Stanford University Faculty & Staff: Important changes to your 2020 plan
With Stanford Medicine at its core, Stanford Health Care Alliance has always given you access to world-class specialty care, evidence-based medicine, leading edge clinical trials and more. In 2020, we’re making a few changes to your plan to enhance coordination of care for an overall healthier you.
Questions? Call member care services at 855-345-7422
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Summary of Changes
A personal doctor as your advocate for the best care
In 2020, you’ll need to designate a primary care physician (PCP) to act as your dedicated personal doctor. Your PCP will get to know you, your health goals and medical history, and will make sure your care is well coordinated.
- Select a network PCP from the provider directory during open enrollment
- If you do not choose, one will be assigned to you based on your care history and location
- Each family member may choose a different doctor
- You can switch PCPs at any time
Navigation for specialty services
Your PCP will serve as your personal navigator and refer you to specialty network providers when you need additional care or medical services. This ensures that you get precisely the right care, from precisely the right doctor.
- Any visit to a specialist will need to be directed by a primary care referral
- Many PCPs offer virtual visits and specialty care e-consultations
Campus specialty pharmacies added to the network
Stanford Health Care Pharmacy and Lucile Packard Children’s Hospital – Children’s Home Pharmacy have been added to the Stanford Health Care Alliance specialty pharmacy network.
Benefit changes
Please refer to your Stanford University faculty and staff open enrollment materials for additional information on 2020 benefit changes for all plans, however key changes include:
- A 10% coinsurance added to advanced imaging (e.g., MRI or CT scans)
- A 10% coinsurance added to specialty drug prescriptions (your cost is capped at $200 per specialty drug)
FIND A PRIMARY CARE PROVIDER (PCP)
During open enrollment, you will be required to select a PCP for yourself and each member of your family by indicating the provider’s name and provider ID number. If you don’t choose a PCP at open enrollment, one will be assigned to you based on your care history and location.
Find a provider's name and/or ID number:
We look forward to welcoming you back into the Stanford Health Care Alliance network in 2020, and providing you a world-class coordinated care experience.
Yes, Stanford University faculty and staff members will need to select a personal physician. You can either select a PCP during open enrollment, or one will be assigned to you based on your care history and location. Each family member will need to have a PCP. By choosing a Stanford Health Care Alliance physician as your personal doctor, you have a dedicated care partner – one who is connected to an entire team of experts and specialists with shared expertise and commitment to the leading edge care you’ve come to expect from Stanford. Your personal doctor will collaborate and consult with other providers for all your care needs – from routine to specialty care. This is a similar model to other plans offered in 2020, including Trio and Kaiser.
Yes, you can change you PCP at any time after January 2020 by calling Member Care Services at 1-855-345-SHCA (7422). (Monday – Friday, 6:30 a.m. – 7:00 p.m. Pacific Time).
There is ever-increasing evidence of the health-promoting benefits of primary care, including better care coordination, understanding of the “whole” person/patient, and improved preventive care. Having a personal doctor to act as your dedicated care advocate can improve your health. Your doctor will get to know you, your health goals, and your medical history, and will serve as a central touchpoint to make sure that your care is well coordinated. Establishing care with your personal doctor is like having a “medical home”.
In this medical home model, your personal doctor will coordinate care including referrals to specialists on your behalf. The referral process is a well-established process, in which your PCP can authorize multiple specialty visits for ongoing needs.
You can search the Stanford Health Care Alliance provider directory for a PCP, or you can call Stanford Member Care Services at 1-855-345-SHCA (7422) for assistance selecting a personal doctor. You have the option to choose from hundreds of Stanford Health Care and University HealthCare Alliance PCPs located at 70+ clinics throughout the bay areas. We additionally have partnered with several physician organizations that are part of the network, including Affinity Medical Group, Brown & Toland Physicians (in San Francisco), Washington Township Medical Foundation, and Sutter Pacific Medical Foundation (in San Francisco).
PCPs include Pediatricians, Internal Medicine, Family Medicine, and General Practice doctors. Additionally, you may be able to choose certain OB/GYN doctors who have elected to be designated as a PCP – the provider directory will note this where applicable.
Yes, several hospitals across the Bay Area participate in the plan, including El Camino, Good Samaritan, Sequoia, Washington, Alta Bates, and California Pacific Medical Center hospitals. To find in-network hospitals, you can search the provider directory, or call Stanford Member Care Services at 1-855-345-SHCA (7422).
Stanford Health Care and University HealthCare Alliance has more fully developed our capabilities to deliver an integrated medical home model than in past years. We know that access to your doctor is just as important as your out-of-pocket costs. To that end, we have worked hard to develop a full network of primary care physicians to serve you better. Stanford Health Care has also implemented substantial upgrades to our appointment scheduling (both online and telephonic) and administrative systems which increase our efficiencies and support better access to care.
Over the past several years, most Stanford Health Care Alliance plan members (roughly 70%) have already established care with a Stanford PCP. That relationship continues under the new plan – with the added benefit of having your PCP as your care navigator. For Stanford University faculty and staff who have not yet established care with a PCP, it’s a good time to select one and schedule a visit for your annual preventive care exam. Also, many PCPs offer virtual visits and specialty care e-consultations.
A primary care physician specializes in diagnosing, treating and preventing a wide variety of conditions, and is focused on preventive care and screenings to ensure your health conditions are diagnosed early. Developing a relationship with your PCP extends beyond preventive care and allows for consistency and familiarity with a care giver who knows you, and can coordinate with the specialists to meet your specific needs.
No, the Trio and Kaiser plans offered to Stanford University faculty and staff in 2020 are also primary care models in which members must select a PCP.