More than 4000 Physicians Now Designated Patient Centered Medical Homes by Blue Cross Blue Shield of Michigan

Some 4,022 primary care doctors, have been designated as patient-centered medical homes for the 2014 program year by Blue Cross Blue Shield of Michigan.

The doctors are members of 1,422 physician practices that combined care for more than 1.2 million BCBSM members in 78 of Michigan’s 83 counties.

The program, in its sixth year, continues to lead the nation in size and cost savings, BCBSM said.

The health plan said it recorded certified savings of $155 million in prevented ER and hospital claims from the first three years of the PCMH designation program.  Savings estimates for year four are expected later this year.

“Data from 2013-2014 shows adult patients in Blue-designated PCMH practices had a 27.5 percent lower rate of hospital stays for certain conditions than non-designated practices,” BCBM said. Continue reading

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Key Trends Facing Private Practice Physicians in the New Year Identified

Physicians in private practice have their non-clinical work cut out for them in the year ahead. Results of the ACA changes, the launch of the federal and state health insurance market places, demanding paperwork burdens, and coming changes in coding requirements and health IT are all issues facing the physicians in 2014.

Among the key trends that seen to be bearing down on practicing physicians are:

 –  Rapidly increasing medical consolidation seen across health care systems and insurance companies alike.

–   The difficulty physicians experience while trying to negotiate favorable terms with payers because  the total number of health insurers has been decreasing for some time as a result of industry consolidation.

–   Physicians are continuing to struggle with a growing regulatory paper work burden.

In addition the recent launch of the health insurance exchanges is already driving high levels of confusion among patients, physicians and employers.

Coping with minimal education and support on the new health insurance exchanges from the government, many private practice physicians are unsure of how these new insurance policies will affect their practices. Continue reading

Physician Organizations – IPAs – PHOs Can Improve Care Management For Smaller Practices, New Study Finds

On average, physician practices participating in independent practice associations (IPAs) and physician hospital organizations (PHOs) provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did, the results of a new study found.

The difference is dramatic – 10.45 percent versus 3.85 percent, found the researchers. And, half of these processes were provided only by IPAs or PHOs.

All the recent initiatives surrounding physician practice including pay-for-performance, public reporting, and accountable care organization programs places pressure on physicians to use health information technology and organized care management processes to improve the care they provide.

The problem is physician practices that are not large may lack the resources and size to implement such processes.

The researchers said they used data from a “unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which IPAs and PHOs might make it possible for these smaller practices to share resources to improve care.”

Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients, the study found.

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IPA-PHO Database – The National Directory of Physician Organizations profiles more than 1,300 physician organizations. Listings include: physician hospital organizations (PHOs), independent practice associations (IPAs), multi-specialty medical groups, physician primary care networks, and management service organizations (MSOs) The National Directory of Physician Organizations

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These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations, said the researchers.

“The data presented suggest that IPAs and PHOs may be able to provide an additional, potentially viable organizational alternative during an era of major changes in how health care is delivered and paid for,” the study authors wrote.

The research team was led by Lawrence P. Casalino, MD. The study results appeared in the August Issue of Health Affairs.

Physician Turnover Increases; Competition, Pace of Turnover and Retirements Expected to Increasee

Medical groups reported an average turnover rate of 6.8 percent in 2012, according to the 8th annual Physician Retention Survey.

Likewise, there was turnover of 11.5 percent among advanced practice clinicians (APCs), which includes physician assistants and nurse practitioners, found the survey by Cejka Search and the American Medical Group Association (AMGA). Continue reading

New Physician Organization Leadership Survey Seeks Insight – Opinion

The Managed Care Information Center periodically conducts our Physician Organization Leadership Survey to identify the issues, challenges and opportunities today for physician organizations.

We are seeking survey responses from those engaged in the management and administration of or who are members of such physician organizations as IPAs, PHOs and MSOs.

For your participation in this brief survey, we will send you free an executive summary of the analyzed results.

What are the ‘looming’ challenges? Any opportunities? What is the most pressing concern from your perspective?

The survey only takes a few moments. You do not have to identify yourself if you choose.

As you know, survey results are reported in the Managed Care Information Center reports, in our Managed Care Weekly Watch, as well as the MCIC Blog, Facebook and Twitter and are posted at our website.

To participate in this survey, go click on this link now: http://bit.ly/JhFn9o

If you are connected with executives of members of PHOs, IPA or MSOs, please let them know about this survey.

Will large numbers of physician organizations or physician groups develop an accountable care organization?

Will large numbers of physician organizations or physician groups develop an accountable care organization?

“No.  Although an important component to a successful ACO, physicians will not have the infrastructure needed to develop an ACO,” a Regional Network Manager with a health plan told us in our Managed Care Leadership Survey.

“Physicians want to own healthcare but they have no infrastructure or expertise on the risk side of healthcare,” a consultant said.

“The emphasis on integration, EMR, quality and payment require a solid infrastructure which is beyond the capacity of most physicians per se,” said another consultant.

Said another respondent: “Most do not have the infrastructure, resources or expertise necessary to lead the development.” Few have the motivation.”

“We need provider buy-in and that doesn’t happen quickly,” according to a health plan manager of strategic growth.

Only a small number of physician organizations/groups “have the capital to develop an ACO without getting into the pockets of insurance companies,” said another senior consultant.

The survey is conducted by the Managed Care Information Center, which produces the National Directory of Physician Organizations Database.

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