Explanation of Blue Cross PPO – HMO, Networks, etc. options
from their official brochures.

PPO plans have large provider networks and give employees more choices than an HMO plan, but monthly premiums and deductibles are usually higher. No primary care physician (PCP) is needed. No referrals for other in-network doctors are required. Choosing doctors, hospitals and other covered medical services that are not in-network might cost employees more out-of-pocket.   Prudent Buyer PPO network — Access to nearly 60,000 California doctors and specialists, and more than 330 hospitals
 
 
Select PPO plans give employees access to the same high-quality providers as a PPO, but usually the network is smaller. The monthly premiums and deductible options offer greater value than the standard PPO. No PCP is needed and no referrals for other in-network doctors are required.  Access to more than 40,000 California doctors and specialists, and more than 300 hospitals
Note: Employers may choose only one PPO network.
 
HMO plans offer network provider choices similar to a PPO, but members must select an in-network primary care physician (PCP) to coordinate their care. Referrals are needed to see other doctors. The monthly premiums and out-of-pocket medical costs are generally lower than other plans.  CaliforniaCare HMO network — Access to more than 42,000 California doctors and specialists, and more than 330 hospitals
 
Select HMO plans work like a standard HMO, but usually the network is smaller. The monthly premiums and out-of-pocket costs are generally lower than most other plans, offering greater value than the standard HMO. Members must select a primary care physician (PCP) to coordinate their care. Referrals are needed to see other doctors.   Access to more than 26,000 California doctors and specialists, and nearly 250 hospitals   Note: Employers may choose only one HMO network
 
Employers must select a network for each plan type.   For example, the employer may offer employees plans  available in the Select HMO network  alongside the Prudent Buyer PPO network. Not all network options are available in every area. Anthem.com *
 
 
 
Links – References 

Heal.com  – In Network House Calls  * 

Live Health ONLINE ♦

Optional PCP Selection can help improve employees’ health and lower costs

A strong relationship between your employees and a primary care physician (PCP) is important to promoting wellness, improving health and reducing costs. Optional PCP Selection lets your employees choose a PCP.

Optional PCP Selection helps members strengthen relationships with their doctors

We are moving from volume-based to value-based payment models, rewarding doctors when they improve patient health and affordability. That focus can be seen in our collaboration with doctors and in our payment innovation programs, like Enhanced Personal Health Care (EPHC), known nationally as Blue Distinction Total Care. Through the EPHC approach, members get the right level of care from the doctor that’s best for them, at the right time. It focuses on the quality of care doctors give, not the number of patients they see.

Why designate a PCP?

When members choose an EPHC doctor from their health plan as a PCP, they’re helping us help them. We can keep their doctors in the loop when they have an ER or hospital visit. We can reach out to that doctor about tests and services a member may need. We also can share other resources that will help doctors emphasize wellness with members. The goal is to have everyone work together so a member’s overall care makes the best sense. And when employees choose an EPHC doctor as their PCP, that doctor can more quickly take over the responsibility of coordinating the member’s care.

Encourage your employees to designate a PCP

Developing a relationship with a PCP is all about improving health care quality, outcomes and affordability. That’s why we’re encouraging members in open access plans to designate a PCP as part of the Optional PCP Selection on anthem.com/ca. They also can call customer service or have you, their employer, complete the selection through Employer Access.

Learn more

To know more about Optional PCP Selection, read our Frequently Asked Questions. And if you have any more questions or want to know if Optional PCP Selection is right for your company, talk to your account representative. Optional PCP Selection is not available to members who reside in Virginia or who wish to select a PCP in Virginia and is not planned for use in attribution outside of our core service area for the foreseeable future.

 

Leave a Reply

Your email address will not be published.