These CCM (Coordinated Care Model) Synergy/Summit Network plans cover the same services as the traditional Moda PPO (Preferred Provider Organization) Connexus Network plans, usually for a lower monthly premium and often a lower out-of-pocket cost share. It's important to note that these plans use a more limited network of providers and require each individual enrolled to select an in-network medical home.
Synergy plans are available in Benton, Clackamas, Clatsop, Columbia, Crook, Curry, Deschutes, Douglas, Hood River, Jackson, Jeferson, Josephine, Klamath, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington, and Yamhill Counties in Oregon as well as in Clark County in the state of Washington.
Summit plans are available in Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa, and Wheeler Counties.
Select a Medical Home In-Network
If you enroll in a Synergy or Summit plan, you will need to select a participating medical home from within the associated network to coordinate your care. You can choose a different medical home for each person on your plan, but each covered individual must receive their care from their selected medical home to qualify for the in-network benefit. In return, you receive better coordinated and managed health care and lower premiums.
To find out which providers participate in either of these special networks, just use the "Find Care" link on the Moda Health website.
If you have further questions about these plans, call Moda Member Services at 866-923-0409.
Coordinated Care: The Oregon Difference
Through the Coordinated Care Model (CCM), Oregonians are experiencing improved, more integrated care. With a focus on primary care and prevention, health plans using the coordinated care model are able to better manage chronic conditions and keep people healthy and out of the emergency department.
Key elements of the coordinated care model include:
OEBB works diligently to incorporate these elements into all OEBB medical plans, but they are particularly evident in the structure of the Moda Health Synergy and Summit plans as well as the healthcare delivery system inherent in the Kaiser Permanente plans.
Learn more about the Coordinated Care Model and Oregon's efforts in this area on the Oregon Health Policy Board website.