The Healthcare Systems & Finance Committee focused on several major problems this last year. Although we achieved no solutions, we’ve certainly gained more information about these problems and, together with the executive committee, have developed strategies for dealing with them.
But first, the committee owes a great debt to its departing Chair, Dr. Gary Chinman, who kept us on track, managed our meetings with great focus and wit, and helped keep discussions productive and amiable. We’re sorry to lose him for next year because of a change in his career path, but we feel grateful for having his guidance over the last several years.
Let me briefly recap our approach for those who may be puzzled by our name. Yes, we’re interested in health care finance, but most of us are private practitioners who take insurance, so our awareness of the impact of insurers’ policies and procedures and authorizations is more direct than if we were working in an outpatient clinic. We are, in effect, our own administrators. We are interested in comparing the quality and ease of use of different claims processing software, electronic medical records, prescribing software, e-faxing software, and video conferencing software. We are also interested in identifying templates that help us remember and record information about patients that will be appropriate for risk management and meet audit criteria for the service codes we’ve chosen. In addition to helping one another and any members who consult with us, we also may identify the impact of bigger issues that need to be and are being addressed by the MPS, the MMS, the APA and the AMA. We offer a perspective from the front line.
Our second major focus derives from the fact that, at least until now, we’ve always had some members who, like me, have had experience in managed care administration. Given the fact that three major insurers are local, we’ve tried to establish a dialogue with our MH colleagues who are administrators in these insurers by meeting regularly and trying to solve problems together. In most cases, our values are the same. What’s hard to move are large bureaucracies in which MH is a sub-sub division with little power over pharmacy benefits managers, claims processing decisions, and audit departments. Confrontation on this level always backfires. But respectful strategizing is sometimes surprisingly helpful, at least on a one-insurer-at-a-time basis.
Our current concerns…
First, we wonder whether more members would be interested in joining the committee if they knew what it did.
Second, we should report a good liaison with Tufts, but much change coming with the new Point 32.
Third, we remain very concerned about the criteria insurers use for auditing procedure codes and will try to learn more and then perhaps teach our colleagues something about it.
Fourth, prior medication authorizations are driving us crazy and we’re grateful the MPS, APA and AMA are trying to do something.
We particularly want to thank Grace and John for their responsiveness and for keeping us informed about what’s happening on the state and national level. And thanks to Debbie Brennan for her untiring support and practical advice.
HEALTHCARE SYSTEMS AND FINANCE (MANAGED CARE) (The committee is being renamed in 2014 to better align with the APA structure and to better reflect the work of the committee and the presidential charge.)
Charge: Advocate for the interests of MPS members in clinical practice and their patients within entities that finance the provision of health care services. This charge includes direct advocacy (with private and public insurers, regulators and legislators), communication with and education of MPS members and as an “early warning system” for member concerns. The committee is additionally charged with an advisory role to the MPS Council and Executive Committee in urgent or timely issues that may arise in these areas.
Mission Statement: The mission of the Healthcare Systems and Finance includes the following:
Advocacy - meet regularly and foster long-term working relationships with insurers to advocate for patients and providers
Legislation & Parity - meet with regulators to advocate parity and non- discrimination, advise the Council, Executive and Legislative Committees
Communication - communicate with MPS members, primarily via a regular monthly column in the newsletter & on the website
Education - sponsor periodic CME events on practice-related issues
Member Concerns - field MPS member front-line concerns and questions, answer questions when possible, incorporate concerns into the overall mission of the committee and liaison with APA on these concerns
Integration of Care – plan to incorporate a new sub-focus on ACOs, mental health and primary care integration, plan to liaison with Public Sector Committee and sponsor a CME program focused on this area
“Ad hoc” issues – nimbly respond to ad hoc issues that arise unexpectedly; e.g. PMP and Psychiatrist members-in-training, telemental health.
Meeting(s): Monthly (third Tuesday of the month), Quarterly meetings with insurers, plus other meetings as necessary Chair: Co-Chair: Michael I. Bennett, MD Members: Rebecca Allen, Michael Bennett, Bruce Black, Jean Boyd, Philip Burke, Gregory Harris, Hon Ho, Pat Kaufmann, Tanya Korkosz, Laura Kramer, Steve Locke, Kirk Lum, Jason Mondale, Arthur Papas, Daniel Shaw, Sally Sveda, Marcia Tracy, Paul Wood.
