ACA Answers Member Questions About Network - EmpowerChiro (Family Health America, LC)
Written by Editor   
Thursday, April 10, 2014 01:00 PM
This information is provided by the American Chiropractic Association in response to several requests for information regarding the chiropractic network, EmpowerChiro.  Members may call the Company (800-819-9571) to obtain more information.  ACA cautions members, as always, to consult an attorney when there are questions regarding contractual matters and to thoroughly consider all aspects of network participation for their clinic.  Finally, ACA reminds all providers that communication between competitors regarding participation with and/or payment from managed care organizations is a matter subject to antitrust regulations.
 
The following information is provided as a courtesy to assist providers' understanding as they research information about EmpowerChiro, and is not intended to either encourage or discourage provider participation.  Each provider should make an individual, fully-informed decision.  The following information was derived from information released from EmpowerChiro and has been reviewed by the Company:
  • The EmpowerChiro network is a subsidiary of Family Health America, LC (FHA) which works with health insurance companies, PPOs, HMOs and other provider networks to help reduce excessive costs of care and utilization while maintaining high quality.
  • EmpowerChiro/FHA reports that it provides the doctor access to a large network of payer/insurer clients and reimbursement for services under fee for service, global, and capitated models.
  • On some accounts, patients are surveyed randomly under their Quality Assurance Program.
  • In February, 2014, the Company entered into an agreement with TriWest Healthcare Alliance (TriWest) to provide the network for Veterans' chiropractic care under the new Veterans Affairs Patient-Centered Community Care (VAPC3) program that permits Veterans access to care locally and not only in VA treatment facilities. The VA awarded two contracts under VAPC3 - one to Health Net Federal Services LLC and the other to TriWest Healthcare Alliance Corp.  EmpowerChiro/FHA is recruiting to expand its network now and seeks to have 30,000 DCs within the next few weeks.
  • Under these new VAPC3 contracts, the VA is seeking "standardized quality metrics, timely return of medical documentation, cost avoidance with fixed rates for services, guaranteed access to care, and enhanced tracking and reporting of non-VA medical care expenditures over traditional non-VA medical care services."
  • According to the CEO of TriWest, EmpowerChiro/FHA will use a fee schedule based upon a discount off the local Medicare fee schedule covering all services that a DC is licensed to perform in their particular state. He also stated that the VA requested a robust chiropractic panel since they have had very positive feedback from the Veterans who have been under chiropractic care in their system currently.
  • Providers may join TriWest and VAPC3 without participating in other payer groups and there are no monthly or annual membership fees.
  • If a chiropractor elects to participate in EmpowerChiro's other accounts, each chiropractor may  choose to participate in the PPO/insurer accounts which meet his/her needs (future accounts may be added at no additional cost).
  • Also included are online listings on their "NeedAChiro.com" and "EmpowerChiro.com" websites (a fee for the website listings is charged for non-paying chiropractors). Once in the network, providers are sent information on various PPO's with which EmpowerChiro participates.  A DC has 30 days in which to decline or be automatically included in all current PPO accounts.  Decisions to opt out at a later time are made by sending a written request via certified mail, return receipt requested and are fulfilled within 180 days.
  • DCs have 30 days in which to opt out of new plans or they will be automatically included.
  • Due to confusion about the TriWest account, FHA has extended the deadline to apply.

Once again, ACA urges all providers to carefully review all aspects of contractual relations as the terms agreed upon can impact the practice in different ways.  If there are any doubts or questions, consult a qualified healthcare law attorney licensed in your state.  ACA members may find ACA's resource for contract reviews can be found at www.acatoday.org/contracts.