In the administration an ACO, expertise in little things you cannot see easily are important: (1) contracts with insurers that consistently result in bonuses for the physicians; (2) credentialing services for all of the contracted health plans that don’t cost the provider any money; (3) access to free Electronic Medical Records systems; (5) a staff of nurse-practitioners who can see every patient in their home and capture all the detailed medical information about them including the HCC coding. This service benefits the IPA physicians and the insurer by increasing reimbursement by as much as 10% and is the primary source of performance bonuses; and (6) organization of the IPA into small teams at each hospital so that the quality of care can be managed more easily with less conflict.
Linked IPAs ( SEMNet, UHPNet, and HMINet) and Texas Physicians ACO have the staff expertise and resources in these six areas. You can become a participating provider in Linked IPAs and Texas Physicians ACO. We have contracts with the following health plans which include the bonus provisions and services listed above:
1. New Era Life Insurance
2. Senior Patient Association dba Patient/Physician Cooperatives
3. Employer Sponsored ERISA Plans
Many times physicians are asked to change their IPA or ACO affiliation or to directly contract with the HMOs. We have had that happen to us over the last 15 years and we have lost a few physicians. However, we have grown from 80 to 520 physicians over those years and we have produced bonuses in every year even when others – companies and IPAs – have come and gone in the business.
In 2010, the open enrollment for the Medicare Advantage Plans resulted in a few thousand new enrollments for PCPs in Linked IPAs. The health plans with whom we contract have some of the best benefits being offered to seniors. In addition to these Medicare Advantage Plans, we have a commercial plan from Patient/Physician Cooperatives underwritten by New Era Life that is exclusive for our IPA and should result in about 10,000 new patients for our participating providers. We also have an Agreement for our ACO with CMS that will begin in January. Not everyone wants to fill their practice with geriatric patients, so, having a younger population in which we have both exclusivity and bonus agreements is a major contracting achievement that no other IPA in Houston has been able to do.
Please consider joining one of our physician teams and becoming a member of the IPA, the ACO, and the Patient/Physician Cooperatives.
Download the following information: Physician Participation Document Set and contact us at the address below.
Splendora, TX 77372