Page 25 - Volume 70 Number 1
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Dr. Simmer also reviewed national trends:
  Medicare Advantage has seen the most rapid and robust shift to risk given a larger economic opportunity for reducing medical cost through improved care management.
  In the commercial segment, most risk approaches have focused on HMO models, which allow for improved provider attribution and member steerage.
  Non-HMO approaches are most often centered around narrow networks that select low-cost, high-quality providers for inclusion.
  Large employers are demanding superior outcomes and guarantees, with a willingness to go directly to provider groups that are open to risk to test alternative models.
  Some payers have begun to transition their approaches to their PPO networks, ramping up shared savings and shared risk contracts.
Of note, due to market conditions, Dr. Simmer anticipates a future cut to the PPO fee schedule to accommodate for discounts provided to their competitors. Additionally, he advised that a need exists for POs to work collectively to better manage population health.
Maintenance of Certification: Based on policy approved by the House of Delegates, MSMS supports MOC only under all of the following:
  MOC must be voluntary
  MOC must not be a condition of licensure,
hospital privileges, or health plan participation
  MOC should not be the monopoly of any single entity.
In addition, MSMS is advocating for a review of BCBSM’s policy through Tri-Staff Committee and BCBSM’s Credentialing Committee. Legislatively, two bills have been introduced in the stat House: House Bill 4134. Which would prohibit linking MOC to medical licensure; and House Bill 4135, which would prohibit making reimbursement by a health plan or HMS contingent on MOC participation. Progress has been stymied due to opposition to these bills from various entities, including the American Board of Emergency Medicine, the Michigan Section of the American Congress of Obstetricians and Gynecologists, the Michigan Orthopaedic Society, and the Michigan College of Emergency Physicians. Such disagreement makes it difficult for House leadership to move these bills forward. >>
Volume 70 • Number 1 Washtenaw County Medical Society BULLETIN 25

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