ObamaCare plans to set-up online health insurance marketplaces called “exchanges”. Beginning in 2014, customers in the individual and small group markets will be able to use these “online stores” to compare different health plans which will be regulated by government, potentially without the help of a broker. Whoops! That’s a big change, but very predictable as expenditures are ratcheted down on all fronts, i.e., for hospitals, physicians, skilled nursing, marketing, etc. Currently, insurers are required to allocate at least 80% of small group & individual premium dollars on direct medical care. That percentage increases to 85% of their premium dollars for larger companies. In parallel with the ObamaCare changes, the insurance industry is significantly consolidating. The remaining major players are reducing broker commissions or redirecting incentives to pay for internet and other mass media sales efforts. As a national article suggested, “Perhaps the traditionally personal ‘shop-the-quote’ insurance agent may go the way of the travel agent.”
Clients have historically considered insurance agent commissions as a benign cost that is usually relationship dependent. The fact is insurers directly pay the broker commissions. But the cost of those commissions gets passed on to everyone who buys insurance. “More premium dollars usually means more commission dollars.”
Change always comes with a challenge. The requirement to pay 80-85% of premium for direct medical cost is quite disruptive for the benefits agent. But the Flagship pre-marketing campaign has found very little response or inquiries from market-based mailings and calls to community brokers. This is surprising as the “Community Health Plan” is designed to work with and benefit local brokers. The Flagship considers the local agent a major asset in providing day-to-day client support. Plus, the agent broker should be at the forefront of the planned “Summer Sales Blitz”. When approximately forty percent of the small businesses in the five-county “Lake Pointe Market Area” do not provide insurance benefits at all, everyone’s support is needed to extend community coverage. The Flagship Network will soon be a solution for “no coverage”.
The Community Healthcare plan is going to continue seeking local agents and brokers that would like to collaborate. The overriding purpose is not commission protection, but coordinated prospective wellness and appropriate care. The Flagship has the physician team, wonderful outpatient services and a great hospital. The team-building flag still waves high, and benefits for 2013 are soon to be considered. The mission is to expand access, manage cost, instill wellness and stop patients from unnecessarily leaving the community.
“When physicians, hospitals and employers form wellness partnerships, everybody wins”
….John Morrissey, a freelance writer in Mount Prospect, Ill
The Flagship Physician Network, a “Narrow Network” of practitioners, facilities, and outpatient services, is dedicated to a revolutionary approach to financing healthcare. The program is aimed directly at the employees of small businesses. That is where the majority of American Workers are housed. They work within the small businesses that make up the community employment landscape. While workers in big business often gripe about their benefits plans and grouse about premiums, the small business worker is either without coverage of any kind or is facing up to a five thousand dollar deductible. That means he has access to a little primary care and coverage for a catastrophic experience. Most of his medical expenses will be out-of-pocket.
The business owner looks at the unsettled economy, rising costs, and government regulations with a mindset to survival of his enterprise that may completely ignore health insurance. Not a pretty picture for Joe and Mary Worker. They do not know about the possibility of ObamaCare exchanges or mandatory insurance. They do know about the cost of gasoline and about their rising medical expenses.
The Narrow Network is a ray of hope for the business owner, manager, and worker. Knowledge can be communicated by blogs, Facebook, Twitter, and every available community social network. Service organizations, patient waiting areas, and physician–patient discussions are important in getting public the concept of community-based care. Every physician office staff member and hospital teammate can also become a source of information.
The message is that hospitals and physicians can work as a team to bring down costs through an intense community program of health risk assessments with biometric screening and access to compelling wellness information. Add in a Company Doctor and committed hospital leadership to broadcast the message that it is time to improve health habits year-round in order to lower costs. This message is a big part of the answer to premium creep. It can help hundreds of employers stem the rate of increase in their employee premiums. Yes, right here in this community.
At the same time, this campaign will result in new business flowing back to the community outpatient services, hospitals and associated physician practices. It is time to slow the flow of patients down I-30 past Lake Pointe. The message is simple. “Get informed, become disciplined, convert better health habits to savings, and stay home for your care!” The business of wellness and cooperation is going well in the Lake Ray Hubbard region.
The Lake Pointe Healthcare Network (LPHN) is creating a community based, vertically integrated healthcare solution. This program is directly aimed at the American Worker. These individuals are the work force of the businesses that support our communities and this nation. Welding shops, retail specialty stores, insurance agencies, fence builders are typical Main Street businesses that employ the majority of non-government employees. These small businesses are not only providing minimum benefits, but often strive to maintain the least possible number of full-time employees. The economy, regulations, taxes, access-to-capital, etc. are all factors depressing community businesses. No wonder “jobs” are the big issue in the USA.
LPHN is doing something terrific for the American Worker.
The solution that is being developed is the “Narrow Network”. It is a community network of a core hospital and related outpatient services that coordinate care with only the most efficient physicians and clinicians. This compact, efficient ecosystem connects and links the forces of care into a service system that is vertically integrated in the local community. For the American Worker, it means access to great care, near home, and for a better price.
The first four months of results in building the “Flagship” Narrow Network have been impressive. From the cooperative and innovative corporate office leadership to the physician relations managers that knock on doctors’ doors, the result has been excitement over enlistment in the Flagship Network and Physician Direct Access (PDA/The IPA). The Hospital CEO and Flagship leaders have personally called on the majority of the physicians surrounding the hospital. That personal, face-to-face interaction makes the LPHN a very unique community hospital. It also represents the Flagship community brand.
To date, the primary care physician and nurse practitioner/physician assistant cadre commitments are 62 strong. What would a big hospital system pay to employ 62 primary care providers??? Add in the specialists, and the final package is going to wind up with about 250 terrific providers of care. And, the ecosystem will be caring for their patients that make the local economy work. Yes, it is exciting. It is change! This is capitalistic, free enterprise thinking to prevent out-migration downtown and to reverse the trend of curtailed company benefits. Smart community leaders are finding ways to offer additional access to good care at an affordable price. This opens the door to biometric testing, wellness and transitional care. There is a new healthcare ecosystem coming to Dallas and neighboring communities.
As the Flagship Physician Network makes final preparations for marketing to employers, some interesting questions about details of this program are called in to the office. Actually, the Flagship team learns from each question.
Most importantly, this is an organization that has included the independent practitioner in the planning process from the very start. An organizer of PDA, Dr. Dwight A. Lee and Dr. Daniel S. Karin were day one contributors to the concept of directing new revenues to independent physicians. This program has two major avenues for augmenting physician income and a myriad of niches for practitioners with special interests. The PDA mantra is to help physicians make more money without hassle and without additional time commitment.
As to the first major avenue, the Flagship is ready to bring a new flow of commercially insured patients to the offices of member physicians. Working with Tenet Healthcare, direct contracts for medical care are being signed with employers in the Lake Pointe community. This is a concentrated effort to direct employees from Rowlett, Rockwall, and surrounding communities to local PDA physicians. PCP recruitment has been very successful, and the Flagship is now focused on enrollment of specialists. We invite member physicians to encourage doctors in their referral network to join PDA. That way, you’ll be able to maintain the same referral pattern for Flagship patients that are being used for your other patients.
Secondly, PDA is now the official IPA for Universal American Insurance with its TexanPlus Medicare Advantage plan. Physicians who currently have a direct contract with Universal American are being referred by the insurance company to PDA for continuance of their relationship. New memberships are being welcomed as well. This plan allows you to upgrade the income you receive from your current Medicare patients, and it gives you the opportunity to add new Medicare Advantage patients if you wish. As a PCP, you will receive 100% of normal Medicare reimbursement plus you will receive a monthly bonus for each MA patient in your practice plus you will be eligible for significant “gain-sharing” revenues. Specialists will have an upgrade to 105% of normal Medicare reimbursement.
Niche opportunities include participation as a Company Doctor, telemedicine, transitional care, and medical management. The Flagship will also give our physicians ways to expand the services they offer in their offices.
Please continue sending your questions. PDA is committed to developing new strategies and action plans for the marketplace. It is on the cutting edge of new ideas, and it studies the success of others as well. Most important, encourage physicians in your referral pattern to enroll.