It’s Hard to be a PCP

It is hard. With reimbursements under pressure, the PCP struggles to keep his efforts financially worthwhile.  Making matters worse, the patient that came to the practice years ago may have grown frail.  The time for referral to rehabilitation, skilled nursing or even an LTAC facility is hard for the patient, their family, and certainly for the physician.  The doctor-patient relationships built over the years become personal.  They are to be valued, actually cherished.  It is inescapable that the loss of patient mobility means separation from the primary care physician.  Reimbursement and managed care have forced the PCP to crank up visits, and he/she must struggle to maintain long-practiced care patterns like making hospital rounds or seeing a patient in the emergency room.

PDA is developing a “transitional care” solution.  The PCP is going to be given a phone number which will be answered 24/7.  There will be an available list of “Flagship Approved Facilities” to use for referrals.  These facilities will provide clinic-level care, allowing the patient to steer clear of the emergency room.  And, there will be a follow up by a concierge person who works the entry point of each facility. The concierge is there to let the family and patient know that that the primary care physician is following the case and that there is a care team ready to serve.  The total team is the referring physician (PCP), the Nurse Practitioner/ Physician Assistant, a talented Hospitalist, a homecare service, and if needed, a hospice service. This team will strive to deliver true transitional care.

Managing the challenges of primary care practice can be assisted by PDA and the Flagship proprietary network.  The strength of the PCP group is the growing critical mass of independent physicians.  The year 2011 and the first thirty days of 2012 have been very positive.  The PCP group is definitely expanding, but the challenge is to keep the mantra in front of everyone.

“Make more money, with less hassle and in less time”. That is the message for 2012!

Diabetes Recognition Program

PDA would like to bring an opportunity to the attention of its members.  The Dallas-Fort Worth Business Group on Health, working in concert with the BCBS of Texas Physician Rewards Program, is making a financial incentive available to physicians who have a “best practice” approach to diabetic patients.  It is clear that the guidelines will increase the cost of medications and increase the number of office visits.  The savings, estimated at $1,200 per patient per year, accrue from fewer emergency room visits and fewer hospitalizations.

If you have at least 25 diabetics in your practice and you would like further information, please contact the PDA office.

The Impact of Behavior Modification

Altering behavior is the only effective pathway to wellness.  Modifying behavior has an impact on critical factors such as smoking, over-eating, compliance with medication schedules, and appropriate follow-up visits with a physician.  To affect a significant change in the workforce wellness index, a game-changing, internet-residing program will be deployed immediately.  The “Flagship Preferred” behavioral wellness program is the next step in conjunction with introduction to a Company Doctor.  Behavioral wellness coordinated with a physician’s support to target health indicators is the pathway to making a workforce healthier.  And, that is big news!

The major insurers give lip-service to wellness programs, but they have not made a true commitment.  Their real commitment is to their profit statement.  Wellness programs tend to show concrete results in the intermediate and long term, but certainly not in the current fiscal year.  By the time a client’s wellness program is gaining real traction, the client will probably have a different insurer. 

The Flagship Network has a different orientation.  We can provide immediate cost reductions through direct employer contracting with healthcare providers.  Those savings will be sustained over the longer term by achieving wellness through behavioral modification.  Double digit premium increases can become a distant memory.

Today is the day that a small southwestern college is changing its benefit plan.  The strategy is to make the workforce healthier and personally accountable for wellness.  They will move through a biometric testing experience.  Each employee will have personal test reports printed out.  The management will receive a “blinded” report that analyzes imbedded chronic disease.  The actuarial deal changers, namely the employees with major health problems, will have their anonymity totally protected according to HIPAA regulations.  The workers with good health indicators will be positively reinforced, and the benefits consultant will be able to craft a perfectly tailored plan.  Again, that is big news!

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Our Community Healthcare Network

How can an employer with fifty workers reduce healthcare costs?  PDA leadership thinks about this question which hounds business managers and owners.  Remember the concept “It takes a community”?  Well, the big hospital systems, the insurance mega-companies, and the government have failed.  The solution is right here in our own community with our own hospital and our own physicians!  It does take the right information, trustworthy colleagues and a plan of action to deal with healthcare cost issues for the 25 to 250 life company.  It also takes a network like the Flagship Physician Network to serve as the delivery system for solutions that provide quality care at a cost-effective price.  Physicians have always been part of the solution in providing cost-effective, dependable care.  Another necessary component is an acute care hospital that wants to be part of the solution, and we have just that at Lake Pointe Medical Center, at Centennial Medical Center, and at Doctors Hospital. 

 Next, a catalyst and a new tool are needed.  The catalyst is the Flagship Physician Network (FPN) and its related benefits consulting services. The network and its consultant, working with a third party administrator, are constructing an ERISA-funded direct care plan. This solution is being put together today, and the result will be cost savings and a custom tailored benefits plan.

 There still is, however, a vital component needed to complete the equation—the tool.  The new tool is a behavioral wellness program that meshes with biometric testing and the direct support by the company doctor. To meaningfully change behavior is to directly impact disease and medical costs.  There are behavioral factors which underpin the management of practically every disease process.  Individual emotional and psychological issues cause people to be inactive, smoke, drink too much, and over-eat.  Emotional issues can also cause patients to ignore symptoms and delay management when early treatment is the efficient approach.  The FPN has identified this reality and sought out the best program of behavior wellness support and training.  This program is available and can be purchased by individuals or by groups.  It fits perfectly with biometric testing. The program allows self-paced, individual progress in managing personal medical issues.

 In coming weeks, we will tell you more about this program and explain cost and access. Yes, the FPN is breaking the mold.  In 2012, it is going to provide quality care with cost savings to the American Worker.

Adding Opportunities in 2012

It was a very good year & 2012 is going to be even better.  Physician Direct Access (PDA) came out of the blocks fast today. An exclusive Medicare Advantage program with a great insurer has now been inked.  All their direct-contracted physician provider participants will be encouraged to transition to PDA.  A new medical management program headed by Daniel S. Karin, M.D., Medical Director for PDA and supported by a cadre of proven medical leaders is starting up.  PDA is determined to become the most sophisticated medical manager in the local arena.  This expertise is going to be applied to the quality of patient care and negotiation of physician incentives.  The purpose is to be smart for the client, the patient, and the providers. Then, the expertise and experience will be transferred to the commercial, ERISA-based book of business growing under the Flagship Physician Network.  PDA has a clear vision of physicians managing services and contracts that reflect material rewards for performance. PDA is not your idea of what IPAs have always been.

 The Nurse Practitioner and Physician Assistant resource is currently being marshaled. Our colleagues now hear PDA’s code words…”The NPPA Project”.  The acronym “NP” for nurse practitioner is welded to the acronym “PA” for physician assistant to create a new PDA brand…“NPPA”.  And, the leader of this new clinical enlistment is an experienced, aggressive professional with a large, profitable PCP practice.  This year PDA intends to blend PCPs and NPPAs with a multi-dimensional medical and restorative team into a new delivery system. This cost-effective, high-quality unit will be positioned within the “Flagship Narrow Network” delivery system.

 Discussions continue with another healthcare company that is focused on the home visit market. The “NPPA Project” is a catalyst for the home-bound patient market.  PDA physicians could prospectively accept referral and continued leadership with commercial and Medicare patients that are reliant on NPPAs for direct care. This is a huge market that is underserved.  The PCPs of PDA seek an effective solution and freedom from the frustrations of the transitional issues surrounding home care and visits. PDA will move on this opportunity in 2012.