Hop on the Bandwagon!

The Flagship Physician Network (FPN) in association with the Lake Pointe Medical Center is rapidly filling its needs for physicians in the Rowlett/Rockwall community.  Our first thrust was to enlist a strong core of primary care providers, and we have certainly achieved our goal.  The Network is still open to additional PCPs, and we look forward to adding more as we go forward.  If you wish to join, please take action now so that your name will be included when we publish the list of participating physicians.

The Flagship is now focused on enlisting specialist providers.  The Network already has adequate coverage in some specialties and continues to actively recruit in others.  As with PCPs, we currently have no plans to close the panel, but those who are enlisted when we publish our directory will certainly have first crack at the new business.

Our community health plan is a direct contracting initiative between healthcare providers and small businesses of 25-250 employees in the Rowlett/Rockwall area and surrounding communities.    We form direct contracts between Flagship physicians and ERISA self-insured businesses.  Each employer will be carefully screened to be sure of its financial strength and its interest in supporting our wellness-centered program with enhanced patient education.  Texas Health Resources announced a similar offensive on 4/17/2012, but they are aiming at much larger employers in the DFW Metroplex.  Baylor, of course, is competing with a similar approach.  The idea of uniting clinicians and hospital systems is creating a sea change that makes communities the central focus of healthcare.  The integrated mega-systems will concentrate on preventive and diagnostic care in conjunction with providing broad-based services.  The Flagship Network will excel in this arena of proactive care.  FPN is distinctive because of personal attention to the small and midsize employer who is connected through the Company Doctor to the community healthcare base.  This is a neighborhood enterprise that is professionally and personally interconnected with a sound fiduciary foundation.

The collaboration between the Flagship and Tenet is fast and agile.  Flagship physicians must have the same mindset.  Our next targets will be the Doctors Hospital and Centennial Hospital communities.  This is an exciting business opportunity for the independent practitioner.

Flagship Physician Network Specialist Enlistment

We have been to your office to herald the coming of the Flagship Physicians Network!  Our winning team of Lake Pointe PCPs is awaiting the first direct contract patients from our Tenet “Community Narrow Network”, and we are ready now to complete the team of specialists.  Specialists, this is a personal invitation to you to join with your referring PCPs.  And PCPs, this is your opportunity to recommend specialists for inclusion.

Our Network is composed of great physicians, your hospital, and outpatient facilities, all working to provide community-based care to small businesses and local enterprises. Physician compensation is competitive and there are no risk components.  Marketing is by healthcare pros and by physicians with all the appropriate insurance licenses. This is your own store. At last, there is an effective way to stop patients from leaving town for their care!

HOW TO PARTICIPATE

1. Join Physician Direct Access (PDA), an IPA.  This takes care of credentialing, and contracting with the Flagship Physician Network.  PDA is not a traditional “messenger model” IPA.  It is low cost, lean, and very aggressive.  It does not make profit off the physicians’ backs, but provides all credentialing and contracting services at cost.  PDA is proud to be your hospital’s preferred IPA.

As a special incentive, the IPA has slashed its fees in the Lake Pointe market to $499 for the first 12 months!  That is probably less than half of your current IPA expense.  Like most IPAs, PDA offers optional participation in thirty plus managed care contracts. But unique to PDA, direct contracts are the core thrust, and there are other new products currently being developed for telemedicine, transitional care, biometrics, wellness, etc. PDA is a new marketing-oriented physician’s sales team that just happens to own an IPA.

1. Give five minutes to Market Manager James Mathis to get your signature, cut a check, and it’s done.  Since PDA can credential five physicians per day, you will be ready to see self-insured ERISA patients in short order. The marketing will start carefully and build up to the big employers such as the school district.
2. You can tell PDA if you are available to be a new client’s “Company Doctor”.  As new employers enlist in the Flagship Network, they will be provided the option of biometric assessment and a terrific wellness program.  The immediate and best step is to introduce the employees to a Company Doctor.  The Flagship Benefits Consultant will always suggest that the Company Physician be positioned next to the CEO or business owner as they begin to chart a new pathway to wellness and cost control.  This is how a Narrow Network functions…local employers, community primary care, their referral specialists, and a robust hospital with a complete outpatient package.

That’s the package:  a new source of commercial patients discovered and directed by your own marketing team and supported by a powerful hospital.  Healthcare is a community affair.  In that arena, the Flagship Network rules!

Phone 972-484-5889                       Fax 866-230-7104                Email: blog@themiersgroup.com

AETNA Begins Economic Credentialing Initiative

The Aetna decision to deselect 130 physicians is effective July 1st, 2012, and is national in scope.  A year ago, the insurer warned physicians of its concern about billing practices primarily involving levels 4 and 5 E&M codes.  PDA reminds you that anytime a practitioner receives such a warning, it is your option to alert the IPA management.  That action needs to become a standard of performance for all office administrators.  This action has impact beyond one major insurer dropping a physician.  It represents a “sea change”.  Aetna’s confidence in eliminating physicians due to researched billing practices is a dramatic escalation of data-based medical management capability, i.e., third party administration with a definite directive to lower expense.  Also, the decision to state “billing patterns” as a causative reason for winnowing physician ranks raises questions as to the undisclosed analysis of quality outcomes.  Even more important, it also causes anxiety about how other managed care plans will react when it becomes public information that a physician is excluded from medical panel participation by Aetna.  Will there be an industry move in aggregate to exclude that physician from other managed care panels? 

TMA has developed a white paper on physicians’ basic rights and responsibilities regarding network terminations.  TMA also clearly takes the position that the report is not specific to Aetna or to any physician deselected by any health plan.  The value of venting or speaking out about this issue is a personal option for each PDA practitioner to weigh.  Getting on the soap box is a natural thing to do as the areas of independent medical practice and self-determination are rapidly eroding.  The PDA response is to (1) evaluate this historic step by Aetna, (2) carefully parse the TMA whitepaper, (3) ask Aetna for additional explanation, and (4) consider the counsel of others…including the PDA membership’s input.  PDA values our relationship with Aetna and the recent improvements in the Aetna-PDA agreement.  Aetna is simply moving forward with the evolutionary steps we have expected from the insurance industry.

It does seem obvious that the PDA initiative to build a strong, cutting edge medical management program is essential for the IPA to function in the “new-normal” of healthcare.  And, PDA must continue proactively developing alliances such as the Flagship Physician Network in which open self-directed medical management programs can directly partner with client company leadership.  The IPA mantra is to help you make more money, eliminate hassle, and not demand more time at work.  For those who were wondering if PDA had added value compared to the IPA alternatives in Dallas, now is the time to pay very close attention.  The music has stopped, and some physicians have no chair to grab.  The Community Health Plan, Medicare Advantage, and other developing initiatives are vital strategies to make the PDA practitioner successful in the here-and-now!  The medical delivery game just ratcheted up in challenge and difficulty.  PDA and its practitioners have work to do.  The music will stop again, and soon. 

Taking Action

PDA is “practitioner based”.  PDA leaders understand the grueling nature of medicine in this time of managed care and potential ObamaCare.  Actually, PDA lives in the same space of no frills and hard work as the typical practitioner.  This message is very specifically aimed at realizing the mantra of “Making more money, avoiding hassle, and not calling for more work”.

At the core of a busy physician practice is the practitioner who always works long and arduously.  Patients typically come to the physician, presenting through the sliding glass window of the office.  It is important to keep in focus that patients are not uniformly the same and neither is compensation for one’s knowledge, skill and judgment.  So, the challenge is to maximize profit margins where appropriate and where clear opportunity exists.  Healthcare in the United States is in a period of transition, and where there is change, there is opportunity.

PDA physicians have a significant opportunity now in the I-30 corridor east of Dallas.  The opportunity is a community health plan flying the banner of “The Flagship Physician Network”.  This is a community-wide movement to provide direct contracting for owners/operators of businesses that employ 25-250 workers.  Middlemen and layers of bureaucracy do not exist.  The community is a self-contained system connected socially and economically.  That is how trade binds communities together.  The same participants at community meetings, clubs, service organizations, etc. are going to be able to feel that there is a grass roots solution to the high cost and bureaucracy of managed care.  This is an important beginning, and PDA is part of the foundation.  The physician payments range from good to great. The Hospital and outpatient facilities are 100% behind the effort!  Seats at the table are still available, but fifty PCPs have already stated their commitment, and the team is suiting up. The network will fill out quickly with specialists.  If you want to catch the direct contracting express, call James Mathis, Market Manager of the Flagship at 817-239-2399, or ask one of the Lake Pointe Medical Center physician representatives for assistance.

THIS IS GREAT BUSINESS SERVING THE AMERICAN WORKER AND THE LOCAL ECONOMY. BENEFIT PLANS ARE CREATIVE, PDA IS THE “PREFERRED IPA”, AND COST SAVINGS WILL BE ACHIEVED.  THE ONLY HURDLE IS FOR YOU TO MAKE IT HAPPEN. (1) CALL, (2) ENLIST, AND (3) WE WILL START MARKETING YOU!  INERTIA, DELAY, AND THE PARALYSIS OF ANALYSIS ARE THE ENEMY.