	HSB Network Services HSB PRIMARY CARE NETWORK (PCN) In 1985, the HSB Primary Care Network (PCN) was introduced as a Care Manager option, an innovative way of managing employee healthcare costs in non-urban locations. As employers shifted their focus to recognize the need for employee choice, we used our network development expertise to develop a Preferred Provider Option Network. Today, our programs offer you choice as well. Our networks can be integrated into your healthcare plan and funding arrangement in a variety of ways; they are flexible programs with interactive service, offering fully integrated programs or stand-alone options. HealthSCOPE Benefits offers a gatekeeper or PPO model to meet your exact needs. HSB Care Manager Model • Employees choose a local participating Primary Care Physician (PCP). • This PCP is accessed for all non-emergency care. • This PCP acts as a health manager coordinating quality, cost-effective care. • Employers receive the benefit of a network designed to create efficiencies, encourage cost management, and provide for strong medical management. Employers and providers share in managing the network so that the HSB PCN achieves mutually agreed-upon cost containment and quality assurance objectives. HealthSCOPE Benefits provides the network's advisory council with extensive, creditable data that allows it to evaluate performance, develop strategies, and measure results. Preferred Provider Option Network (PPO) • Employees are free to choose from participating Primary Care and Specialty physicians in this open access option. • Employees then receive maximum in-network benefits. • Employees can also opt out of the network and receive reduced benefits. • Employers receive access to strong provider contracts. Recently, PPO enrollments have surged nationally. The attraction has been the wide choice of providers and easy access to medical care. Employees benefit from "no balance billing" from PPO network providers, while the company's health benefit plan is financially enhanced by our effective cost controls. HSB PPO COMPLETE HealthSCOPE Benefits provides HSB PPO Complete to take advantage of the discounted rates of large, national healthcare networks, as well as smaller, regional networks. We will analyze and recommend access to the networks which best fit your company's specific needs. HealthSCOPE Benefits will handle claim repricing so that claim processing is seamless for you and your employees. Members can also locate participating providers through the Internet. In addition to primary HSB PPO Complete network access, HealthSCOPE Benefits will include its unique Edge product, as well as a comprehensive transplant program. Edge enables employees who must seek services from non-PPO providers or who live out-of-area to avoid paying excessive medical expense. EDGE Edge is a discount negotiation product that provides important cost savings to employees who live outside the network service area, must seek emergency care while traveling, or choose to use non-network providers. HealthSCOPE Benefits offers the Edge product to its Third Party Administrator (TPA) clients as a supplement to their primary PPO access. If employees use providers who are not part of the primary PPO network, the Edge may allow them to avoid paying billed charges, these discounts may range from 5% to 40%. The Edge product effectively reduces the cost of your employee benefit program. HSB NETWORK CONSULTING/DEVELOPMENT HealthSCOPE Benefits has sixteen years of experience in building healthcare networks that meet the unique needs of employers and payers in rural and urban communities. Our services include: provider contract negotiation, provider reimbursement and fee systems design, provider credentialing, and employee benefit plan design. HSB HEALTHWATCH Through our extensive work with disease management in the High Impact program, we know that adults with multiple risk factors for disease are more likely to be high cost employees. They will use more medical care and incur higher costs; they will be at risk for catastrophic events; they have a higher rate of absenteeism, disability and overall lower productivity. Fortunately, many of the key risk factors are controllable through lifestyle modifications and the promotion of healthier habits including appropriate diet and exercise, promoting mental health and physical well being and decreasing risky behavior such as tobacco and alcohol use. HSB HealthWatch combines the positive features of HSB High Impact while also providing the tools to help members make these changes on the web and through lifestyle coaching. At HealthSCOPE Benefits, we believe investing in a healthy workforce is investing in a company’s future! Health promotion enhances the client’s bottom line by improving productivity, decreasing medical costs and boosting employee morale. UTILIZATION MANAGEMENT The HealthSCOPE Benefits' utilization management program applies stringent but credible criteria to medical assessments. All reviews are conducted in a Utilization Review Accreditation Committee (URAC) approved unit by experienced nurses who strive to redirect care to the most appropriate intensity of care setting. CASE MANAGEMENT Specially trained registered nurses interact closely with the patient, family, and healthcare providers to ensure that treatment plans in catastrophic cases are effective and appropriate. Nurses with extensive experience and CCM (Critical Care Management) or CIRS (Critical Incidents Reporting System) credentials identify and negotiate lower cost treatment and placement alternatives. DISEASE MANAGEMENT HealthSCOPE Benefits uses a "best in class" approach for our High Impact disease management program. Rather than build a program, HealthSCOPE Benefits has created one using highly focused, specialized companies to provide the services most needed for our populations. HealthSCOPE Benefits provides case identification, patient stratification, coordination between case management and disease management, and access to some of the best disease management programs available. DEMAND MANAGEMENT The demand management program offered by HealthSCOPE Benefits helps patients make more appropriate healthcare decisions. A specially trained nurse provides information, education, and support to patients considering various treatment options. Patients become knowledgeable consumers of healthcare services through written and recorded materials, referral support, and health risk appraisals. MENTAL HEALTH/CHEMICAL DEPENDENCY HealthSCOPE Benefits' Mental Health/Chemical Dependency program is designed to provide quality managed behavioral health benefits and integrated Employee Assistance Program (EAP) to employers and employees. Through our national network affiliation, HealthSCOPE Benefits offers a complete array of products and services. HSB HIGH IMPACT/SPECIAL BEGINNINGS/HIGH RISK OBSTETRICAL HealthSCOPE Benefits' maternity management program is designed to enhance the support provided to pregnant mothers and their babies. To reduce the incidence of costly premature births and other complications, a maternity nurse specialist educates the expectant mother about important health issues. Back To Top

HSB Network Services

HSB PRIMARY CARE NETWORK (PCN)
In 1985, the HSB Primary Care Network (PCN) was introduced as a Care Manager option, an innovative way of managing employee healthcare costs in non-urban locations. As employers shifted their focus to recognize the need for employee choice, we used our network development expertise to develop a Preferred Provider Option Network.

Today, our programs offer you choice as well. Our networks can be integrated into your healthcare plan and funding arrangement in a variety of ways; they are flexible programs with interactive service, offering fully integrated programs or stand-alone options.

HealthSCOPE Benefits offers a gatekeeper or PPO model to meet your exact needs.

HSB Care Manager Model

• Employees choose a local participating Primary Care Physician (PCP).

• This PCP is accessed for all non-emergency care.

• This PCP acts as a health manager coordinating quality, cost-effective care.

• Employers receive the benefit of a network designed to create efficiencies, encourage cost management, and provide for strong medical management.

Employers and providers share in managing the network so that the HSB PCN achieves mutually agreed-upon cost containment and quality assurance objectives. HealthSCOPE Benefits provides the network's advisory council with extensive, creditable data that allows it to evaluate performance, develop strategies, and measure results.

Preferred Provider Option Network (PPO)

• Employees are free to choose from participating Primary Care and Specialty physicians in this open access option.

• Employees then receive maximum in-network benefits.

• Employees can also opt out of the network and receive reduced benefits.

• Employers receive access to strong provider contracts.

Recently, PPO enrollments have surged nationally. The attraction has been the wide choice of providers and easy access to medical care. Employees benefit from "no balance billing" from PPO network providers, while the company's health benefit plan is financially enhanced by our effective cost controls.

HSB PPO COMPLETE
HealthSCOPE Benefits provides HSB PPO Complete to take advantage of the discounted rates of large, national healthcare networks, as well as smaller, regional networks. We will analyze and recommend access to the networks which best fit your company's specific needs. HealthSCOPE Benefits will handle claim repricing so that claim processing is seamless for you and your employees. Members can also locate participating providers through the Internet.

In addition to primary HSB PPO Complete network access, HealthSCOPE Benefits will include its unique Edge product, as well as a comprehensive transplant program. Edge enables employees who must seek services from non-PPO providers or who live out-of-area to avoid paying excessive medical expense.

EDGE
Edge is a discount negotiation product that provides important cost savings to employees who live outside the network service area, must seek emergency care while traveling, or choose to use non-network providers. HealthSCOPE Benefits offers the Edge product to its Third Party Administrator (TPA) clients as a supplement to their primary PPO access. If employees use providers who are not part of the primary PPO network, the Edge may allow them to avoid paying billed charges, these discounts may range from 5% to 40%. The Edge product effectively reduces the cost of your employee benefit program.

HSB NETWORK CONSULTING/DEVELOPMENT
HealthSCOPE Benefits has sixteen years of experience in building healthcare networks that meet the unique needs of employers and payers in rural and urban communities. Our services include: provider contract negotiation, provider reimbursement and fee systems design, provider credentialing, and employee benefit plan design.

HSB HEALTHWATCH
Through our extensive work with disease management in the High Impact program, we know that adults with multiple risk factors for disease are more likely to be high cost employees. They will use more medical care and incur higher costs; they will be at risk for catastrophic events; they have a higher rate of absenteeism, disability and overall lower productivity. Fortunately, many of the key risk factors are controllable through lifestyle modifications and the promotion of healthier habits including appropriate diet and exercise, promoting mental health and physical well being and decreasing risky behavior such as tobacco and alcohol use. HSB HealthWatch combines the positive features of HSB High Impact while also providing the tools to help members make these changes on the web and through lifestyle coaching.

At HealthSCOPE Benefits, we believe investing in a healthy workforce is investing in a company’s future! Health promotion enhances the client’s bottom line by improving productivity, decreasing medical costs and boosting employee morale.

UTILIZATION MANAGEMENT

The HealthSCOPE Benefits' utilization management program applies stringent but credible criteria to medical assessments. All reviews are conducted in a Utilization Review Accreditation Committee (URAC) approved unit by experienced nurses who strive to redirect care to the most appropriate intensity of care setting.

CASE MANAGEMENT

Specially trained registered nurses interact closely with the patient, family, and healthcare providers to ensure that treatment plans in catastrophic cases are effective and appropriate. Nurses with extensive experience and CCM (Critical Care Management) or CIRS (Critical Incidents Reporting System) credentials identify and negotiate lower cost treatment and placement alternatives.

DISEASE MANAGEMENT

HealthSCOPE Benefits uses a "best in class" approach for our High Impact disease management program. Rather than build a program, HealthSCOPE Benefits has created one using highly focused, specialized companies to provide the services most needed for our populations. HealthSCOPE Benefits provides case identification, patient stratification, coordination between case management and disease management, and access to some of the best disease management programs available.

DEMAND MANAGEMENT

The demand management program offered by HealthSCOPE Benefits helps patients make more appropriate healthcare decisions. A specially trained nurse provides information, education, and support to patients considering various treatment options. Patients become knowledgeable consumers of healthcare services through written and recorded materials, referral support, and health risk appraisals.

MENTAL HEALTH/CHEMICAL DEPENDENCY

HealthSCOPE Benefits' Mental Health/Chemical Dependency program is designed to provide quality managed behavioral health benefits and integrated Employee Assistance Program (EAP) to employers and employees. Through our national network affiliation, HealthSCOPE Benefits offers a complete array of products and services.

HSB HIGH IMPACT/SPECIAL BEGINNINGS/HIGH RISK OBSTETRICAL
HealthSCOPE Benefits' maternity management program is designed to enhance the support provided to pregnant mothers and their babies. To reduce the incidence of costly premature births and other complications, a maternity nurse specialist educates the expectant mother about important health issues.