Pennsylvania Medical Society PHC 4 Measuring the Quality

Pennsylvania Medical Society PHC 4 -Measuring the Quality of HMOs Bernard Lynch Senior Director of Payer Relations June 4, 2003

Pennsylvania Medical Society Topics for Discussion n PMS Physician members position on PHC 4 public reports n PMS Physician members contribution to composing this report and other reports n Utility of this report in physician practices n Dialogue of current issues with payers n Concluding Remarks

Pennsylvania Medical Society PMS Physician members position on PHC 4 public reports n The Medical Society supports PHC 4 public reports as long as the data is “clinically based and severity adjusted”. n The Medical Society does not endorse a specific vendor. n The data currently collected by PHC 4 does meet our definition of clinically based data.

Pennsylvania Medical Society PMS Physician members contribution to composing this report and other reports n Physician Representative on the PHC 4 Council n Internal Committee of the Medical Society’s Board of Trustees--Committee on Health Care Cost and Quality Data n Technical Advisory Group n Ad-hoc groups of physicians for specific disease reports

Pennsylvania Medical Society Utility of this report for physician Three themes to our strategic plan u Political Advocacy u Practice Advocacy u Patient Advocacy

Pennsylvania Medical Society n Utility (cont’d) u Political Advocacy t Tort Reform Efforts t Fair Reimbursement

Pennsylvania Medical Society Utility (cont’d) u Practice Advocacy t Improvement of Payer Relations t Services to assist practice management t Provide tools and educational materials for practice management

Pennsylvania Medical Society Utility (cont’d) u Patient Advocacy t Preserving the Doctor/Patient relationship t Patient related educational materials for physician offices t Goodwill efforts in the community

Pennsylvania Medical Society PHC 4 Measuring the Quality of PA’s commercial HMOs n Available as a handout in the physician’s office n Waiting room periodical n In Brochure or Actual report format n Physician’s seen as a trusted source

Pennsylvania Medical Society Dialogue of current insurance issues with payers and others includes: u Managed Care Medical Director’s Forum Development of the Diabetes Flow Sheet u Payer Collaboration initiatives u Increased reliance by payers on quality data in reimbursement schemes u Work with business coalitions throughout the state to explore alternatives forms of insurance Consumer Driven Health Plans, MSAs, etc…

Pennsylvania Medical Society Concluding remarks n Clinical Quality data is essential in not only the clinical realm, but also in the payment methodology equation n The Society supports PHC 4 in their reauthorization efforts n The Medical Society should now be looked upon as a resource for information for both physicians and patients