Kelsey-Seabold Direct Contract with the City of Houston

Thursday 12.13.2012: Based on direct contacts in Houston, internet resources and the Modern Healthcare Magazine

The City of Houston has been welcomed as a “KelseyCare Powered by Cigna” client. That represents approximately twenty-five thousand employees and retirees. If Houston was an independent nation, it would rank as the world’s 30th largest economy.

To add more impact to this accomplishment, Kelsey-Seybold Clinic, a Houston physician group, is the first healthcare provider to be accredited as an accountable care organization by the National Committee for Quality Assurance (NCQA) The 350-doctor, 20-location clinic was one of six organizations that first applied for ACO accreditation after the NCQA began taking submissions in March of this year.

Kelsey-Seybold’s ranking as a deliverer of coordinated, patient-centered care while improving quality, reducing costs, and enhancing the patient experience is based on NCQA’s evaluation process.The assessment focused on characteristics such as structure and operations, access to providers, patient rights and responsibilities, and performance reporting.  “By being the first organization to earn NCQA ACO accreditation, Kelsey-Seybold has demonstrated to payers and other purchasers that it has met challenging requirements designed to show the efficiency, integration and high quality expected of an accountable care organization.”

The Medicare shared savings program for ACOs is generally deemed to be the incentive for ACO development and construction.  However, a clinic spokeswoman said that Kelsey-Seybold is not participating in the CMS program at this time.  To PDA, that would seem to be a commitment to a direct contracting, “volume-in & volume out” thrust. 

Along with the new ACO accreditation, the Washington-based NCQA also ranks insurance companies. It is known to offer a patient-centered medical home recognition program. This effort has recognized 5,036 practice sites as medical homes. Things are changing fast, and direct contracting between providers and employers is becoming a major destination. The Flagship Network is just in time. 

Organizational Announcement

Dwight A. Lee, M.D., President of Physicians Direct Access of Texas (PDA) has been appointed Chairman of the Governing Board of Doctors Hospital at White Rock Lake. This is an extremely high honor and is bestowed only on those who have demonstrated service and loyalty to patients, peers, and the community. He has previously served as Chief of the Medical Staff.

Dr. Lee is a board certified ENT. Among other academic and professional certifications, he is a licensed health insurance professional, a student of quality management, the founder of a city-wide group of ENT specialists, and Chief Medical Officer for The Miers Group, L.L.C. (TMG), a healthcare delivery venture.

This recognized leader of his community hospital is distinctive in that he is a hard-working professional. His patients know that he is a stellar caregiver who cares most about the individual’s well-being. Dr. Lee is accessible and open to new ideas and strategies for independent physicians.

The PDA physicians and allied health practitioners hail this outstanding individual for leadership, recognition, and success.

[The Flagship Physician Network, a community healthcare program formatted as a “Narrow Network”, is powered by PDA of Texas. The Flagship has great momentum as it prepares for a January 1st, 2013 launch in Dallas, Rockwall, and Hunt counties. Collin County will be added in the first quarter of 2013.]

PDA’s Value Proposition

Physicians spend less than one percent of their net revenues on practice development. This pattern is very different from that seen in other professions. Even the last bastion of cottage healthcare, the local dentist spends more than that on contacting patients and reaching out to encourage use of services. In contrast, chiropractors, who cannot write prescriptions and have very defined practice limits, spend a major percentage of their revenues on community media, point-of-service advertising, equipment, education on how to expand their practice area, and other promotions. The cost-of-sales line item for most medical practitioners is quite small with the exception of a few niches such as weight loss and plastics.  It is clear that cost-of-sales is a revenue multiplier.  Each dollar spent generates many dollars of cash flow.

Members of the DFW healthcare oligopoly (Baylor and THR) understand the importance of advertising and promotion.  If a physician sells his practice and becomes an employee, the integrated healthcare system umbrella of marketing, advertising, and promotion envelops the physician, and  “brand recognition” takes over.

If a practitioner elects not to be direct labor for a corporation, or if the system elects not to invite the practitioner into the “club”, then the question becomes one of seeking a strategy to survive in the ObamaCare consolidation.

That’s where PDA enters the picture.  On the surface, PDA offers basically the same services as its competitors (credentialing, messenger-model contracting, and claims trouble-shooting).  At PDA, we do not consider these three services to be our value proposition to our members.  Our advantage, our true value is that we are working to develop new revenue sources for our physicians.  Our mission is to help our physicians make more money, with no added hassle, and without new demands on the physician’s time.  We have a multi-pronged approach to the “new normal”, and our number one strategy is to be the marketing expert for our practitioners.

Typically, an independent physician spends $1,500 a year on an IPA managed care contracting utility, and nominal dollars for business cards and other listings. The practitioner is still “hanging out a shingle” and passively waiting for patients to walk through his door.  By joining PDA, a physician pays dues of $499 for the first year and gains access to our wide range of marketing initiatives and 12 months of solid IPA service.  For program details, please contact us now!