We don’t just talk about change

Allies HMO is a large group offering with a limited network centered on Newton-Wellesley Hospital. Members also have access to Mass General Brigham’s renowned academic medical centers and specialty hospitals when referred by their provider. Allies HMO make choosing and receiving care easier, more convenient, less confusing, less costly. Dedicated Allies Health Navigators help simplify the experiences between members and providers. Members can save by using virtual care options at $0 cost sharing and can choose the Virtual Health primary care practice at Newton-Wellesley. Employers save on premiums compared to our full network plans.

Available in 65 communities from MetroWest to the neighborhoods of Boston. See the Service map here.
  Important notice: This plan provides access to a network that is smaller than AllWays Health Partners’ full commercial HMO provider network. In this plan, members have access to network benefits only from the providers in the Newton-Wellesley Hospital Community Plus network. Please visit the Newton Wellesley Hospital Community Plus provider directory  to determine which providers are included in the Newton-Wellesley Hospital Community Plus Network.

Allies Choice HMO is a small group offering with a limited tiered provider network centered on Newton-Wellesley Hospital. Members have access to Mass General Brigham’s renowned academic medical centers and specialty hospitals when referred by their provider. Tier 2 (higher) cost sharing for certain services will apply. Newton-Wellesley Hospital is a Tier 1 (lower cost) hospital. Dedicated Allies Health Navigators help simplify the experiences between members and providers. Members can save by using virtual care options at $0 cost sharing and can choose the Virtual Health primary care practice at Newton-Wellesley. Small group employers save on premiums compared to our full network plans.
 
Available in 65 communities from MetroWest to the neighborhoods of Boston. See the Service map here.
 


Important notice: This plan includes a limited tiered provider network called Newton-Wellesley Hospital Community Plus Tiered HMO and provides access to a network that is smaller than AllWays Health Partners’ full commercial HMO provider network. Members have access to network benefits only from the providers in the Newton-Wellesley Hospital Community Plus Tiered HMO network and pay different levels of copayments, coinsurance, and/or deductibles depending on the tier of the provider delivering a covered service or supply. This plan may make changes to a provider’s benefit tier annually on January 1. Please consult the Newton-Wellesley Hospital Community Plus Tiered HMO provider directory to determine which providers are included in the Newton-Wellesley Hospital Community Plus Tiered HMO network and the tier of those providers.

Members with Down syndrome and their caregivers get no-cost access to a virtual clinic that provides personalized care plans

The brainchild of researchers and clinicians at Massachusetts General Hospital, the virtual clinic at DSC2U.org aims to improve the health care journey for patients with Down syndrome and make sure they get the right kind of care, at the right time. AllWays Health Partners  members and their caregivers can access this service throughout the year at no cost to them.
 

How it works

Members and their caregivers answer questions in a comprehensive survey on the virtual portal at DSC2U.org. They'll then receive a personalized plan with information, resources, and recommendations for their overall care. The caregiver can then share this information with the member's primary care provider to ensure they're getting the right care for their condition.

Topics may include:

• Recommended labs, tests, and procedures 
• Potential new conditions/diagnoses to be considered 
• Health and wellness resources
• Nutrition information
• Education/therapy resources 
• Information, resources, and supports

 
All the tool’s recommendations are anchored in published practice guidelines, best practices, and/or expert consensus. According to research, 100% of caregivers would recommend DSC2U.org to another caregiver of someone with Down syndrome.

Designed to help members at risk of developing type 2 diabetes

Path to Lifestyle Change is a lifestyle intervention program that is modeled after the Center for Disease Control and Prevention (CDC)-endorsed original Diabetes Prevention Program.

This program helps eligible members to make changes to promote weight loss and healthier living, which can delay or prevent the onset of type 2 diabetes. Led by an expert team of lifestyle interventionists and dietitians from Mass General Diabetes Center, participants learn about nutrition, physical activity, and behavioral strategies and receive the education, tools, and support they need to make lasting lifestyle changes. Members access group sessions by phone.

This program aims for:

• 7% weight loss
• 150 minutes of weekly activity

Accomplishing this goal can reduce the risk of developing diabetes by 58% over 2.8 years and sustain a 34% reduced risk of developing diabetes after 10 years. ^1,2  

How the program works

Members track activities and outcomes that enable the program’s dietitians to outreach and offer member support with every member, as appropriate.

• Months 1-6: A minimum of 16 one-hour group phone sessions
• Months 7-12: Monthly 1-hour sessions to support participants’ healthy behaviors and continued progress toward their goals
• Year 2: Monthly maintenance sessions to sustain lifestyle skills, behaviors and continued progress toward their goals

 

Potential cost savings for members and employers

In 2017, people with diagnosed diabetes incurred average medical expenditures of $16,750 per year, 2.3 times higher than expenditures in the absence of diabetes.¹

So, when we can help members to live healthier lives and avoid a diabetes diagnosis, we help both members and employers to save in health care costs.

1  Knowler WC, Barrett-Conner E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.

2  Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, Hamman RF, Christophi CA, Haffman HJ,
3  American Diabetes Association. Economic costs of diabetes in the U.S. in 2017. Diabetes Care 2018. https://doi.org/10.2337/dci18-0007

State-of-the-art care management

iHeart Champion helps members reduce their bad cholesterol, blood pressure, and risk of heart attacks. The program is a collaboration with Brigham and Women’s Hospital Remote Cardiovascular Health Program. Eligible members find it easy to engage with navigators and digital tools to return impressive results — all without the need for office visits or additional member costs. Among study participants, average results are:
 

• 40% reduction in bad cholesterol in 12 weeks
• Blood pressure values decreased by an average of 30/10

These reductions would reduce the risk of heart attacks and strokes.

Three no-cost pediatric sick and behavioral health visits

This parent/wallet-friendly benefit covers the first 3 sick PCP visits and 3 behavioral health visits for members age 18 and younger at no member cost sharing, per benefit period.

Removing the cost barriers to care options

Built on the understanding that there’s more than one way to solve a problem, Care Complement gives members the flexibility to try alternatives to opioid painkillers and new treatments for managing chronic conditions.

$0 cost for:

• The first 6 visits to a chiropractor
• The first 6 acupuncture visits (20 visit limit)
• Pain-management therapies
• The first 6 for visits for physical or occupational therapy
• Cardiac rehabilitation therapy
• Services that decrease diabetes complications including an annual routine eye exam, diabetic education, and nutritional counseling
• Medication-assisted therapy office visits and prescriptions to treat substance use
• Recovery coaching
• 11 common prescription medications to treat depression, heart conditions, and high blood pressure

Cash back for making smart choices about care

Members can save money — and earn rewards of up to $500 — with the DoctorSmart Rewards program.

Different providers may charge very different prices for the same procedure, even when they’re delivering the same level of care.

DoctorSmart Rewards makes it easy to find these high-value providers, so members can save on their out-of-pocket costs.

But there’s more. DoctorSmart Rewards also gives members a cash incentive for making smart choices about where to get their care. Eligible services include common procedures like colonoscopy, CT scan, mammogram, MRI, and upper GI endoscopy.

To participate, members simply shop the full list of DoctorSmart Rewards on our secure member portal. Once they select and have a procedure, we’ll process the claim and send them a check in the mail.

Convenient, high-quality virtual urgent care visits 24/7 

On Demand offers convenient, high-quality virtual urgent care services for minor illnesses and injuries—and it’s available anytime and anywhere in the United States. Members (adults and children age 3 and older) connect to providers through a secure, interactive video visit on the web or mobile device. 

On Demand is NOT for medical emergencies. For medical emergencies, call 911.

Our LiteSwitch program takes the burden of switching plans off your shoulders.

Account Executive
Your Account Executive provides ongoing support after implementation and through the renewal.

Dedicated online transition center
New members have access to our online transition center, designed to answer common questions about changing plans. There, they can also find and fill out a Transition of Care Form to privately communicate their care needs.

Broker and Account Services and Support (BASS)
After enrollment, the experienced representatives on our BASS team are available to handle account eligibility inquiries, member-specific add/term requests, account and broker collateral requests, and administrative-related questions.

Prescription drug support
​We offer auto auth-placement for drugs that require PA and Step Therapy if a transition fill occurs in the first 120 days of a plan.* Non-covered drugs will be covered for the first 6 months based on the transition fill. We'll work with members to make a switch to a covered drug.**

Live customer service and online chat
Members can speak with one of our expert customer service professionals in English or Spanish by calling 866-414-5533, or use our convenient live online chat. We also offer translation services in more than 200 languages.

On-site enrollment health fairs
AllWays Health Partners representatives help provide clients and employees with information about the plan’s benefits, features, the provider network, and more.
 
Welcome calls and emails
A welcome message greets the new member within 24 hours and connects them with resources that explain their benefits and other important information and services.

* Approval length will vary based on the clinical indication for the drug.
** For excluded drugs (such as cosmetic, OTC not on the OTC list, drugs not FDA approved), the program does not apply.

World class service — guaranteed
AllWays Health Partners is the only health plan in the U.S. to offer personalized performance guarantees ranging from $20,000 to $50,000 for new business accounts with at least 100 eligible FTEs.*

Performance guarantee metrics include customer service call response time, first call resolution rate, and claims processing turnaround times.

*To qualify, the new account must have at least 80 enrolled on the AllWays Health Partners plan and be in good standing. Performance guarantee values vary depending on actual size of new employer customer: up to $20,000 for employers with at least 80 subscribers and up to $50,000 for employers with 500+ employees and 350 enrolled subscribers. Performance guarantees apply only to an employer’s first year with AllWays Health Partners. Upon renewal, other arrangements may mutually be agreed upon. Performance failures attributable to a force majeure event or an event beyond AllWays Health Partners control excluded from measurement.