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Ohio practice helps manage cap contracts
Practices tired of the so-called hassle factors in managed care — from making sure precertification requirements are met to following up on payments owed the practice — have sought out physician practice management companies as a way to spend less time on administrative functions and more time taking care of patients. One Ohio OB/GYN practice has developed this kind of expertise on its own and is now using this experience to help other OB/GYN practices interested in better managing their managed care contracts.
OB/GYN Management Ltd. in Dayton, OH, has parlayed its four years of managing risk contracts for OB/GYN practices that contract with United HealthCare Corp. in the Dayton area into providing similar services for OB/GYN practices in other markets.
"We’re not a practice management firm, and our doctors still practice medicine," says David Astles, executive vice president for the company. What the group does provide is utilization management, outcomes reporting, and other services necessary to manage capitated contracts for groups of OB/GYN physician practices that contract with the same payer.
OB/GYN Management was formed when the two-physician Huey & Weprin OB/GYN practice responded to a request for proposals that United circulated to manage all OB/GYN contracts under United’s specialty network manager program. The practice now manages the capitation dollars for a 113-physician OB/GYN network in the 15-county Dayton region. "Our vision of the world is that OB/GYNs need to organize and deal with integrated health care systems and deliver quality, efficient care. If incentives are aligned correctly, you don’t need to do the kinds of preauthorization and care denials that traditionally are associated with managed care," says Stuart Weprin, MD, CEO of OB/GYN Management. "We’re offering stability to physicians; not only financial stability, but a way for physicians to regain control of their lives and speak with one voice."
The firm’s experience with United was so positive that Weprin began speaking to groups in other markets. The exposure led to him being approached by payers and physicians in several markets outside Dayton. Within the past year, OB/GYN Management has signed deals with groups in Florida representing a 275-physician network contracting with BlueCross BlueShield Health Options and about 100 physicians in Kansas City, MO, who contract with Prudential HealthCare.
The deals the company has with physicians and payers vary by market, but essentially allow OB/GYNs to receive a per-member, per-month (PMPM) capitation rate for physician services from the payer (facility fees for hospital care are not included). Unlike traditional subspecialty management network setups, OB/GYN pays the physicians in each network based on the number of patients seen. Weprin says incentives are built into the system for physicians who are efficient utilizers.
Weprin admits that outcomes data tracking is hard to set up, but he gives the group advantages by allowing it to demonstrate cost-effective care with good outcomes. The firm has its own proprietary software system that has been developed over the last four years and is still being modified.
Day-to-day utilization management is left in the hands of physicians for D&C cases, laparoscopy cases, and hysterectomies performed by the 80% of physicians in the Dayton market who have demonstrated good utilization capability. For other cases that require an immediate decision, Weprin as medical director is consulted. In addition, cases are discussed at monthly governing board meetings that consist of eight physician representatives in each market.
The bottom-line outcome, Weprin says, is a win-win situation for the physicians and the managed care organizations with whom they contract. "It gives the physicians a way to get their care in order, reduces the excesses in care, and allows the HMOs to be competitive," he says.