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Locally-based health plan moving forward

May 15, 2000|By ANDREA ROWLAND

Backers of a five-year-old Washington County-based health plan said they're ready to market their product after ironing out some kinks.

cont. from front page

A policy-making board of directors for the TriState Community Health Plan (TCHP) now feels confident that Annapolis-based InforMed, which provides administrative, billing and collection services and data analysis via secured Internet applications, is "the right fit" for the local plan, said TriState Health Partners Medical Director Robert J. Cirincione.

By using Web-based applications to access and share information within the medical network, communication is easier and the overhead costs often associated with managed care are cut, he said.

"The best quality health care in the long run is the most efficient health care," said Cirincione, an orthopedic surgeon at Mid-Atlantic Orthopedic Specialists in Hagerstown.

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The locally controlled and managed health care plan is a medical network owned by TriState Health Partners Inc., a cooperative partnership between Washington County Hospital and 175 area physicians.

This partnership is a Physician Hospital Organization, or PHO.

TriState Health Partners was formed in 1995 as a joint initiative of Washington County Hospital and local physicians who wanted to simplify health management by cutting through the managed care "hassle factor," Cirincione said.

The local health practitioners wanted to create a seamless system of standards that didn't vary based upon insurance company guidelines, said TriState Health Partners Executive Director Beverly David.

"At the end of the day we provide health care," Cirincione said.

Plan proponents said it offers area employees more access to doctors, cuts managed care red tape, and keeps local health care decisions in the community.

"The one true thing that makes our network unique is that we are neighbors taking care of neighbors," a TCHP brochure says.

Employers and patients can access claims and other data from the TriState Health Partners Web site at www.tristatehealth.com, but the major perk to plan users is the easy access to physicians that it provides, Cirincione said.

With the local health plan, "You aren't on your own with three (doctors) in a handbook," he said.

More than 90 percent of the physicians on staff at Washington County Hospital participate in the plan, David said.

The local PHO has also partnered with physicians in nearby Frederick County, Md., and Franklin County, Pa., and is now in contract discussions with City Hospital in Martinsburg, W.Va., and providers in Winchester, W.Va., Gettysburg, Pa., and McConnellsburg, Pa., David said.

TriState Health Partners has forged strong referral bonds with such nationally recognized hospitals as Johns Hopkins in Baltimore and the University of Maryland Medical Center, Cirincione said.

These hospitals are "tertiary centers" that enable TriState Health Partners to offer specialized services out of the area that is considered in the local network, David said.

"You see the doctor at Hopkins the same as if he was across the street. It's seamless," Cirincione said.

In addition to easier access, TCHP patients benefit from local decision-making, plan proponents said.

Local patients' health care decisions aren't made by "nameless, faceless bureaucrats" in an office far away, Cirincione said. "The bureaucrats have names and faces. And you know them."

Primary care providers manage their patients' care, access claims and other information via secured Internet applications, and forward referrals to Cirincione for authorization via the Web, he said.

If the orthopedic surgeon has a question about a case, he said he doesn't hesitate to consult specialists within the PHO.

The community health plan now covers more than 8,000 area employees under the self-insured and small group employer plan categories, David said.

The small group plan, which is fully insured by state-mandated Educators Health Partners insurance company, offers an 80/20 plan with an annual deductible, David said.

The premium varies based upon age, marital status and size of group, she said.

Larger employers will likely fall under a flexible plan design regulated by the federally regulated Employee Retirement Income Security Act (ERISA), David said.

Employers will benefit from lower premiums due to direct contracting and reduced administrative costs, and can design plans tailored to the needs of their employees, David said.

TriState Health Partners chose a mid-range fee schedule to keep costs reasonable in order to remain competitive, Cirincione said.

Participating physicians split profits with Washington County Hospital, so the dollars funneled through the plan into the nonprofit medical facility "rattle around in the community," he said.

The TCHP's success will be measured by its ability to provide high-quality health care while keeping patient premiums low, Cirincione said.

"It is our only interest to provide high-quality health care," he said. "This is a very cooperative organization. The reason it has to be cooperative is because we live and work and play together."

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