Pennsylvania Medical Society

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

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

3. 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 does not endorse a specific vendor. • The data currently collected by PHC4 does meet our definition of clinically based data.

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

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

6. Pennsylvania Medical Society • Utility (cont’d) • Political Advocacy • Tort Reform Efforts • Fair Reimbursement

7. 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

8. 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

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

10. 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…

11. Pennsylvania Medical Society Concluding remarks • 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 Medical Society should now be looked upon as a resource for information for both physicians and patients