2014 and the Flagship Physician Solution

 

In 2014, The Flagship Physician Network will successfully and profitably provide healthcare solutions for commercial payors, i.e., self-funded small business employers with 10 to 250 workers:

The Product Is Reliable, Self-Controlled Healthcare

* Cost effective delivery systems

* High quality patient care

* Population management

* Mental health maximization

                      * People smart connectivity

The customer that makes up the Flagship niche is the small business operator. They are getting squeezed by new taxes and regulations. At the same time, the economy has been in a slow growth mode since 2008. They get no union exemptions and have few big corporate international cash reserves. They just want to have a level playing field to compete. And, they want workers to have health insurance and the security that they can deal with an accident or critical illness. But, they are not going to lose their businesses over benefits or poor worker productivity.  The small business leader is in a quandary.

The Flagship self-insured product is the dynamic resource to accomplish all the main street shop and service companies’ goals until the nation straightens out its “make-it-up-along-the-way” direction. The catalyst is for independent physicians to clinically and economically integrate to deliver reliable, self-controlled community based care. Then, small businesses will buy the program, pay a fair price and get behind the making the self-insured system work.

Drilling down, the Flagship ecosystem that is being developed includes (1) the employee benefits expertise, not antiquated insurance processes, to run self-insured programing correctly out-of-the-way from the ObamaCare regulations; (2) the critical mass of PDA, the independent physician association that serves as the core platform of provider performance and reward; (3) and productive, collaborative clinical integration relationships with the facility [inpatient & outpatient] component of patient care. Those are the main pillars of the integrated, uniquely connected system, i.e., the underpinning of an organic ecosystem with physician led passageways/capillaries that can achieve cost effective, high quality care.

Each message to you in 2014 will explain of how the Flagship product works and what is in the program for your interests! Step-by-step…this is the year. And, this is your invitation to get-with-the program and participate.


The Lay of the Land

Doctors and benefits marketers share scuttlebutt with PDA. It is the nature of our industry segment. The word is Aetna has narrowed its preferred network for two local employers, Walmart and Home Depot.  In healthcare today this is another re-badging of the concept of “steering patients” or developing Exclusive Provider Networks.  Effective Jan. 1, 2014, Aetna is opening a narrow network…by our definition. And, not every healthcare system is participating. PDA’s market reporters say that Texas Health facilities and Texas Health Physicians Group providers will no longer be in the preferred network for employees of Walmart and Home Depot enrolled in the employers’ Aetna medical plan.

From the market feedback, employees of Walmart and Home Depot are the only Aetna groups currently impacted by this change. Plus, Texas Health facilities and Texas Health Physicians Group providers can continue to serve these patients regardless of their coverage…if they wish. It is clear that Texas Health continues to be a valued in-network provider for many other Aetna members, as is PDA.

But, what this means to PDA is:

  • ·         Financial terms drive change in a big way.
  • ·         Patients that do not utilize the Flagship Network, Aetna Narrow Networks, or any other exclusive provider plan (EPO) will likely pay higher costs
  • ·         The ObamaCare situation is driving adaptation of exclusivity of provider participation.
  • ·         PDA and its hospital colleagues must get in a hurry about adopting pay-for-performance capability.

PDA urges you to think through this development because there is much more to come. Independence is more than governance or equity. It based on ability to perform.

HAPPY HOLIDAYS…PDA SENDS THEIR BEST FOR NOW AND 2014


Exchange Contracts

As January 1, and day one of ObamaCare approaches, we wanted to take a moment to let you know a few items regarding the exchange contracts.

            Please note that none of our current managed care contracts are for exchange related products, new contracts are being issued for this line of service. They are still the same commercial and Medicare advantage products that exist today. We do currently have the first exchange contract “in-house” and under review. At first blush, the terms and conditions appear to be more demanding on reporting and accountability. There is no direct increase in provider compensation.

We also want to let you know that as we receive new fee schedules from the plans, we will pass them along to you.

Thanks for your Membership!


2014 Preview

The month of December is racing by with icy roads, the possibility of a coming “flu bug” season replete with coughs and colds, and full surgery suites as patients hurry to get elective service done before the black-hole of ObamaCare & 2014 opens up. It is an interesting time. And, your independent practitioner IPA is well aware of the environment. It is widely believed that PDA is better informed regarding ObamaCare then the competition as our Chairman and Medical Director are participants & champions of (1) the Dallas Association of Health Underwriters, (2) a benefits consulting endeavor, (3) and the exciting proprietary Flagship Physician Network (a direct contracting machine for self-funded benefit plans).

A motivated and energetic PDA management is considering a quest to enlarge its operation. To that purpose the Board has stepped forward to support a number of initiatives that are all aimed at adding more value for the membership. Everyone knows that the only way PDA can prosper is through contributing to generating more practitioner income. Also, there needs to be “zero-tolerance” for regulatory traps and demands for more time at direct work. But, the big urgent requirement is…making the membership more money. It is clear that selection of an IPA vs. a competitor is no longer solely dependent on the incremental pittance of money from one code to another. Focusing on what one BUCHA principle force pays is myopic. Blue Cross, United, Humana, Aetna, etc. are important and a reality, but so is good problem solving and service. And even then, service is not enough in this marketplace. The 2014 IPA has to drive membership market share, more profitable volume, and increased margins.

Here is what is happening this month to jump-start PDA’s 2014.

  • The Management Services Organization (MSO) has been asked to propose a service agreement and structure that would encourage development and the ability to capitalize IPA growth.
  • PDA is developing a “Pay-For-Performance” driven Clinically Integrated Organization (CIO). This plan will chart the pathway to improved inpatient & outpatient cooperation with a new bargaining power for managed care.
  • As a CIO organization takes shape, the technology plays related to home monitoring of chronic disease; behavioral support and telemedicine are in development.

The 2014 Monday Blog is going to become even more important in getting news to members. As CIO and MSO strategies and tactics are implemented, updates will be issued. 2013 was a good year marked by hard work and healthcare government upheaval. 2014 will be a better year. It will be marked by new energy, opportunities, and direction.


REASONS TO LAUNCH AN INDEPENDENT PDA-IPA CLINICAL INTEGRATION ORGANIZATION

As a cynical politician said. “You have to pass this bill to see what is in it.” The discovery of complex issues imbedded in the Patient Protection & Affordable Care Act continues!

The service capability of the national physician team is a confusing and foreboding problem for 2014. In a few weeks, nine million people are gaining Medicare coverage. A total of 29 states will expand Medicare with financial inducement from the federal regulators and ObamaCare. No one knows if the demand will or can be met.

While it is unnecessary to rail or rant over the poor reimbursement of the Medicare payor group, or the program bureaucracy, much less the complexity of patient care needs and chronic disease…

The Independent Physician Association (IPA) should consider:

  • The government, with its access to the financial printing press is allowing a compensation fix that raises Medicaid to Medicare levels. This is just for primary care practitioners. It is clear that the adjustment ends with the close of 2014. Sounds a lot like another step to a single-payor reimbursement program. A failed ObamaCare system may be a “Trojan Horse” for a Medicare like single payor.
  • The second caution marker is the definite uncertainty of accommodating current Medicaid and Medicare patients. Plus, the government community organizers,      navigators, etc., are sure to bring new numbers of eligible Medicare enrollees out of the proverbial weeds. The patient frustration is not a pretty picture at the office portal.
  • Physician fatigue permeates this entire process of federal management and funding of healthcare. Physician Direct Access (IPA) observes this with physicians,      office staffs, and clinicians. The front-line caregivers are tired and lack incentives. There are more PCPs not working on this Black Friday weekend than ever observed before.

Beyond these three points are many other warning lights and fog horns along the federally managed channel to the future of healthcare. The IPA must steer a good course, but one that is profitable and cost effective.

An Integrated Clinical Organization will be available for PDA members in January of 2014.