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Value in IPAs
03 July 2014The vast majority of fulltime GPs have realised the importance of joining Independent Practitioners Associations (IPAs), according to Dr Tony Behrman, Chief Executive Officer of the IPA Foundation (IPAF).
IPAF is the overarching unifying body of many of the IPA movements in SA.
Dr Behrman says in the past three years, the IPAF has made considerable headway in changing the way medical schemes have traditionally dealt with GPs.
Speaking at the 18th KwaZulu-Natal (KZN) Doctors Healthcare Coalition (previously the KZN Managed Care Coalition) where he strongly advocated for unaffiliated GPs to join an IPA, which is affiliated to an umbrella body, like IPAF, he noted, “Family practitioners as individuals do not have the expertise to ensure that every contract we sign is fair, that schemes’ methodologies are even handed and that their peer review is transparent. The IPAF is now doing this on behalf of our members and we are seeing a far greater degree of acceptance and cooperation from the willing progressive thinking medical schemes.”
In a later interview he told Medical Chronicle, “Family practitioners down to the last man realise that the funders have allowed hospitals and specialists to run away with the costs leaving only a small amount for primary and preventive healthcare.
“Funders and administrators too have slowly realised how they, (to their members’ financial detriment) have been neglecting primary
care practitioners.
Previously, open schemes focused on member satisfaction at all costs. They championed open access to almost unlimited hospital and specialist benefits ensuring that their members could enter this referral chain at the drop of a hat.
“But that’s not how to cure a nation,” says Dr Behrman. “As we move towards NHI the focus is clearly going to be on primary healthcare and recently this has made a huge impact on forward-thinking schemes with whom IPAF consults.”
Managed care changing
Dr Behrman acknowledges that in many quarters, traditional managed care remains a thorn in the side of doctors but says this is changing.
“When funders introduced managed care, it was basically aimed at managing costs downwards and little space was left for quality, standardisation, accreditation, peer review and analysis of outcomes,”
he said.
“In the IPAF – aligned schemes that’s completely changed. By focusing on quality patient care and good medical outcomes, we have been able to demonstrate the savings on downstream costs, which the schemes have long been seeking. They, in return, accept, trust and respect what we do at IPAF, as our data is irrefutable.”
One outcome of increasing cooperation is that most peer review, peer-to-peer mentoring and counselling is now being done by the IPAF, rather than by people appointed by schemes.
What Medscheme says
Mike Marshall (General Manager: Healthcare Professional Relations and Contracting) at Medscheme, agreed that there is an ‘increasing focus on disease management and care coordination as a strategy to control costs’.
“With that, doctors and medical schemes are finding common ground and are entering a stage of healthier cooperation with doctors being
offered higher rates for better patient outcomes.
“The Medscheme IPA forum, which shares much of the same leadership as the IPAF, has been a successful vehicle that has facilitated structured engagements with IPA affiliated family practitioners through their mandated leadership,” he said.
“Family practitioners should be aligning themselves to organisations that provide strong clinical leadership as the basis for facilitating cost effective and quality outcomes for patients and medical scheme beneficiaries.”
Peace of mind for GPs
With 4800 members, Dr Behrman believes IPAF represents some 70% of GPs in fulltime practice. “We are neither price makers, nor do we compel any doctor or group to join us, or to accept any or every contract with a scheme with which IPAF is aligned. We enhance the outcome for patients and funders through quality assurance and peer review, and in return schemes are prepared to reward the participating practitioners with percentage enhancement of the fees, which they individually deem to be affordable.
“Through our good offices with aligned schemes we can assist doctors in sorting out late payments, bureaucratic holdups, claims under query or, where a valid benefit is not paid for in full, standardisation of forms, and centralisation of peer review.”
The vast majority of fulltime GPs have realised the importance of joining Independent Practitioners Associations (IPAs), according to Dr Tony Behrman, Chief Executive Officer of the IPA Foundation (IPAF).
IPAF is the overarching unifying body of many of the IPA movements in SA.
Dr Behrman says in the past three years, the IPAF has made considerable headway in changing the way medical schemes have traditionally dealt with GPs.
Speaking at the 18th KwaZulu-Natal (KZN) Doctors Healthcare Coalition (previously the KZN Managed Care Coalition) where he strongly advocated for unaffiliated GPs to join an IPA, which is affiliated to an umbrella body, like IPAF, he noted, “Family practitioners as individuals do not have the expertise to ensure that every contract we sign is fair, that schemes’ methodologies are even handed and that their peer review is transparent. The IPAF is now doing this on behalf of our members and we are seeing a far greater degree of acceptance and cooperation from the willing progressive thinking medical schemes.”
In a later interview he told Medical Chronicle, “Family practitioners down to the last man realise that the funders have allowed hospitals and specialists to run away with the costs leaving only a small amount for primary and preventive healthcare.
“Funders and administrators too have slowly realised how they, (to their members’ financial detriment) have been neglecting primary
care practitioners.
Previously, open schemes focused on member satisfaction at all costs. They championed open access to almost unlimited hospital and specialist benefits ensuring that their members could enter this referral chain at the drop of a hat.
“But that’s not how to cure a nation,” says Dr Behrman. “As we move towards NHI the focus is clearly going to be on primary healthcare and recently this has made a huge impact on forward-thinking schemes with whom IPAF consults.”
Managed care changing
Dr Behrman acknowledges that in many quarters, traditional managed care remains a thorn in the side of doctors but says this is changing.
“When funders introduced managed care, it was basically aimed at managing costs downwards and little space was left for quality, standardisation, accreditation, peer review and analysis of outcomes,”
he said.
“In the IPAF – aligned schemes that’s completely changed. By focusing on quality patient care and good medical outcomes, we have been able to demonstrate the savings on downstream costs, which the schemes have long been seeking. They, in return, accept, trust and respect what we do at IPAF, as our data is irrefutable.”
One outcome of increasing cooperation is that most peer review, peer-to-peer mentoring and counselling is now being done by the IPAF, rather than by people appointed by schemes.
What Medscheme says
Mike Marshall (General Manager: Healthcare Professional Relations and Contracting) at Medscheme, agreed that there is an ‘increasing focus on disease management and care coordination as a strategy to control costs’.
“With that, doctors and medical schemes are finding common ground and are entering a stage of healthier cooperation with doctors being
offered higher rates for better patient outcomes.
“The Medscheme IPA forum, which shares much of the same leadership as the IPAF, has been a successful vehicle that has facilitated structured engagements with IPA affiliated family practitioners through their mandated leadership,” he said.
“Family practitioners should be aligning themselves to organisations that provide strong clinical leadership as the basis for facilitating cost effective and quality outcomes for patients and medical scheme beneficiaries.”
Peace of mind for GPs
With 4800 members, Dr Behrman believes IPAF represents some 70% of GPs in fulltime practice. “We are neither price makers, nor do we compel any doctor or group to join us, or to accept any or every contract with a scheme with which IPAF is aligned. We enhance the outcome for patients and funders through quality assurance and peer review, and in return schemes are prepared to reward the participating practitioners with percentage enhancement of the fees, which they individually deem to be affordable.
“Through our good offices with aligned schemes we can assist doctors in sorting out late payments, bureaucratic holdups, claims under query or, where a valid benefit is not paid for in full, standardisation of forms, and centralisation of peer review.”
Source: Medical Chronicle