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2019 NMRHCA SWITCH ENROLLMENT BENEFIT PRESENTATION

January 2019 through December 2019

9HOSPITALS

Foundedin1908

758,518 INDIVIDUALCUSTOMERSserved

474,624 PresbyterianHealthPlanMEMBERS

981HOSPITALBEDS

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HEALTHCAREPROFESSIONALS

throughoutNewMexico

9,000+CLINICS

throughoutNewMexico

100+

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Top Scoring Proposal Highest Level 3 Recognition

for Central NM PMG Primary Care Clinics

$4.5M Grant Recipient

cccccc Medicare Advantage HEDIS Reporting

Award Winning Healthcare

Ø  BestHealthcareOrganiza.onØ  BestDoctors

Ø  BestHealthPlanØ  BestHospital

Sources: December 2017 Albuquerque Metro Consumer Survey, 2018 ABQ Journal Reader’s Choice Awards

Ø  BestERØ  BestUrgentCare

cccccc

Extensive Statewide Network

• Over 9,000 Providers in 554 Locations

• 2,200 Primary Care Physicians

• 7,000 Specialists No Referrals Required

• Over 600 hospitals and other facilities •  Hiring of providers to meet the increased healthcare needs of New Mexicans.

•  Ongoing facility investments that offer convenient and innovative care to New Mexicans.

Nationwide PPO

•  900,000Na=onalProviders

•  4,000Facili=esNa=onwide

•  AccesstoCentersofExcellenceFacili=es

–  MayoClinic,MDAndersonJohnHopkinsUniversity,andmanymore.

•  LogosonthebackofyourIDcard

•  AlwaysIn-Network

www.mul=plan.com/presbyterian

Presbyterian Nationwide Network

Value HMO Benefit In-Network Out of Network

Annual Deductible $1500/ Individual N/A

Out of Pocket $5500/ Individual N/A

Office Visit Primary - $35 Specialist - $55 N/A

Preventive Care (including mammograms, pap test,

colonoscopy & immunizations)

100% Deductible does not apply N/A

Lab, X-Ray, and Pathology

100% Deductible does not apply

N/A

Emergency Room $175 $175

Urgent Care $40 N/A All other covered

services(including inpatient/outpatient, rehab and MRI, PET &

CT)

30% N/A

Value HMO Plan

Premier PPO Benefit In-Network Out of Network

Annual Deductible $800/ Individual $800/ Individual

Out of Pocket $4500/ Individual $4500/ Individual

Office Visit Primary - $30 Specialist - $45 50%

Preventive Care (including mammograms, pap test,

colonoscopy & immunizations)

100% Deductible does not apply 50%

Lab, X-Ray, and Pathology

100% Deductible does not apply 50%

Emergency Room $125 $125

Urgent Care $35 50% All other covered services

(including inpatient/outpatient, rehab and MRI, PET & CT)

25% 50%

Premier PPO Plan

New Options for 2019!

•  Premier PPO Option Deductible Waived $500 copay $650 copay

Outpatient Surgeries- Presbyterian (Kaseman Hospital Albuquerque/ Rust Medical Center Rio Rancho) •  Hernia •  Laparoscopic Cholecystectomy Surgery New Mexico Orthopedics (Albuquerque) •  Shoulder Arthroscopy •  Knee Arthroscopy

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•  Value HMO Deductible Waived

Access To Care Appropriate and Affordable Options for Care

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PresRN Your Nurse Advise Line

Speak to a registered nurse by phone 24/7, 365 days a year, even in Spanish.

866-221-9679 or 505-923-5570

No fee for members to access this service.

With PresRN, members have:

}  Direct access to Presbyterian nurses

}  Minimum 10 years clinical experience.

}  Use national protocol to triage, diagnose and treat.

}  Nurses have access to your plan info and electronic

health record for past and current health conditions,

treatments and Rx.

}  Navigate you to appropriate care based on your

diagnosis.

}  Capture the details of your care in MyChart.

}  Automatically message your PCP, Specialist or Care

Coordinator.

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Video Visits Video Conference with a Healthcare Provider

No fee for members to access this service.

“Skype” with a healthcare provider 24 hours a day, 365 days a year.

With Video Visits, members can:

•  Schedule a Video Visit on any computer, tablet or smart phone.

•  Use at home, work or when travelling.

•  Get diagnosis and treatment for common health issues

like earaches, cold/flu symptoms and allergies within 1 hour.

•  Receive prescriptions to the pharmacy of your choice.

•  Receive a text or email summary of your visit.

•  View the details of the Video Visit in MyChart.

•  Receive a doctor’s note for school or work via email.

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With MyChart, members can:

•  Send and receive messages with their care team.

•  Schedule primary care appointments, confirm

or cancel appointments.

•  View lab and test results.

•  Request prescription renewals.

•  View visit summaries, health summary, care plan,

allergies and immunizations.

•  Receive health reminders.

•  Pay doctor and hospital bills.

MyChart: Be An Active Part of Your Care Team

Presbyterian Health Plan members have secure online access to their Presbyterian electronic health records.

No fee for members to access this service.

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Member Advocate Team

Ø  Locate a Provider - within PMG or Contracted Network including Specialists, Facilities, Behavioral Health and Multiplan. Ø  Contact and consult with the Provider for availability to ensure

a good fit for the member.

Ø  Schedule an appointment using the members preference for dates, times etc.

Integrated Dedicated Customer Service Team Ø  Located in New Mexico

Ø  Claims, Benefits, General Questions

Ø  Patient Financial Services

Member Advocate Team: Presbyterian Customer Service Center

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www.phs.org/sonm

(505) 923-5600 or 1-888-ASK PRES

Email: info@phs.org

Investments in Access

Urgent Care

24/7 Emergency Services General Surgery Orthopedics

Podiatry

Physical, Occupational and Speech Therapies

Lab and Imaging, including CT and MRI 30 Adult Inpatient Beds, some licensed ICU beds 6-Bed Birthing Unit

Telehealth Services

Presbyterian Santa Fe Medical Center Coming 2018

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Ambulatory Surgical Centers

Membersa.sfac.on

Effec.veoutcomes

Cost

Ambulatory Surgical Centers Ø  Lower Cost Setting: 30-50% Reduction Ø  Increased Member Satisfaction Ø  Effective Services Ø  3 Locations Albuquerque Metro Area

Value of Presbyterian

Non-Profit Organization

Investing in New Mexico

Expanding Access and

Improving Outcomes for

New Mexicans

Locally Owned and Operated New Mexicans serving New Mexicans

Emergency Care Nationwide

Serving 1 in 3 New Mexicans

Innovative Access to Care Video Visits, PresRN, MyChart, UC Scheduling

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