Page 6 - HCN Professional Services Booklet

Health Choice Network
Value Based

Services

Since its foundation in 1994, Health Choice Network, Inc. (HCN) has worked to develop a
wide-range of value based services aimed at providing both financial savings and improved
management to community health center members. From launching a managed service
organization in the 1990s to creating Florida’s first capitated provider service network, HCN has
leveraged the synergies of its growing network to benefit its member centers, federally
qualified health centers (FQHCs) and community mental health centers.

As the managed health care environment continues to evolve, it is our goal to pursue new
opportunities with government and private health plans, accountable care associations and others
to enable members to successfully compete in the market.

Contracting Administrative Support
and Reporting

Contract Negotiation
Fair and competitive performance-based contracts Value based payment management for HCN
Shared financial benefits and value-based agreements contracted plans
Non-risk gain sharing and risk contracts for: Operational meetings to review performance
Medicaid Contract analysis
Medicare Financials
Commercial lines of business Quality measures
Clinical outcomes
Provider network operations
Provider Credentialing
Quality Improvement and
Health Data Management
Health Plan Delegated Provider Credentialing
For all HCN Contracted plans: Clinical performance review with health plans
Single file credentialing process Strategies for achieving desirable outcomes
Credentialing and re-credentialing services Education and training
Abides by guideline and policies and procedures Actionable reporting:
of contracted plan or agency HEDIS measures

Pharmacy utilization
Third Party Credentialing Delegation
Hospitalization and ER utilization
Credentialing and re-credentialing services Hospital re-admissions
Medicaid and Medicare enrollment High risk and high cost members

Chronic disease management
Medical Risk Assessment (MRA) coding
Marketing and Membership
Development Support

Health plan and member center coordination
Marketing and membership development activities
support
® ®
9064 NW 13 Terrace I Miami, FL 33172
Additional information available upon request. www.hcnetwork.org 25 + Years of Service

2022, Health Choice Network, Inc. All Rights Reserved.