Opportunity in Medical Management

The IPA has an agreement in the final stages of closure to provide “Medical Management” for a Medicare Advantage insurer.  PDA has carefully selected a single insurer, Universal American. The selection process included due diligence review of the company from an investment banker viewpoint plus feedback regarding the plan’s success in the mature and competitive Dallas and Houston markets. The final selection was made after face-to-face interaction and negotiation. Universal American is the right choice. PDA is going to concentrate on one Medicare Advantage agreement in 2012. The physician participants serving under the PDA banner will know that their IPA is totally focused and committed to being the most efficient, patient centered provider team in the Metroplex. 

The plan is to build a high quality medical management program to support this Medicare Advantage initiative. The immediate opportunity for PDA practitioners is:

• Participation in the UAM plan with an upside opportunity and no downside risk.
• Education on how to make Medicare Advantage pay in terms of financial incentives and satisfied patients
• Compensation for physicians achieving the position of “Associate Medical Director”.
• Upward mobility for providers that seek “Medical Director” status.

Please consider not only this medical management opportunity but also the predictable nature of the growth of commercial and Medicare business with both a financial up-side and a down-side.  All physicians would like to have their practices loaded with high-paying commercial insurance, but the shelf life of fee-for-service medicine is an issue. Yes, the future is going to require that physicians have “skin in the game”.  For those practitioners who are merely resigned to serving the Medicare patients that are currently in their practices, such patients can be converted to an improved compensation level by encouraging them to sign up for Universal American’s TexanPlus program.  The PCP will receive full Medicare reimbursement PLUS $8.00 per member per month PLUS an opportunity for gain-sharing.  Specialists receive 105% of Medicare rates.  For those practitioners willing to increase their Medicare load, Universal American certainly provides extra incentive.  For the independent practitioner, the issue is how to adjust patient mix to maximize reimbursement.

If interested, please contract Daniel S. Karin M.D., Medical Director of The Flagship Physician Network. 

Team Development

Lake Pointe Medical Center (LPMC), the centerpiece acute care hospital of the “Flagship Physician Network”, has developed a stroke unit, a neonatal intensive care unit, new invasive cardiology, and has acquired the Lake Pointe Cancer Center.  Significant capital has been invested by Tenet Healthcare to keep LPMC at the forefront of medical care. This technology and service edge is very important for the Flagship direct contracting thrust.

The joint effort of independent physicians and the Lake Pointe Health Network aims to develop a healthcare project which will link community business to the community hospital and community physicians.  The enlistment effort of physician leaders is currently underway.

Outpatient services such as wound care, sleep medicine, imaging, fitness and rehabilitation are also being included in what will be a comprehensive benefit plan offering. Low overhead, cost-effective care, and motivated providers promise just what the small business owner seeks…cost-effective coverage for their workers and families.

Competition is really the zest of life in a free society. The PDA Flagship program is highly flexible, opportunistic, and focused on excellent customer service.  PDA is composed of independent, community-based practitioners. The Tenet Healthcare facilities are a perfect fit for the “Narrow Network” model, i.e., a concentric network of high quality physicians and a cutting edge, high technology acute care facility with surrounding outpatient services. Lake Pointe Health Network management is determined, strategic and very competitive.

PDA is becoming a component of an integrated community healthcare solution. That is big news. Call 972-484-5889 and join this team.

Flagship Milestones

The Flagship Physician Network has come a long way.  The strategy is similar to the program offered in the 1990s to municipalities, school districts, and corporations by the JVE Physician-Hospital organization. The JVE aggressively used direct contracts to add profitable incremental income to Presbyterian Healthcare System (PHS) and physicians of Presbyterian Hospital of Dallas, Presbyterian Hospital of Plano, Presbyterian Hospital of Winnsboro and affiliates in Greenville and Paris, Texas.  The program was so robust that PCPs outside the PHS system were also recruited and involved as equals.  Led by the JVE CEO, Buddy Miers, the book of business rapidly grew to nearly 48,000 covered individuals. The program ultimately was viewed as competition to the hospital-owned North Texas Healthcare Network and was ultimately de-emphasized by the Presbyterian system.

With subsequent business successes, Buddy Miers envisioned a new application of ERISA, self-funded direct contracting that was attuned to the “new-normal” of ObamaCare.  Flying the Flagship Physician Network brand, PDA serves a broad swath of American business that includes small to medium size companies (25-250 workers).  From its moment of conception in 2010, it has successfully reached one milestone after another.  The first step was to revamp PDA from a withering IPA to an aggressive, forward-looking organization on the cutting edge of new healthcare solutions.  Doing this involved bringing talent on board, including much of the talent that helped Buddy build the JVE.  Recent additions are Tim Paquette, past COO of the Jefferson Group of PCPs, Dr. Dan Karin, past JVE Board member, and Elliott Uchiyama, past leader of the Genesis Medicare Advantage Program.  JVE proved very successful at building income streams for physicians, and the new PDA is totally focused on making the member physician more money, with less intrusion and hassle, and without working any harder.

Along the road, PDA and the Flagship have formed a new alliance with Tenet Healthcare, creating close relationships with Lake Pointe Medical Center, Centennial Hospital of Frisco, and Doctors Hospital at White Rock Lake.  The community healthcare project is rapidly taking shape with its initial surge of activity beginning at Lake Pointe.  Tenet has developed a special hospital fee schedule for the community project.  A physician compensation schedule has been developed and reviewed by PCPs and specialists.  The Flagship is currently in discussions with Lake Pointe hospital-based physicians including anesthesiology, radiology, and pathology.  The Flagship has also developed a strong relationship with Boon-Chapman, an elite third party administrator with offices in Rockwall. 

It is all coming together.  Each step is a milestone, and each milestone brings the Flagship Physician Network closer to its goal:  a win-win for providers and for employers.

The Big Picture

In the PDA blog of 9/6/2011, the Flagship Physician Network announced that it was building a “Narrow Network” to provide direct-contracting medical care. The customer is the small and medium-sized employers in the DFW market.  In parallel, we are carefully studying the Atlantic coast “Narrow Network”, the Houston large physician organizations, and the warrior physician IPAs of the west coast. Here in DFW we have the “Narrow Network” kickoff as well as a new large physician organization associated with a Tarrant County group of physicians, and covert heavy recruitment of a premier specialty group. That is a lot of action. Today, our initial headline target is the Rowlett/Rockwall market segment, with Frisco and East Dallas primed to follow. 

 Today, the Flagship received the official commitment from Tenet we have been waiting for.  With this commitment, all of the pieces are now in place.  We have the Tenet financial proposal and are just opening it up; we already have a very favorable physician compensation schedule; we have an agreement with an outstanding third party administrator; we’ve had meetings with the “rain-maker” practice management leaders; and we are addressing stop-loss issues.  Making use of our insurance benefits consultant license, we are in contact with 40 agent-brokers in the Rowlett/Rockwall arena.

 But, the same rules still apply. The strategy must make the independent physician more money with less hassle and absolutely no more work. That is us.

Healthcare is definitely a community service. Together, we will establish that fact with the purchasers and end-users of care.  Targeted physician enlistment and network completion efforts roll out immediately.  At the same time and in parallel fashion, we will begin to approach employer prospects.

This is an important day as the game is now on.  November the 7th, 2011 is a memorable day. Hooray!!!

The PDA Value Proposition

PDA is a distinctive organization, aggressive in style and inclusive in orientation.  But the word “aggressive” does not capture the true nature of this organization.  Even more than aggressive, PDA strives to be disruptive in the Dallas medical marketplace.  PDA’s goal is to find new ways to help members make more money with less hassle and no additional workload.  “Make more money” sounds almost crass and one dimensional, but it’s time for someone to finally stand up for practitioners.  Physicians, and all health providers for that matter, have seen the government, the insurers, and the lawyers whittle away at our income for too long a time. 

And PDA is inclusive.  It welcomes M.D.s, osteopaths, podiatrists, clinical psychologists, nurse practitioners, physician assistants, and all medical professionals with open arms.  Our central strategy is to develop markets. PDA is the adhesive force in community markets.  The Flagship Network is made up of hospital, outpatient facilities and services, transitional care units, and a complete physician service network.  PDA and its marketing partner can therefore directly contract for the self-funded medical needs of the backbone of American business…the local enterprises that employ 25-250 workers. These are the companies that are experiencing major insurance premium increases. These are the employers that make up a large percentage of the total business universe that have decided to just not offer insurance any longer.  PDA and the Flagship will serve these small business owners and managers.

That is a simple, direct to the target plan. It is also the independent physicians’ answer to big system integration. We must all stand together, or the divide and conquer strategy will successfully target one provider group at a time.

If you are a PDA member who works with nurse practitioners, physician assistants, or other ancillary healthcare providers, please share their contact information with us.  PDA’s special services can be of immense benefit to them too when they enlist into our program.  Our goal is to include these providers as PDA becomes the finest and broadest practitioner group in Texas with a self-directed marketing capability.