Healthy Boiler

What’s new? A recap, review and more shared on HealthSync network

As of January 1, 2020, Purdue employees and dependents covered on a Purdue health plan have had the option of using providers within the HealthSync network. Whether or not you use HealthSync is up to you; it’s simply another option to help you save money and better manage your healthcare dollars as a wise healthcare consumer.

Like our tiered lab benefit, your health plan networks are tiered to save you money on all Purdue health plans. With the addition of HealthSync, you now have three network levels (tiers) for 2020:

  • HealthSync (tier 1) saves you the most
  • In-network, but not HealthSync (tier 2) are available at a slightly higher cost
  • Out-of-network (tier 3) gives you additional access, but you will pay the most out-of-pocket for these providers.

network levels

“Our goal with adding HealthSync specifically is for employees and their family members to have strong relationships with top-performing providers and to experience better health outcomes,” said Candace Shaffer, senior director of benefits in Human Resources. “Based on historical data from Anthem, the providers within the HealthSync network have proven to be successful in increasing the quality and affordability of care to their patients through a more personalized, patient-focused approach. More options for our employees and their families via the three-tiered benefit, gives them more control over their healthcare needs and provides a resource to help align their physical health, behavioral health and financial wellness all within one network.”

Benefits of using HealthSync

Let’s take a look at some of the ways that the HealthSync network can benefit individuals:  

  • You receive more personalized care, faster specialist appointments and access to high-quality providers. Participants in HealthSync are accountable care organizations (ACOs), responsible for meeting cost and utilization targets and outcomes. Additionally, provider organizations and hospitals within the HealthSync network provide these support services to Anthem HealthSync members:
  • Support from a patient navigator to assist with securing annual wellness visit (physical), scheduling a “sick visit” with a provider within one business day of request and scheduling visits with specialty providers.
  • Access to telehealth visits for minor and / or routine covered services
  • Specialty EConsult access for patients through a primary care provider
  • Welcome package and patient outreach
  • Lower deductibles, lower out-of-pocket maximums and lower coinsurance

Throughout the year, as you incur medical expenses, they all count toward your HealthSync deductible and out-of-pocket maximum. They also count toward your in-network deductible and out-of-pocket maximum—as long as you stay in-network.

Services provided by HealthSync providers

A provider within the HealthSync network is no different than a provider anywhere else in regards to providing preventive care, treating acute illnesses, managing chronic conditions and providing specialty care. However, Human Resources – Benefits has received inquiries about specific services that might not be covered by the existing HealthSync networks.

“Ensuring our Purdue population has access to the healthcare services they need and want for themselves and their families has always been and continues to be a priority,” Shaffer said. “In the case of a service that appears to not be provided by an existing HealthSync provider, Anthem has documented their process for us, and it is as follows.”

  • General access to care tiering changes (including reproductive/religious policies):
    • If services are required from a provider/specialist not available within HealthSync, Anthem will shift benefits from tier 2 to tier 1 appropriately
      • This can be rendered prior to services being provided if the service comes through precertification/medical management or if a member contacts Anthem in advance of services.
      • This can be adjusted manually on the back end (after claim has come in and processed) if member contacts Anthem post-service and Anthem validates that there was not an appropriate specialist available within HealthSync.

 “It’s important to remember that if this does occur, changing how the rates are processed will not be automatic and will be handled on a case-by-case basis,” Shaffer added. “Therefore, in these types of cases, individuals will need to work directly with Anthem and in advance of the services where possible.”

We will provide detailed lists of services provided by the major HealthSync systems on our website as soon as they are available. In the meantime, the statewide providers map is a helpful resource, and to find a HealthSync provider, utilize Anthem’s “Find a Doctor” search tool – specifically designed to search within the HealthSync network.   

More information

“As with any new program or resource, we learn more about the HealthSync system as we have more employees utilize the network,” Shaffer said. “March will only be month three with HealthSync, even though sometimes it does feel much longer, that we’ve had the ability to work with providers within the new network. HealthSync information will continue to be shared on an ongoing basis to ensure we all have the knowledge and resources available to help us continue to make the best healthcare decisions for ourselves and our families.” 

Questions

HealthSync information is available on Purdue’s HealthSync web page.

Contact Anthem Health Guides at 855-502-6365.

Contact Human Resources at 765-494-2222, toll free at 877-725-0222 or via email at hr@purdue.edu.