Pennsylvania Medical Society PHC4-Measuring the Quality of HMOs Bernard Lynch Senior Director of Payer Relations June 4, 2003

Pennsylvania Medical Society Topics for Discussion PMS Physician members position on PHC4 public reports PMS Physician members position on PHC4 public reports PMS Physician members contribution to composing this report and other reports PMS Physician members contribution to composing this report and other reports Utility of this report in physician practices Utility of this report in physician practices Dialogue of current issues with payers Dialogue of current issues with payers Concluding Remarks Concluding Remarks

Pennsylvania Medical Society PMS Physician members position on PHC4 public reports The Medical Society supports PHC4 public reports as long as the data is “clinically based and severity adjusted”. The Medical Society supports PHC4 public reports as long as the data is “clinically based and severity adjusted”. The Medical Society does not endorse a specific vendor. The Medical Society does not endorse a specific vendor. The data currently collected by PHC4 does meet our definition of clinically based data. The data currently collected by PHC4 does meet our definition of clinically based data.

Pennsylvania Medical Society PMS Physician members contribution to composing this report and other reports Physician Representative on the PHC4 Council Physician Representative on the PHC4 Council Internal Committee of the Medical Society’s Board of Trustees--Committee on Health Care Cost and Quality Data Internal Committee of the Medical Society’s Board of Trustees--Committee on Health Care Cost and Quality Data Technical Advisory Group Technical Advisory Group Ad-hoc groups of physicians for specific disease reports Ad-hoc groups of physicians for specific disease reports

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

Pennsylvania Medical Society Utility (cont’d) Utility (cont’d)  Political Advocacy  Tort Reform Efforts  Fair Reimbursement

Pennsylvania Medical Society Utility (cont’d)  Practice Advocacy  Improvement of Payer Relations  Services to assist practice management  Provide tools and educational materials for practice management

Pennsylvania Medical Society Utility (cont’d)  Patient Advocacy  Preserving the Doctor/Patient relationship  Patient related educational materials for physician offices  Goodwill efforts in the community

Pennsylvania Medical Society PHC4 Measuring the Quality of PA’s commercial HMOs Available as a handout in the physician’s office Available as a handout in the physician’s office Waiting room periodical Waiting room periodical In Brochure or Actual report format In Brochure or Actual report format Physician’s seen as a trusted source Physician’s seen as a trusted source

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

Pennsylvania Medical Society Concluding remarks Clinical Quality data is essential in not only the clinical realm, but also in the payment methodology equation Clinical Quality data is essential in not only the clinical realm, but also in the payment methodology equation The Society supports PHC4 in their reauthorization efforts The Society supports PHC4 in their reauthorization efforts The Medical Society should now be looked upon as a resource for information for both physicians and patients The Medical Society should now be looked upon as a resource for information for both physicians and patients