Cigna Healthspring Network Interest Committee

As the Accountable Care Act becomes more deeply entrenched, its influence and impact grow. The accelerating trend for insurance carriers to constrict their networks of providers can now be felt locally.
Until now, Cigna-HealthSpring has accepted all PDA members into their provider network. Going forward, applications will be reviewed by the Cigna “Network Interest Committee”, and applicants will be accepted into the network on the basis of “network need for their service”. No definition of “need” is offered.

This program goes into effect in 30 days (August 1, 2014), so any provider wishing to participate in the Cigna-HealthSpring panel would be well advised to do so immediately.

To our knowledge, current PDA members on the Cigna panel are not impacted by this pronouncement. Cigna has not mentioned any effort to limit the network by purging current members.

As major carriers adapt to ObamaCare by shrinking their networks, the Flagship Physician Network is aggressively growing to fill the niche. The Flagship now has self-insured companies directly contracted to Flagship physicians for their care. Our “local solution for the national problem” is bearing fruit. If you have not yet seen Flagship patients in your office, please keep your eyes open for them and receive them warmly into your practice. This is our solution for the future of medicine.
Stay tuned for future developments.

Outsourced Physician Services

The author of this message had the privilege of developing and managing a nation wide “Hospitalist” Company. Competition included EmCARE, ICS, CP American, etc. The enterprise was highly successful and profitable. It continues as such today, In-patient outsourcing is here.

The outsourcing of in-patient physician services has been a common event for a decade or more. The mainstream emphasis has been on hospital based medicine physicians and emergency groups. Now, anesthesia has moved into large group contracting and hospital employment of nurse anesthesiologists.
This has several profound points for the independent PDA practitioner. Clearly, there is an avenue to remain individual or work in a group that is independent in terms of ownership and internal reporting freedom; however, the support of hospital productivity (direct & indirect professional services) and patient through-put development (volume) makes total sense. For example, the management services leadership (MSO) of Physicians Direct Access (PDA) totally supports the acquisition of medical practices and construction of a Tenet Healthcare clinically integrated organization (CIO) for special managed care contracting. In parallel, the Tenet support of this small community centered IPA and the niche based Flagship Physician Network for small business self-funded benefits currently works very well and is appreciated as “win-win”.
The pressure on hospital productivity and pricing is intense. The time to choose partners and get with the competitive program has been here for quite a while. It is better to have a voice in a changing business environment than to rail at the moon. We have real issues related to our small entity interests. Outsourcing medical services will continue. PDA must figure it out and align appropriately to support the marketplace winners.
Change continues. We have to make it work for you, our allies, colleagues and Flagship customers. Future blogs to follow on outsourced physician management services and what it means to PDA and the Flagship Brand.