Blog Follow-Up

Blog follow-up

We appreciate the response to our request for 5-6 of your most frequent CPT codes.  We are working through that data, compiling it, and building a fee schedule that is provider-based.  If you have not yet responded to the invitation, now is the time to submit your codes. Take five minutes to add your voice.

Daniel S. Karin, M.D.

Medical Director

Sharing Experience

PDA in an independent physician association.  

 We are an association of independent physicians, owned by independent physicians and run by independent physicians.  If we want to remain independent, we must support our organization financially, and occasionally we must work for the organization.

 PDA has an important question for its physicians.  As you have learned from previous blogs, PDA is developing a direct contracting model for self-insured employers.  Practitioner compensation is a critical component, and we are soliciting your input during this development stage.  Trust that we know a lot about compensation as we have forty managed care contracts, and physician compensation is a constant and dynamic discussion. Please jot down the five or six CPT codes that are most important in terms of frequency of occurrence to your specialty.  If you want to stop there, OK.

 If you want to contribute even more to building a fee schedule, give us the high and low end of your managed care payment experience.  We request your input now to help in general compensation understanding. This is a real opportunity to share actual experience across the seventeen Flagship counties. Please send your notes to the PDA’s Medical Director Daniel Karin, MD at  dkarinmd@flagshipnetwork.com.

Working Together…The Flagship Community Health Plan

PDA is determined to become more than a messenger model IPA for managed care access.  The vision is to make member practitioners more money, without any new hassle or additional work.  It is all about adding value.

This mantra is supported by the commitment to explain how the IPA works collaboratively within the communities served by PDA physicians.  For example, there is a five county primary PDA marketplace with a population in excess of three million.  PDA and the Flagship Physician Network have collaborated with the Tenet Healthcare team to develop a patient care system supported by direct contracting expertise and specific insurers.  This conduit of service will unite solid financing and high quality medical care.

Here is how the collaboration converts into new patients, commissions, and physician profit.  First, there is the core Flagship team that is made up of licensed insurance agents and physicians.  They are positioned to interact with owners and managers of community businesses.  The target market includes companies with 25 to 150 employees.  Next year, the experience will allow moving after municipalities, school districts, etc.  These are people that all live and work in the same community. The Flagship will utilize biometric testing and wellness programs to assess medical benefit needs and financial capability. After careful thought and analysis the end result is an innovative benefit proposal.  The new plan is intended to be optimistic and directed at improving employee coverage with enhanced outcomes. 

Dr. Daniel Karin, the Flagship Medical Director, along with the designated “Company Doctor” from the local practice area will transition from plan design development to plan monitoring with the support of a proprietary information technology system. The medical advisors will also have access to the industry-leading brain trust and high technology of Cap Management Systems, Inc. (CapCMS). This firm provides services for clients. It is believed that their client list is in excess of 500,000 individuals. They excel in third party administration, stop-loss reinsurance and data management.  CapCMS has a decade of excellence in supporting physicians and other clients from their west coast base.

This is very exciting. The physicians will be paid at market commercial reimbursement and these new Community Health Plan patients add incremental income that is much better than the government pay level.  Also downtown migration of patients will be impacted.  Community care is the best care.  To that PDA says: “Collaboration is a win-win experience”.   

Each PDA physician will be contacted to participate in this new program.

For more information, contact James Mathis or Christopher Cash at PDA.