NCPPO and HealthLink?s disciplined approach to fixed payment methodologies, precise modeling/forecasting of rate changes and actuarial calculations allows us to establish aggressive pricing targets by market and product.
Inpatient Services:
- Multiple per diem rate structure
- Fixed case rates for high cost services and drugs
Outpatient Services:
- Pricing for surgery centers
- Caps, fixed rates or case rates for certain services
- Fee schedules for diagnostic services
Physician/Ancillary Services
- Fixed fee schedules
- Pricing for surgery centers
- Fixed rates for home health services and dialysis
Health Care Management Program
HealthLink?s Health Care 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 includes three levels
of services: HealthLink Signature Services; HealthLink Wellness Plus; and HealthLink Personal
Care Resources.
HealthLink Signature Services
Medical Management - Medical Management is comprised of two components:
Utilization Management and Case Management.
- 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 HealthLink and other health professionals who manage the resources necessary to support individuals with catastrophic or chronic medical conditions. Case Management helps the treating health care professional(s) help the patient achieve optimal and timely medical outcomes.
HealthLink 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.
- MaterniCall™ - Maternity management program helps participants make informed decisions during pregnancy and after childbirth.
- MedCall® - 24/7 nurse hotline and audio library of more than 300+ health topics.
- WellPoint NextRx - Aggressive pharmacy benefit manager targets costs and includes a national retail network, mail order and specialty prescription programs.
HealthLink Wellness Plus
The following programs are offered at no charge to the client or member:
- SpecialOffers Online Discount Program - Helps promote health and wellbeing. More than 20 third-party vendors provide discounts on services related to family and home, fitness and health, and vision/hearing/dental treatment.
- TLC® (The Last Cigarette) - Smoking cessation program. Members request a TLC quit kit to assist in their efforts to be smoke-free.
The following programs are 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 your workplace to share knowledge on a variety of health and lifestyle topics.
- Lifestyle Management Programs - Engaging online programs and inspiring coaches use proactive outreach activities and support strategies to help employees in the areas of: tobacco cessation, weight management, stress management, physical activity and diet/nutrition.
HealthLink Personal Care Resources
The following value-added electronic member resources are available at no cost to
clients and members:
- Healthy Living Website - Health and wellness tips and tools available online 24/7.
- eHouseCall - Monthly wellness newsletter for members.
- Women?s Health eNewsletter - Monthly publication for women of all ages.
- Preventive Health Guidelines - As recommended by the U.S. Preventive Services Task Force and other health related agencies.
- Healthy Habits for Healthy Kids - Nutrition and activity guide from the American Dietetic Association.
- Enrollee Rights and Responsibilities - General guidelines for health care consumers.
National Capital Preferred Provider Organization, Inc. ("NCPPO") is a Maryland corporation. HealthLink®, Inc., is an Illinois corporation. Both are organizers of independently contracted provider networks, which are made available by contract to a variety of payors of health benefits, including insurers, third party administrators or employers. Neither has control nor right of control over the professional, medical judgment of contracted providers, nor are they liable for any acts or failures to act, by contracted providers. Neither is an insurance company and neither has liability for benefits under benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc. Both companies are subsidiaries of WellPoint, Inc.