Specialty Networks

In addition to Outpatient Therapy and Eye Care, Health Network One operates several single-specialty
full risk networks: Dermatology, Podiatry, Gastroenterology and Urology. For each, we are typically delegated UM, Claims, Credentialing, and Network Management.

The hallmarks of all of our specialty networks are: high provider and member satisfaction, professional services cost savings (Part B) through capitation, significant procedure reductions which result in dramatic and permanent facility cost (Part A) savings.

Our typical impact is a 50-70% reduction in procedures - a good example is a decrease in bilateral procedures. Further, we guide care to ASCs, also resulting in a 50% or more savings. Our inclusive approach also reduces lab leakage, network leakage, and includes POS and pharmacy redirection

Medical cost savings are only a starting point for our team. For each specialty we have devised and implemented programs designed to reduce overall cost of care through prevention and either the inclusion or exclusion of screenings, for example:

We work with providers to engage any member with a Melanoma diagnosis who has not been in the prior 12 months. And we have contemporary Mohs Surgery guidelines to ensure those specialists are limited to the most appropriate procedures.

Our focus is on members with diabetes, with screening protocols for peripheral artery disease and diabetic ulcer prevention.

Our approach is age-driven. We work with our providers to avoid invasive procedures for elderly patients. In addition, we engage with providers on bladder cancer and prostate cancer follow-ups.

We believe in prevention. We focus on colon cancer screenings to facilitate early diagnosis.

Diabetic Retinopathy screening (HEDIS measure); 20/40 or better vision 90 days post-cataract exam; 15% decrease in intraocular pressure in glaucoma patients.

We close the loop with PCPs by ensuring coordination of care in each of our specialties back to the primary care physician.

Contact us to learn how we can partner with you to improve clinical and financial performance in one or more of our medical specialties.

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