IPA

Under new healthcare models, reimbursement is moving from volume based fee-for service to value-based contracting. Physicians, hospitals, and other practitioners will need to work together in an organized way to meet these challenges and achieve success. The IPA, which is a Clinically Integrated Network of primary care physicians and specialists, acts as a third party to negotiate performance-based commercial contracts collectively for its members, under the premise that cost savings and improved patient care outcomes will be rewarded by a performance bonus, that would only be achievable by the cooperation of all the participants, and the comprehensive coordination of care for the patients. The key function of the organization that maximizes performance is an active and productive Quality and Utilization Management Program that measurably affects patient care costs and outcomes.
Our model actively represents and negotiates on behalf of the network with single signature power and the contracting functionality is a by-product to support the mission of Clinical Integration. The IPA does not manage the physician practices, but the physicians agree to see patients under certain guidelines or metrics which provide the opportunity for shared savings above and beyond their current fee-for-service rates and/or increased billing charges based on performance. This structure allows the PremierMD IPA network physicians to provide the highest level of medical care while controlling health care costs.

CONTRACTING WITH HEALTH PLANS

PremierMD IPA negotiates with a variety of health plans to achieve fair and competitive performance based contracts for physician providers as well as supportive provider relations. By entering into one contract with PremierMD IPA, we are able to maintain a single credentials file for each physician while the physician gains access to multiple payor contracts. Additionally, the insurance company or payor can execute one contract with PremierMD IPA enabling access to the credentialed physicians who participate in PremierMD IPA, thus ensuring that we have fair and balanced contracts with payors that result in a win-win situation for all parties.

The Company currently has the following contracts:

  • Medicare Shared Savings Program (Approximately 9,000 beneficiaries) (www.premiermd.net/aco)
  • Humana Commercial Insurance Exchange (Approximately 1,000 beneficiaries)
  • Coventry Commercial Insurance Exchange (Approximately 8,000 members)
  • Blue Cross Blue Shield Patient Centered Home (Approximately 1,500 members)
  • Humana Medicare Advantage (Not yet active)
  • Humana Medicaid (Not yet active)

PremierMD is in contract negotiations with Aetna, CIGNA, United and other major payors and will continue to expand its contract base.

Our PremierMD IPA staff works closely with contracted health plans to ensure supportive provider relations. In the event there is a patient care or a claims payment issue, PremierMD IPA will act as an advocate for our affiliated physicians.

For more information about these and other contracts in the negotiation process, please contact PremierMD IPA at: (954) 561-5135.

GROUP PURCHASING

As a physician led organization, PremierMD IPA endeavors to use its purchasing power to negotiate favorable discounts on services and supplies that physicians use every day. PremierMD IPA currently has contracts with companies providing many supplies or services a physician may need, at group discounted rates.

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