuals, families and communities
My Pres Online
Online services include:
– Look up your benef...
Improving the health of individuals, families and communities
REASONS TO CHOOSE PRESBYTERIAN
• One of the plans with the
L...
Improving the health of individuals, families and communities
People helping People. It’s our tradition.
Upcoming SlideShare
Loading in...5
×

BS_PresbyterianPresentation.ppt

167

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
167
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
1
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of "BS_PresbyterianPresentation.ppt"

  1. 1. Improving the health of individuals, families and communities Presbyterian Health Plan Open Enrollment 2008
  2. 2. Improving the health of individuals, families and communities Our Purpose Presbyterian serves to improve the health of individuals, families and communities.
  3. 3. Improving the health of individuals, families and communities Presbyterian Health Plan  Founded in 1908, Presbyterian Healthcare Services has served New Mexicans for nearly a century.  Presbyterian Health Plan was established in 1986.  We’re the largest health plan in New Mexico with over 430,000 members.  We are New Mexicans serving New Mexicans because we are the only local owned and operated health delivery system.
  4. 4. Improving the health of individuals, families and communities • Eight hospitals in seven communities • Nineteen primary care clinics • Seven urgent care clinics • Clinics in over twenty-five specialties • Two Healthplex facilities • Employ nearly 500 physicians • seven An Integrated System – Healthcare Delivery
  5. 5. Improving the health of individuals, families and communities Statewide Network • Over 1,300 Primary Care Physicians • Over 5,400 Specialists • Over 600 hospitals and other facilities
  6. 6. Improving the health of individuals, families and communities • M.D. Anderson began providing radiation cancer treatment at Kaseman Hospital in the Spring of 2007 • Cancer Center at Presbyterian now provides medical oncology and hematology, surgical oncology, and radiation oncology • Medical oncology team includes three board-certified hematology/medical oncologists Developments in Our System – Oncology
  7. 7. Improving the health of individuals, families and communities MultiPlan and PHCS Nationwide Network Please note: • The Multiplan/PHCS network only applies outside of New Mexico. • For State of New Mexico members (effective 07/01/08), Multiplan/PHCS network providers are considered “in- network,” therefore copayments or co-insurance apply.
  8. 8. Improving the health of individuals, families and communities MultiPlan and PHCS Nationwide Network • Over 450,000 Providers • Over 4,000 Facilities • New logos for the MultiPlan and PHCS healthcare provider networks will be on the back of your ID card and can help you save money when you need to be treated when traveling outside of New Mexico.
  9. 9. Improving the health of individuals, families and communities Las Cruces Network • Presbyterian is contracted with 95 % of Las Cruces Physicians • Presbyterian is contracted with both Las Cruces Hospitals – Memorial Medical Center – Mountain View Regional Medical Center
  10. 10. Improving the health of individuals, families and communities El Paso Network • Presbyterian is contracted with 96 % of physicians • Presbyterian is contracted with 7 El Paso Hospitals – Del Sol Medical Center in El Paso, Texas – Las Palmas Medical Centers in El Paso, Texas – Physicians Specialty Hospital of El Paso in El Paso, Texas – Providence Memorial Hospital in El Paso, Texas – R E Thomason General Hospital in El Paso, Texas – Sierra Medical Center in El Paso, Texas & Scci Hospital El Paso – Southwestern General Hospital in El Paso, Texas
  11. 11. Improving the health of individuals, families and communities Plan Highlights • One of the plans with Lowest Premium • Lowest Deductible • No Referrals Needed • Urgent and Emergent Care Nationwide • Value-Added Benefits • Multiplan/PHCS Network as in- network providers
  12. 12. Improving the health of individuals, families and communities Benefit Highlights Deductible $50 Office Visit/Gyn Care $10* Specialist $25 (no referral) Preventive Care $ 0* Lab Work $ 0* X-Rays $ 0 Hospital Inpatient $300 MRI-PET-CT scans 10% up to $200.00 *Deductible not applicable Maternity Care $10 (Pre & Post-Natal) one time co-pay Delivery $300 Emergency $150 In/Out of Network Urgent Care $35
  13. 13. Improving the health of individuals, families and communities Plan Benefit Example Billed Allowed You Owe Preventive $154 $116 $ 0 PCP/GYN $ 90 $ 58 $10 Specialist $190 $120 $25 (deductible) $50 X-Ray $50 $30 $0 Out-Patient Surgery $5,000 $2,500 $250 $5,484 $2,824 $335
  14. 14. Improving the health of individuals, families and communities Care Coordination and Disease Management Care Coordination for Acute Conditions - Transplant services - High-risk Pregnancy management Disease Management for Chronic Conditions - Diabetes - Coronary Artery Disease - Asthma
  15. 15. Improving the health of individuals, families and communities Transition of Care • Transition of members from previous carriers to PHP • Pertains to certain services, procedures, or specialty care including: - Chronic or catastrophic medical conditions/transplants - Coordinated through Case Management - Second/third trimester of pregnancy - Limited time period
  16. 16. Improving the health of individuals, families and communities Helpful Resources Nurse Advice Line 1-866-221-9679 • Direct access to a Registered Nurse • 24 hours a day/ 365 days a year • Free, confidential medical advice • General health information • Audio health library Tobacco Quit Line 1-888-840-5445 • Confidential and convenient support • Enroll to receive up to five coaching sessions • Free nicotine replacement therapy products
  17. 17. Improving the health of individuals, families and communities Prevention and Wellness • Member Education • Web-based preventive health information and resources: www.phs.org, A.D.A.M, LifeMasters OnLineTM • Statewide educational classes for various diseases, as well as special courses (e.g., healthy cooking/diet, meditation, smoking cessation, anti-stress) • Quarterly newsletters on health and wellness topics for all members; specific newsletters for Asthma, Diabetes, and Coronary Artery Disease
  18. 18. Improving the health of individuals, families and communities Member Services Dedicated Member Service Unit – Welcome calls and member surveys – Bilingual services – Order ID cards – Check status of claims – Details on covered benefits (505) 923-5600 or 1-888-ASK PRES
  19. 19. Improving the health of individuals, families and communities www.phs.org
  20. 20. Improving the health of individuals, families and communities My Pres Online Online services include: – Look up your benefit plan – Change PCP (effective the next day!) – View the status of your claims – Request replacement ID Cards – Update address and other information – Send Member Services questions online – Access to A.D.A.M. Health Information Site
  21. 21. Improving the health of individuals, families and communities REASONS TO CHOOSE PRESBYTERIAN • One of the plans with the Lowest Premiums • Lowest deductible • NM Based / Not for profit • Contracted with 95% of physicians in Las Cruces • Contracted with both LC hospitals • Contracted with 96% of physicians in El Paso • Contracted with 7 El Paso Hospitals
  22. 22. Improving the health of individuals, families and communities People helping People. It’s our tradition.
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×