Follow-Up

Yesterday’s blog message was an introduction to PDA’s new Medicare Advantage offering. The special element in this product is medical management of the patient population.  A team made up of PCPs, PDA’s Medical Director, and actuarial engineers with cost accounting strives to manage quality care and excellent customer/patient service. This is accomplished for the same dollars that Medicare provides the “free style patients” that are on their own to figure out the current healthcare system. There are financial incentives are to motivate the PCP to put his arms around a specific population of patients and to use his medical skills and judgment to maximize their health.  The key to success is to provide effectiveness and efficiency of care in a measurable way.

The Texas Department of Insurance defines this product as an “HMO”.  The mention of “HMO” dredges up countless negative emotions in those who practiced medicine in the 1980’s and 90’s.  What we really have here today is a straightforward mechanism for converting your current Medicare patients into a better demographic profile.  In plain English, you’ll be paid more for the work you’re already doing.  You will simply invite your current Medicare patients to enroll (at no additional cost) for improved benefits and continued access to your office.  If you are caring
for Medicare patients, this is a very positive approach.  Then, if you find that the program suits you, additional patients can be added.

The first wave of organization is PCP-focused.  The second effort will relate to the PCP-specialist
referral patterns.  The physician credentialing process begins next week.  There is no time for PCPs to be concerned that they won’t be able to refer to their favorite specialists, or for specialists to worry that their referring PCPs won’t be in the network.  PDA will work this out together as a team, guys.  PCPs can spread the word to their specialist friends and vice versa.  Even better, PDA can take an active role in this process.  Simply give us the names of physicians you would like us to approach, and we’ll take care of the rest.  Time is very short.  Please contact the PDA office now to be included in this program.

---