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Since its foundation in 1994, Health Choice Network, Inc. (HCN) has worked to develop a wide-range of value based care 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

  • Contract Negotiation
  • Fair and competitive performance-based contracts
  • Shared financial benefits and value-based agreements
  • Non-risk gain sharing and risk contracts for:
  • Medicaid
  • Medicare
  • Commercial lines of business

Provider Credentialing

Health Plan Delegated Provider Credentialing For all HCN Contracted Plans:

  • Single file credentialing process
  • Credentialing and re-credentialing services
  • Abides by guideline and policies and procedures of contracted plan or agency

Third Party Credentialing Delegation

  • Credentialing and re-credentialing services
  • Medicaid and Medicare Enrollment

Marketing and Membership

Development Support

  • Health plan and member center coordination
  • Marketing and membership development activities support

Administrative Support and Reporting

  • Value based payment management for HCN contracted plans
  • Operational meetings to review performance
  • Contract analysis
  • Financials
  • Quality measures
  • Clinical outcomes
  • Provider network operations

Quality Improvement and Health Data Management

  • Clinical performance review with health plans
  • Strategies for achieving desirable outcomes
  • Education and training
  • Actionable reporting:
  • HEDIS measures
  • Pharmacy utilization
  • Hospitalization and ER utilization
  • Hospital re-admissions
  • High risk and high cost members
  • Chronic disease management
  • Medical Risk Assessment (MRA) coding

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Health Choice Network  • 9064 N.W. 13 Terrace Miami, Florida • 33172 • www.hcnetwork.org • © 2024