Networking for Better Care

Brevard Physicans Network tackles the challenge of managing health care

Brevard Physicians Network (BPN) began humbly 17 years ago when a group of about 20 local physicians decided it would be beneficial to come together to form a network with the main purpose of contract negotiations with health plans. As they say, there is strength in numbers and BPN was able to negotiate more equitable contracts for its group of providers than the providers had been able to obtain individually.

“BPN began as, and has remained, a not-for-profit organization with the best interest of physicians and patients in mind,” says Cindy Hambidge, manager of provider relations for BPN. “We provide a vehicle for physicians to maintain an independent practice of medicine; yet be part of a large negotiating entity.”

BPN has evolved over the years, moving through many phases of the health care business. The organization has acted as an Exclusive Provider Organization for the Brevard County School Board, a third-party payer for Medicaid plans, and has managed the care of thousands of Medicare beneficiaries.

In 1998, BPN became a delegated credentialing entity for all of the health plans that it contracts with, giving the organization single-signature authority on behalf of its provider members.

INCREASED EXPERTISE & RESPONSIBILITY

“We have increased our expertise through the years and grown in membership and responsibility,” says Hambidge.

She explains that during the past four years, BPN has become even more involved in the managed health care arena, as the organization has taken on contracts with several Medicare Advantage plans and Medicaid HMO plans. As a network of over 270 physicians in all specialties, BPN is uniquely suited to effectively deliver the high-quality, cost-effective care that is necessary to make partnerships with the Medicare Advantage plans successful.

The organization offers its providers assistance in working with the Medicare Advantage plans through its online referral and authorization system which helps to reduce the amount of time providers’ office staff must spend on these tasks. Additionally, BPN acts as a liaison for its providers if they ever have an issue when dealing with the organization’s contracted payers, helping them to get a timely resolution.

“The BPN staff is highly qualified in the areas of credentialing, utilization management, contracting, health care IT and health care administration, giving our physician members access to the important resources that they need to help them manage their medical practices,” says Hambidge. “We believe that physicians should be freed from the ever-growing administrative burdens brought on by the continually changing and complex payer and government requirements. We offer a solution to the small physician practices that do not have the manpower to keep up with the quickly changing health care landscape.”

BPN’s network of providers has been so successful in managing the population of Wellcare Medicare beneficiaries assigned that they earned shared savings financial incentives over the past year adding up to over half-a-million dollars. Providers who were leaders in achieving HEDIS quality measures were presented with awards recognizing their accomplishment at the annual BPN Physicians Dinner Gala in November 2011.

“As BPN and our providers continue to work together to improve our quality and cost effectiveness, we are confident that we will all be very successful in the future as we enter the newest phase of health care, the Accountable Care Organization (ACO),” explains Hambidge.

THE FUTURE OF HEALTH CARE

As the Center for Medicare and Medicaid Services (CMS) has issued additional reforms and mandates over the past few years, especially due to the Affordable Care Act, BPN continues to evolve and is determined to step into the future of health care as a leader in the industry.

Currently, BPN is in the process of forming an ACO that will meet the standards set forth by CMS and the Department of Health and Human Services (HHS). “As our providers come together in this endeavor, we are engaging all of our staff and business partners in building the new organization, Medical Practitioners for Affordable Care (MPAC),” says Hambidge.

According to Hambidge, the ACO will dramatically change the face of health care. High-quality, cost-effective care is the new mantra. This will be achieved using health care IT, integration, communication and evidence-based medicine as the backbone, and the catalyst will be the committed medical professionals on all fronts who are willing to fully embrace change.

“Improving the coordination of care for Medicare beneficiaries is one of the primary goals of the ACO and is seen as one of the best ways to reduce costs,” says Hambidge. “To make this possible, primary care providers must work to oversee the care of their patients throughout each patient’s journey through the entire health care system. This is not an easy task and will depend upon the use of electronically integrated systems and improved communications between the PCP, specialists and all other health care providers.”

BPN has a well-established infrastructure that will serve to make possible the necessary integration and communications that will make the goal a reality. Its network of providers has proven that they are ready and able to tackle the challenge of managing the care of the Medicare population and will continue to provide the outstanding quality of care necessary to succeed.

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