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Question: Who negotiates with insurance companies on behalf of PHMG docs? I have the impression that, in the past, that function was on the "org chart" somewhere in hospital administration.
Answer: Insurance company contracts are negotiated both in the Networks, for contracts that are locally focused, and at the system level for those insurance companies with operations in multiple Networks. The negotiations are led by our payer contracting team in conjunction with the CFO team. Doug Watson, PHMG's CFO, participates actively in these conversations. Many contracts are negotiated together with the hospital, however, PHMG contracts rates are defined separately and are evaluated by the team to determine reasonableness as the negotiations occur. (Source Doug Watson, PHMG CFO)
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"Flipping" Health Care
The Institute of Healthcare Improvement (IHI) held its 25th national forum last month. PeaceHealth recorded nine of the major talks and has them available on the network. The Weekly will feature one talk per week. The first is by IHI CEO, Maureen Bisognano, who talked on "flipping" the balance of:
- care from hospitals to community
- delivery from individuals to care teams
- power from the provider to the patient and family
- costs from treatment to prevention and co-production
- emphasis from volume to value
Click to watch (63-min.)
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 | | Dr. Howard Graman |
This week, I had the pleasure of meeting several PHMG colleagues at the all-provider meeting in Oregon. Thanks to Dr. Doug Carr, Henry Veldman and the rest of the group for their hospitality. Being face-to-face with members of our group is powerful and energizing. On this last round, I heard loud and clear the importance of facilitating our providers' role in organizing improvements in the care we provide. We intend to foster more of these activities to enhance both our quality of care and the professional satisfaction of our providers. Like others at PeaceHealth, PHMG leaders are being frugal about our travel. Still, we feel it's important to visit the communities we serve to better understand the culture, staff, patients and environment so that we can better support our physicians and providers there. I and other members of the executive team look forward to continuing to visit our communities periodically in the coming months. And we extend the invitation to visit the PHMG team in the Shared Services Center in Vancouver. If you're in the area, feel free to stop in--you're always welcome. Even if I'm not available, there are others at the office supporting the medical group who would appreciate the opportunity to meet you. A few additional notes:
- Thanks to Dr. Eleen Kirman for her excellent service as the medical director of Specialty Care. If you or someone you know is interested in taking on this role, please let me know. (Read job profile.)
- It came to my attention that the last MGLT summary did not include the financial statement. It does now. Click to view the updated summary.
- We hope that several of our primary care offices consider applying for the medical home pilot project (read more below.)
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January 31 - Deadline for Applications
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Recently, the Medical Group Leadership Team approved plans to create a Medical Home pilot at PHMG. "There's a lot of great work happening on medical home at PHMG. The pilot project is intended to help us hone in on best practices and give the work some extra focus," said Dr. Karen Sharpe, medical director of PHMG Primary Care and project sponsor.  "Our goal is to create the team-based care model at a local level that can be replicated and become the standard for PHMG," she said. "Practice sites will receive extra resources and training to quickly implement the new model and participate in its expansion to the rest of the organization." Clinics interested in being a medical home pilot site are encouraged to complete and submit an application by January 31. Sites will be chosen and the work will kick off by early March. Read the program introduction.Read and complete the project application. Questions can be directed to Shelley Buettner, Medical Home Program Manager.
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Shadow Report Now Available
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 As many of you know, in July 2013 we changed our VISTA quality measure for DM to a DM Quality Bundle using the Wisconsin Collaborative for Healthcare Quality (WCHQ) as a benchmark. However, our numerators and denominators were measured slightly differently making it difficult to truly compare our performance. Beginning in July 2014, we will change our specifications so they exactly match that of the WCHQ. PHMG has developed two shadow reports using the new specifications: M23508 DM Quality Bundle Measure WCHQ by System/Region and Clinic/Provider. All customers who currently receive the M22976 monthly reports via e-mail will also receive the shadow reports beginning on January 10, 2014. The shadow reports are intended to inform providers of their potential performance starting in July. PHMG will continue to report and distribute the DCTR Scores By Clinic and Clinician (303) report as it captures many elements of best practice for diabetes care that are not currently in the bundled measure. Read the memo for highlights on the key differences between the current VISTA DM Bundle Measure report and the shadow report and includes two visual flow diagrams for the shadow report specifications. Questions? Please contact David Killaby at dkillaby@peacehealth.org.
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