This August Health Plan Select will celebrate its 10th anniversary of providing quality healthcare to Northeast Georgia. We take great pride in this local, community health plan. It is important that employers have options for healthcare other than the national, for-profit plans. Despite our early losses, we are now meeting our financial goals, and we look forward to continued success.

Physician participation has been an important part of our success. Numerous physicians have served on our committees through the years. We would like to say thank you to everyone who has served.

Pay for Performance (P4P)
Over the last several years we have had a P4P program for primary care physicians, which encouraged them to prescribe generic drugs. We are modifying this program. We will have a total of 5 measures, 4 new ones plus the generic drugs. The new measures will be diabetic eye exams, pap smears, mammograms, and emergency room utilization.

This program is being phased in over 6 months, from April 1st through September 30th. In the past, PCPs have received a monthly check for their generic prescribing. Under the new plan, checks will be sent quarterly. The first quarterly checks will be sent in July. We will continue to send monthly payments for generic utilization through September. In October only quarterly checks will be issued.

Health Saving Accounts (HSAs)
Health Plan Select is pleased to announce that it now has HSA plans to offer to the local employer community. HSAs are high deductible plans which are attached to flexible spending accounts. The details of these plans are beyond the scope of this newsletter, but the HPS plans will have deductibles of $1,100, $2,850, and $5,500 for individuals and $2,200, $5,700, and $11,000 for families. For more information on these plans, contact the Sales Department at 706-549-0549, option 4.

Pharmacy
We are not making any significant mid-year changes to our preferred drug list. Click here for our Preferred Drug List.

The cost of injectable drugs continues to climb. They have been a strain for many small employers who have members who are on drugs that cost $1,500 to $2,000 per month. Many of these employers are opting for the new plans with deductibles and co-insurance.

The $4 generic programs at Walmart and Target have been very helpful for many people. You can get the updated drug lists at Walmart.com and Target.com.

Governance Committee
We would like to thank Drs. Mohammad Obeidin and Steve Chesser for serving on the Governance Committee. Their terms ended at the end of 2006.

The other members of the Committee are Drs. Mark Firth, Bob Cannon, Greg Delaurier, Kevin Adams, Mark Ellison, Andrew McElhannon, Chris Edwards, Tom Wells, John Elder, and James Swails. We appreciate all of the work these doctors do. Each of them has agreed to serve a 6-year term, which is a big commitment.

Quality Improvement Committee

The QIC has three ongoing projects: monitoring of patients on chronic medications, chronic kidney disease, and emergency room utilization. You may have seen communications from HPS regarding these projects. The goal of these projects is to help our members get the best care in a cost-effective manner.

The Medical Records Documentation Audits (MRDA) are reported to this committee. We are required by the state to do these on a periodic basis.

Network Development and Credentials Committee
If your practice is adding a new physician, please allow enough time to complete the credentialing process. It can take two to four months to become credentialed for the HPS network. The ND and C Committee meet monthly to review the credentials of our providers. The committee consists of Drs. Andrew McElhannon, Bryan Barnes, Amanda Downs, Chris Doerr, and Tom Hawk. We appreciate their efforts on behalf of this committee. Each provider (if such a need exists for our network as determined on both a geographic and provider-type basis) must meet our criteria for initial credentialing and then be recredentialed on a two-year renewal basis.

The steps for being initially credentialed and the time each step may take is listed below:
1.  Submit initial or recredentialling application. Day 1
2.  The completed application is then sent to Credent, our Credentialing verification Organization where it takes 45-60 days to verify an application.
3.  The verified application is then presented at the next ND and C meeting, which may occur within 1-28 days upon receipt of the application from Credent (depending on the next scheduled meeting).
4.  The approved application is then submitted to the Board of directors of Health Plan Select for admittance into the network, which may occur within 1-30 days after the ND and C committee meeting (dependent on the timing of the next Board meeting).
5.  The 1st day of the month after the Board approval occurs is when a provider will appear as an in-network provider for Health Plan Select, which is usually 10-14 days after a Board meeting.

As you can see from this timeline, the process from submission of an application to being included in the network therefore can range from 2 to 4 months.

A. Fred Young, M.D. - Medical Director
Geoffrey P. Cole, M.D. - Medical Director