PHP - Kansas/Western Missouri Network Option Printer Friendly

Network Strength and Stability
The HealthLink PPO and Preferred Health Professional (PHP) relationship is built on a tradition of providing quality health care products and service to the marketplace. Our managed care networks offer unsurpassed access to carefully selected providers who demonstrate commitment to patient care and managed care principles. Our provider retention rate reflects the high levels of satisfaction that have become a HealthLink and PHP standard.

HealthLink and PHP Network Solutions
The HealthLink and PHP managed care product portfolio offers a choice of five PPO networks. HealthLink offers Freedom Network and Freedom Network Select solutions for clients with multiple employment locations.

HealthLink PPO
Members residing in Arkansas, Illinois, southwest Indiana, Kentucky, and central, southern, and eastern (St. Louis) Missouri will use the HealthLink PPO Network as the primary PPO network. The HealthLink PPO network offers access to more than 55,900 health care professionals and 780 hospitals in these service areas.

Freedom Network
Clients with members residing in the Kansas and Western Missouri metropolitan service area have access to the Freedom Network. The Freedom Network includes 70 hospitals and more than 7,800 physicians in the metropolitan area.

Freedom Network Select
The Freedom Network Select provides even deeper discounts to clients with members in the Kansas and Western Missouri metropolitan service area. The Freedom Network Select includes the majority of Freedom Network providers, with over 60 hospitals and 7,660 physicians.

Freedom Network Select Default
The Freedom Network Select Default encompasses all of the above. This program allows a client to use Freedom Network Select and HealthLink as its primary network options, and still receive discounts from Freedom Network providers.

Health Partners of Kansas PPO (HPK)
Clients with corporate offices in Kansas City or Wichita and satellite offices throughout Kansas may benefit from this affiliate network. HPK contracts with providers throughout the central and western Kansas service area.

PHP PPO Network.
Clients with members in the Kansas City area have access to the original PHP PPO network of 47 hospitals and over 5,300 physicians.

Flexible Plan Options
HealthLink and PHP have the flexibility to work with a wide range of third party administrators, including most TPAs chosen by a contracted client. Clients may purchase the basic PPO program package, add components on a menu basis, or purchase a comprehensive PPO package of programs and specialty components at a special, discounted rate. Our PPOs are designed for seamless integration with your plan, with all claims re-priced by HealthLink. Most pricing is based on a percentage of savings, although Freedom Network, HPK and PHP have per member per month (PEPM) fee options. Please contact a sales representative for pricing information.

Basic PPO Program Package Includes:

  • PPO network access
  • IP/OP Medical Management
  • Claims Repricing
  • Client Management Reporting

Comprehensive PPO Program Package Includes:

  • Basic PPO Program Package
  • Case Management
  • Condition Management Programs
  • Maternity Management
  • 24-Hour Nurse Line

PPO Components Available on a Menu Basis:

  • Case Management
  • IP/OP Medical Management
  • Condition Management Programs
  • Maternity Management
  • 24-Hour Nurse Line
  • Worksite Wellness
  • Lifestyle Management
  • Workers' Compensation (MO & IL)
  • Specialty Programs

Specialty Programs
Through the affiliation with WellPoint, HealthLink offers a broad portfolio of specialty programs, including: Reinsurance; Life and AD&D; Dental; Vision; and Employee Assistance Program.

Cost Management Program
The HealthLink Cost Management Program is an extensive suite of health promotion and wellness information, case management and care coordination services to help physicians help their patients achieve optimal health outcomes. The program consists of three components: Signature Services, Wellness Plus and Personal Care Resources.

HealthLink Signature Services
HealthLink Signature Services include the following:

Medical Management
Medical Management is comprised of two components: Utilization Management and Case Management.

The URAC-accredited Utilization Management program provides clinical review of the medical necessity for medical care to help clients determine eligibility in accordance with health benefit plan provisions. Utilization Management includes the following components:
  • Pre-Admission Certification of Planned Hospital Admission
  • Notification of Emergency Hospital Admission
  • Concurrent Hospital Stay Review
  • Discharge Planning
  • Pre-Certification of Selected Ambulatory/Outpatient Services
  • Pre-Certification of Selected Ancillary Services

The Case Management program is a collaborative process among WellPoint and other health professionals who manage the resources necessary to support individuals with catastrophic or chronic medical conditions. Case Management enables the treating health care professional(s) to help the patient achieve optimal and timely medical outcomes.

Signature Services also include the following:

  • Condition Management Programs – Individualized programs for members with Asthma, Chronic Obstructive Pulmonary Disorder, Coronary Artery Disease, Diabetes and Heart Failure.
  • Maternity Management – Maternity management program helps participants make informed decisions during pregnancy and after childbirth.
  • 24-Hour Nurse Line – 24/7 nurse hotline and audio library of more than 300+ health topics.

Wellness Plus
Wellness Plus includes the following programs, available on a fee-for-service basis. Please contact a sales account representative for pricing information.

  • Worksite Wellness Programs – Health educators and registered dietitians visit the workplace to share knowledge on a variety of health and lifestyle topics.
  • Lifestyle Management Programs – Online support and one-on-one telephonic coaching to help members make healthy behavior choices in five key areas: tobacco cessation, weight management, physical activity, diet/nutrition and stress management.

Personal Care Resources
The following value-added electronic member resources are available at no cost to clients and members:

Administrative Services
HealthLink is committed to supporting your health plan's benefit administration through maximum use of technology throughout our organization. We offer fast, efficient electronic claim repricing, eligibility management, a state-of-the-art customer service response system, a provider portal and a fully interactive website, www.healthlink.com.

Account Management Services
Our account managers serve as liaisons between HealthLink and contracted clients. They are responsible for the timely resolution of day-to-day service issues. Account managers also make on-site service visits and compile/present management reports.

Management Reporting
Timely reporting tracks membership, health care services, claims accuracy, payments and utilization.