Presence Health Partners

FAQ

Frequently Asked Questions (FAQ)

  1. What is Presence Health Partners?
  2. What is the governance structure of Presence Health Partners
  3. Can I continue to share data and be in another clinically integrated PHO or ACO and be a part of your organization as well?
  4. What do I need to do to participate?
  5. Will I have to give up my contract with Resurrection Health Care Preferred or Alliance Health if I join PHP?
  6. If my practice joins Presence Health Partners, is there a fee?
  7. What is the relationship between Presence Health Partners and Imagine Health?
  8. What contracts will I have the opportunity to participate in as part of Presence Health Partners?
  9. Will ancillary services be allowed in PHP? For example, if my practice wants to use its own laboratory or CT-Scan service, can we continue to do this?
  10. Will referrals be restricted to only PHP enrolled specialists or providers?
  11. Will my practice have the opportunity for physicians to gain additional reimbursement by meeting the quality measures?
  12. Do I need to be employed by the hospital or by Presence Medical Group to participate in Presence Health Partners?
  13. When will these new contracts start and become effective?
  14. How is the performance of the Presence Health Partners network?
  15. What is the size of the PHP network?

 

Q: What is Presence Health Partners?

A: Presence Health Partners (PHP) is a physician-led network of health care providers working together to provide high-quality, high-value patient care.

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Q: What is the governance structure of PHP?
 
A: The Presence Health Partners board of directors is a fifteen member board, a majority of who are practicing physicians in the PHP network. The PHP board is chaired by Dr. Aras Zlioba of Joliet.  Local leadership councils have been created to inform operations and decisions in each local geographic region. These committees replace the legacy Resurrection Health Care Preferred (RHCP) and legacy Provena Physicians Alliance (PPA) committees. Over 60 physicians are currently participating in the governing councils and committees.  Please click here to see a full chart of all Presence Health Partners governance committees.
 

Q: Can I continue to share data and be in another clinically integrated PHO or ACO and be a part of your organization as well?

A: Presence Health Partners does not require provider exclusivity if the payer does not require it.  We advise you to check on the specific details of your contracts with other organizations.

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Q: What do I need to do to participate? 

A: If you would like to participate, simply fill out the paperwork included in your packet, attach the supporting documents and return to your PHP contact who will make sure that your application is processed. You will hear back from PHP in a few weeks with a status update.

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Q: Will I have to give up my contract with Resurrection Health Care Preferred or Alliance Health if I join PHP? 

A: Presence Health Partners has grown out of our legacy organizations, Resurrection Health Care Preferred (RHCP) and Provena Physicians Alliance (PPA). 

If you choose to join PHP and you were a member of RHCP in the legacy Resurrection markets or Alliance Health in the Joliet market, you will continue to participate in the legacy organizations as well as PHP for the next 12 months as payer contracts are transitioned to PHP. In order to minimize disruption during the transfer, you will need to sign the PHP agreements so that you can participate in both your legacy organization (RHCP or Alliance Health) and Presence Health Partners for a transition period.

PHP physicians will have access to current and new contract opportunities as they become available. We have relationships with employers as well as all major health plans. We are a leader in offering providers innovative options, such as accountable care and direct-to-employer opportunities.

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Q: If my practice joins Presence Health Partners, is there a fee?

A: Physicians and providers who join Presence Health Partners will not be charged a fee as long as you participate in the clinically integrated contract options (commercial, Medicare/dual eligible and/or Medicaid clinical integration contracts). 

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Q: What is the relationship between Presence Health Partners and Imagine Health?

A: Presence Health Partners is the anchor provider with Imagine Health. They have direct-to-employer contracts with Home Depot and Walmart and offer exclusive rates to us. Many providers who attempted to contract independently with Imagine Health have told us that our exclusive contract rates for Imagine Health are superior to the rates they were offered on their own. Imagine Health does require a selective process for acceptance into the network. PHP will work diligently to have your application approved.

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Q: What contracts will I have the opportunity to participate in as part of Presence Health Partners?

A: We accept a wide variety of health insurance plans and are continually adding others to our network. To confirm eligibility in PHP plans, patients should contact the number on the back of their patient identification card.

Direct-to-employer
  Aetna Choice POS/SmartCare through Imagine Health
*Anchor provider
Medicare
  Medicare ACO - Medicare Value Partners
  HealthSpring Medicare Advantage HMO 
  BCBS Medicare Advantage
  Aetna Medicare Advantage
  United Health Care Ever Care Medicare Advantage 
  Medicare HMO Plans - Sterling Only
  Medicare Assignment (Fee for service)
Commercial
  Blue Advantage HMO 
  Blue Choice
  Blue Cross Blue Shield PPO
  BCBS HMO IL 
  Aetna PPO, POS
  Aetna Cofinity PPO
  Aetna HMO - Fee for Service Only
  Beech Street (Viant) PPO
  Choice Care PPO
  CIGNA PPO, POS
  CIGNA HMO - Fee for Service Only
  CIGNA (State of Illinois) - PPO only
  CIGNA Care Network
  CIGNA Choice Fund
  CIGNA HMO and Network
  CIGNA Open Access, Open Access Plus
  Coresource
  CorVel PPO
  Coventry/First Health
  Coventry/First Health Workers Compensation
  Evolutions Healthcare
  First Health (Coventry)
  Galaxy Health Network
  Great West (Cigna) PPO, POS
  Great West (Cigna) HMO - Fee for Service Only
  HFN PPO
  Humana HMO – Medical Groups:
  Humana PPO, National HMO, National EPO, National POS-Open Access, Choice POS, ChoiceCare PPO
  Humana HMO - Fee for Service Only
  MultiPlan/PHCS PPO
  MultiPlan/PHCS Savility
  PHCS (Multiplan) PPO, EPO
  ppoNext
  Preferred Network Access
  Preferred Plan Inc. PPO
  Tricare/Champus
  United Health Care PPO, POS
  United Health Care HMO - Fee for Service Only
Medicaid
  Aetna Better Health (Medicaid program for the aged, blind and disabled)
  All Kids - No PCP Required - Traditional Medicaid
  Family Health Network (Medicaid) Site 
  IlliniCare (Medicaid program for the aged, blind and disabled)
  IL Healthy Women (Medicaid)
  Illinois Health Connect (Medicaid) 

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Q: Will ancillary services be allowed in PHP?  For example, if my practice wants to use its own laboratory or CT-Scan service, can we continue to do this? 

A: This is managed through each individual health plan. Please have the patient contact their insurance provider by calling the number on the back of their Patient Identification Card to confirm that the service or lab is part of that plans network.

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Q: Will referrals be restricted to only PHP enrolled specialists or providers? 

A: This is managed through each individual health plan. Please have the patient contact their individual insurance plan by calling the number on the back of their patient identification card to confirm that the specialist or provider is part of that plan's network.

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Q: Will my practice have the opportunity for physicians to gain additional reimbursement by meeting the quality measures?

A: All physicians are eligible to earn incentive based on performance in quality improvement programs and meeting performance measures.

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Q: Do I need to be employed by the hospital or by Presence Medical Group to participate in Presence Health Partners? 

A:No, employment is not required. Presence Health Partners was designed to work with independent physicians and providers.

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Q: When will these new contracts start and become effective?

A: After you return a completed application it takes between 60-90 days to process your application and then you are notified afterwards of your effective date.

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Q: What can you tell me about the performance of the PHP network?

A:The network performance is strong. The BCBS-IL’s annual Blue Star ratings of physician managed care organizations are a barometer of objective performance in improving health care delivery processes and outcomes. The four Presence Health physician groups evaluated for 2013 are all performing above the median levels for Illinois physician groups. Please click here to see a chart that rates PHP against other physician managed care organizations in our market area by BCBS-ILBlue Star ratings from 2012.

Our provider performance has not gone unnoticed by others. Stanford University’s Center for Clinical Excellence recently recognized Presence Health Partners Lakeview (formerly Saint Joseph Health Care Preferred) for outstanding performance related to access, quality and outcomes by awarding one of its 2013 American Idols in Health Care awards. Stanford recognized seven groups nationally and will conduct a study of the specific provider capabilities that lead to these results at Seton Family Practice Center in Lakeview.

Presence Health Partners and its subsidiaries will distribute over $8M in provider bonus payments in 2013. The financial performance is the direct result of improving access to higher quality affordable care. Improvements in the care of patients with diabetes, hypertension and asthma; better generic drug utilization, improved delivery of preventive services and reduced in-patient utilization were major contributors to the improved bonus payments.

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Q: What is the size of the PHP network?

A: The PHP network consists of nearly 1,000 contracted providers.  Large scale provider re-contracting is occurring in the Chicago markets and new provider contracting has begun in Elgin, Joliet and Kankakee. PHP managed care contracts, including those of its subsidiaries Medicare Value Partners (MVP) and Presence Health Care Preferred (PHCP), provide services to over 70,000 people.  Patrick Durkin is leading the provider network development and Pat Kohn leads the managed care contracting.

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