What is Next?


What Is Next? 

The Wall Street Journal this weekend spoke to the decision by United Healthcare to reduce physician participation in their AARP branded Medicare Advantage product.

According to the article, other Medicare Advantage providers, including Humana Inc., Aetna Inc. and WellPoint Inc., said they are always evaluating their provider networks, but none appear to be shrinking them to the extent of United Healthcare. It is believed the changes affect eleven states.

United Healthcare is the biggest player, with nearly three million members in Medicare Advantage plans. The company says it had over 350,000 doctors in its Advantage provider groups

This is significant as Medicare Advantage, as an important alternative to traditional Medicare, combines hospital and doctor coverage, and often includes prescription drugs and perks like gym memberships. Enrollment has more than doubled since 2004 to 13 million in 2012, which represents about 27% of Americans on Medicare.

The federal government pays private insurers a per-capita fee to manage the benefits. The rate is currently about 12% more than the average Medicare patient spends annually. The Obama administration plans to cut those extra payments to insurers by about $150 billion over the next 10 years to help pay for the health law. Some experts expect enrollment in Medicare Advantage plans to decline sharply if that occurs.

PDA will closely follow this development. Fall-out from the Patient Protection and Affordable Care Act roll-out is only beginning to be felt.

PDA is an independent physicians association that     strives to generate new revenues for its practitioners, eliminate hassles,     and not require any more time. The organization contracts with commercial     managed care payers, Medicare Advantage Programs, and Medicaid     opportunities. Current new business development is directed at Employee     Retirement Income Security Act (ERISA) contracts, i.e., Direct Contracts to     employers and Department of Defense healthcare programs. Day-to-day     operations issues at the physicians’ offices relating to managed care are     supported by PDA resources. PDA colleagues provide medical marketing to     grow practice revenues and profitability, full service insurance benefits     including medical malpractice, and healthcare operations management. The     Chairman and Board of Directors are independent physicians. Bylaws equally     include nurse practitioners, physician assistants, nurse anesthetists,     podiatrists, and other allied health professionals. Through various     marketing and contractual agreements, PDA is engaged with 780 practitioners     in seventeen counties.

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




An Invitation

 PDA is in the business of delivering healthcare services. And, that said, we operate within a nation that becomes conflicted the moment healthcare is mentioned. You experience this confused, polarized period daily, as does PDA…your Independent Physician Association. Since 1992, the IPA has been successfully contracting with managed care and others that wish to access your services. The address has changed and the administrators have come and gone, but the commitment to the physicians served is lasting.

It is fair to say that PDA is very successful in contracting and credentialing. But, there is a shortfall. Over this long period of service, the IPA has not demonstrated the ability to encourage and motivate practitioner participation. The obvious reality is that pro-bono leadership does not generate corporate financial success. Over the last two years there has been a major effort to encourage a new mantra for operations. The goal is to filter all actions through the following grid:

  • Does it make the physician any more money?
  • Can it be accomplished without any more direct labor?
  • Is it regulation free?

New results of this value re-positioning are the Flagship proprietary network, Medicare Advantage, Workers Compensation, Company Store sales, etc. But, this is just a start. Much more is needed to fire up the membership and attract new leaders while developing material new income.

Management does know that the re-invigoration of PDA must go beyond new contracts. The giant step forward is to collectively embrace “Clinical Integration”. And, that will usher in the coming reality of “risk-reward” contracting.  These changes are necessary to super-charge the Flagship Physician Network and its community based performance.

Another change is our transparency which is a great deal more than just saying our door is open. There is a PDA board meeting this week on Thursday the 14th. It will be attended by a handful of practitioners. Let us be clear that every PDA member and prospect is invited. The only ticket is a positive, constructive attitude and a total avoidance of dredging up past issues, folklore, and war stories. Meetings are capable of going an hour and a half, but usually wrap-up in 45 minutes. If the crowd is too big for the space…we will move out in the hall and stand or sit on the floor. If the crowd is too big for the hall, we will walk over to the hospital lobby. Seriously, if that is not enough space, we will opt to cross the street to the Highland Park Cafeteria. The message is that every member should at least plan to come to the next meeting.  “A few good men” is the call of the Marines. We need a few good members that want a shared relationship in the coming “Clinically Integrated” organization.

The Meeting will be held at White Rock ENT, 1130 Beachview St, Ste 240, Dallas, TX 75218 at 6:30 PM

Please RSVP so we can make arrangements for more space if necessary.

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