Premier Health Group Frequently Asked Questions

Premier Health changes coverage for employees and coverage will roll to large audience in future.

Premier Health recently unveiled the Premier Health Group (PHG) to its employees. Below are some “frequently asked questions” (FAQs) about the plan.

  1. What are PHG and the Premier Health Employee plan and Premier Health Plan?
  2. Why are we launching PHG and the Premier Health employee plan?
  3. How does the Premier Health Group differ from other plans?
  4. Why should I join PHG?
  5. Who is eligible to join PHG?
  6. What is different in this initiative than what we had in place about ten years ago?
  7. Will joining PHG impact my practice?
  8. What do I need to do in order to participate as a provider within PHG?
  9. My practice does not have Epic. Can I still participate in PHG?
  10. Some of my colleagues in my Practice Group do not see Premier employees/patients. Can I/my practice still participate in the PHG?
  11. What is my individual/group’s financial investment required to be part of PHG?
  12. How can I get my voice heard in the decisions that PHG makes?
  13. How would my patients benefit from this initiative?
  14. As an independent physician/practice, how would I maintain my financial/business autonomy?
  15. What roles would the health plans/insurance companies play in this?
  16. What is expected of me to participate in PHG?
  17. As a non-primary care specialist, how would I benefit from participating in PHG?
  18. Will patients be required to obtain a referral from their PCP to see a specialist?
  19. How does the PHG relate to an accountable care organization (ACO)?
  20. On a regular basis, how would I know my quality-of-care performance?
  21. Would I still maintain my contracts with current health plans?
  22. Does PHG offer financial incentives for improving my patients’ health?
  23. How would advance practice nurses and physician assistants participate in the PHG?
  24. How do I get out if I want a buyout?
  25. How will a patient’s confidentiality be kept?
  26. What happens if half of our partners want to join?
  27. Can I join multiple plans?
  28. Will I gain/lose patients in my practice if I join?
  29. How can I receive more information regarding the details of PHG?

1. What are PHG and the Premier Health Employee plan and Premier Health Plan?

The PHG is a physician-led care provider network that will initially provide care to the members of the Premier Health employee plan, and will eventually serve other populations in our region.

Premier Health employee plan is the health benefits plan offered by Premier Health to Premier Health employees. Enrolled Premier Health employees and their dependents began with the plan effective January 1, 2014. The Premier Health employee plan will provide access to an affordable, high-quality health care system that is focused on improving the wellness and improving health outcomes of the employees and their families.

The Premier Health Plan is an insurance company created by Premier to make available to our communities the excellent health and cost-of-care outcomes that PHG providers will create.

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2. Why are we launching PHG and the Premier Health employee plan?

It is a well-known fact that the traditional manner in which health care has been delivered, as well as the rising costs, are not sustainable. It has become too costly for taxpayers and employers to sustain. We believe this dynamic can only change if physicians take the lead in revolutionizing changes in the care delivery model. That is why we have created PHG, a physician-led care delivery network, which will improve the cost and quality of care in our region and, most importantly, improve the wellness of the populations that they serve.

Premier Health is partnering with PHG to provide care to the system’s 18,000+ employees and dependents. As the leading health care system in our region, Premier Health believes it is essential to be an advocate and steward of good health. Premier Health is demonstrating its commitment to the health and well-being of its employees and families by creating a medical plan, the Premier Health employee plan, which offers excellent health care and incentives for a healthier life.

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3. How does the Premier Health Group differ from other plans?

As a provider system ourselves, Premier Health can understand the needs and concerns of local providers. The Premier Health employee plan is committed to ensuring its network providers receive outstanding provider service, fast claims processing of clean claims on average within 15 days, and ease of overall administration. Information is available on the physician online portal concerning electronic funds transfer and provider billing and coding support, to enhance your practice’s efficiencies. The PHG offers local provider relations support, as well as one-call resolution provider service support. Payments and claims processing are provided through the Premier Health Plan, a provider-led health insurance company, created by Premier Health.  PHG provides resources to primary care physicians to manage their complex patients and patients with greater needs by providing support of pharmacists, social workers, care advisors, health coaches, etc., free of additional charge to the patients and at no charge to physicians.

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4. Why should I join PHG?

Participation in our physician network offers you the opportunity to:

  • Provide care to Premier Health’s 18,000+ employees and dependents and, in the future, other regional populations
  • Change the way care is delivered in our community
  • Improve your patients’ health and wellness
  • Gain additional support to care for your complex patients
  • Gain greater physician control over health insurance coverage decisions
  • participate in a physician network with access to best-in-class health plan service operations
  • Be rewarded financially for improving your patients’ health.

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5. Who is eligible to join PHG?

PHG features employed, academic, and independent providers. There are currently more than 2900 providers in our network, and it is growing weekly. 

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6. What is different in this initiative than what we had in place about ten years ago?

PHG is a physician-led, non-equity model. The physician does not have to buy-in to be a provider in the network. In comparison to the 1990s, this clinically-integrated physician hospital organization will be successful because of the robust data capabilities it has to allow the physician to fully understand and treat their population. We focus on transparency of data reporting and provide education to providers to interpreting that data. PHG is focused on a patient-centric model of care similar to primary care medical homes.  PHG directs its resources to the physicians to assist them in taking care of their complex patients.  Physician representatives range from primary care and specialty practices, to employed and independent physicians.

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7. Will joining PHG impact my practice?

Joining PHG will have different effects on each practice. The ultimate goal is to enable providers with high-value support and resources so physicians can focus on what you do best—providing excellent patient care. Achieving this vision may require a variety of different solutions. We work individually with selected practices to have the least impact on individual office dynamics and work flow.

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8. What do I need to do in order to participate as a provider within PHG?

To join the network, please call (937) 499-7441.

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9. My practice does not have Epic. Can I still participate in PHG?

Yes. Your participation within PHG is not dependent upon Epic. We do recommend that practices have an electronic medical record and email communication abilities.  If you are interested in exploring implementing EPIC EMR at your practice, please contact Mike Fitzgerald at Patient Information Partners at (937) 510-7427.

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10. Some of my colleagues in my Practice Group do not see Premier employees/patients. Can I/my practice still participate in the PHG?

Yes.  PHG does, however, contract by group.  Therefore, all providers in the practice would be obligated to see PHG covered lives.  Additional covered lives beyond PHG will be added in 2015 and beyond.

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11. What is my individual/group’s financial investment required to be part of PHG?

There are no direct individual or practice financial investment/capitalization requirements in order to participate in PHG.

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12. How can I get my voice heard in the decisions that PHG makes?

As a physician-led network, PHG is focused on establishing the right structure and process for its physician leaders and participants to shape the direction of the organization. Our board and all our committees are led by physicians of PHG. If you would like to learn more about how you can get involved, please contact the President and Chief Medical Officer of PHG, Jerry Clark, MD, FACP, at (937) 499-7441.

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13. How would my patients benefit from this initiative?

The PHG is designed to reward outcomes-based care. By aligning clinicians with the people, processes, technology, and analytic resources critical to proactively managing patient health, patients will receive higher quality care, with health and wellness as the number-one priority.

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14. As an independent physician/practice, how would I maintain my financial/business autonomy?

Participation within PHG is not intended to alter your financial/business autonomy. We believe that participation in our clinically-integrated network makes being independent in these times more viable for physicians.

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15. What roles would the health plans/insurance companies play in this?

The Premier Health Plan is a new physician-led health plan that will be completely independent of existing health plans/insurance companies in the market. The Premier Health Plan will rely on the physician leadership of PHG to implement clinical policies and procedures with needs of local providers in mind. Premier Health Plan may seek to work with other health insurance companies to provide our excellent population health model and improved wellness and clinical outcomes to them for their customers.

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16. What is expected of me to participate in PHG?

You will be asked to sign a “participating provider agreement,” which contains the standard contractual provisions found in most health plan contracts. Some specific provisions that are important to the success of PHG include:

  • Facilitating the referral of members to participating providers within PHG for the provision of covered services (except in the case of emergency medical conditions or if no participating provider is available)
  • Complying with the quality assurance and utilization management programs and procedures of PHG (descriptions of such programs and procedures may be obtained by provider upon request to PHG).

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17. As a non-primary care specialist, how would I benefit from participating in PHG?

In 2014 and beyond, all of your patients that will be covered by Premier Health Employee plan will continue to have access to your services. In addition, you will have access as populations are added to the coverage of PHG. Furthermore, since PHG’s approach is to reward outcomes-based care, you will be working in a system that has processes, technology, and resources that will allow you to provide a higher quality of care to your patients. Through transparency of reporting and excellent physician-to-physician communication, we hope to improve the quality of referrals that specialists receive from primary care physicians, and will facilitate discussions among physicians in the network, using evidence-based medicine and robust data reporting, to together improve clinical outcome and cost.

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18. Will patients be required to obtain a referral from their PCP to see a specialist?

Patients may access a contracted specialist directly. The PHG offers a member-centric model, where the PCP and specialist communicate frequently regarding the patient’s condition, and together manage all aspects of the patient’s care. No paper referral form is needed.

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19. How does the PHG relate to an accountable care organization (ACO)?

The underlying goals of accountable care organizations align in many ways with PHG’s mission; specifically, creating a model of care optimized to achieve the triple aim (improved quality, patient satisfaction, and cost) for the patients they serve.

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20. On a regular basis, how would I know my quality-of-care performance?

PHG will provide you and your care team regular reports on your quality-of-care performance.

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21. Would I still maintain my contracts with current health plans?

Your participation with PHG will not affect contracts with other health plans.

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22. Does PHG offer financial incentives for improving my patients’ health?

In our first year (2014), we will be able to offer additional compensation for PCPs participating in our complex care management program. For example, you will receive $200 for every initial care plan completed for a Premier Health employee plan member who is deemed eligible for the complex care management program (“PATH”). As we grow and mature, we also intend to offer opportunities to share in the value we create from reduced health care costs and improved outcomes.

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23. How would advance practice nurses and physician assistants participate in the PHG?

Similar to many of your practices, these providers will exist as important, credentialed providers within PHG.

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24. How do I get out if I want a buyout?

Because there are no financial commitments on your part to join PHG, discussions on a buyout of any kind are not applicable. We are meeting with you and your practice because we believe your participation with PHG will strengthen the quality of the network. The decision to join or to leave the network rests with you.

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25. How will a patient’s confidentiality be kept?

Premier Health contracts with Evolent Health, a third-party administrator, to provide claims and medical management support. All patient health information is provided directly to Evolent Health and kept confidential in accordance with HIPAA rules. No personal health information will be provided to patients’ employers.

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26. What happens if half of our partners want to join?

Participation with PHG is a voluntary decision, and, while we encourage all physicians who meet the participation criteria and credentialing standards to participate, PHG contracts by practice tax identification number, not by individual physician.

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27. Can I join multiple plans?

Yes.  Your participation in PHG does not preclude or restrict your ability to participate in other health plans.

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28. Will I gain/lose patients in my practice if I join?

You will not lose patients by joining. Participation in PHG does not restrict your participation in other networks, so your current patients will still be covered as they are currently.

However, you will receive an opportunity to expand your patient base as PHG is the network providing care for members of the Premier Health employee plan in 2014, and for additional populations in 2015 and beyond.

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29. How can I receive more information regarding the details of PHG?

For questions, please contact:

Premier Health Group
Premier Health Center
110 N. Main Street
Suite 950
Dayton OH 45402

Call: (937) 499-7441

Email: PHG@premierhealth.com

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