Frequently Asked Questions
IS PCM AN IPA?
Yes, PCM is a network of affiliated financially and clinically integrated primary care physicians. PCM physicians are independent and not owned or operated by hospitals or health plans.
IS PCM AN ACO?
Yes. We are a network of physicians who have come together to successfully provide coordinated, high quality care to our patients as a Track 1 MSSP participant.
WHY SHOULD I JOIN PCM RATHER THAN STAY WITH MY CURRENT IPA?
Existing IPAs are, for the most part, purely administrative. PCM offers a dynamic platform to meet the challenges of the market and provides population health services that are not currently available to independent physicians in the East Texas market.
IS PCM A CLINICALLY INTEGRATED NETWORK?
Yes, its clinical integration program involves population health and data analytics to identify and stratify newly identified, well managed and end stage status, develop care plans and manage longitudinally in both pre and post acute stages.
IS PCM BEING BUILT TO SELL TO HOSPITALS, AN INSURANCE COMPANY OR ANY OTHER HEALTHCARE COMPANY?
No, we believe healthcare is managed locally for the community it serves. Its purpose is to be a sustainable long-term community asset.
HOW DOES PCM PAY FOR THE POPULATION HEALTH SERVICES AND TECHNOLOGY?
As part of the contracts offered by the payors to PCM, we will receive payment from Medicare and other insurance plans for the provision of population health services for physicians and their attributed patients. PCM’s goal is to help physicians meet or exceed agreed upon quality standards and manage the population in a more cost effective way than the market.
WHY SHOULD I JOIN PCM RATHER THAN A HOSPITAL NETWORK?
PCM allows for you to remain independent and still enjoy the services and structure needed to be successful in the new value based world of healthcare.
WHAT HAPPENS WHEN PCM GENERATES A SAVINGS OR SURPLUS?
In return for providing services to and through the Network, any surplus will be dispersed 60% to the doctors who are members and 40% to PCM to cover management and operational requirements.
WHY DOES PCM PARTICIPATE IN THE SURPLUS?
It will be providing all the services and technology necessary to run the network. The only way for it to make money is for the doctors to make money, thus aligning incentives.
DO I STILL BILL FOR MY SERVICES DIRECTLY TO THE INSURANCE COMPANIES?
Yes, you will bill insurance companies directly on a Fee for Service basis, as you do now.
WHAT HAPPENS IF I SAVE MONEY (CREATE A GAIN SHARE) AND OTHER PROVIDERS DON’T?
First, PCM as a whole has to save money for there to be a gain a share. If there is a gain share, the finance committee made up of physicians will establish a formula that is transparent to all members to decide how to divide the savings.
WHO DECIDES WHAT CONTRACTS PCM SIGNS?
The physician executive board in conjunction with the management sponsor.
WHO DETERMINES THE VENDORS?
PCM with advice from the physician Board of Directors.
WHAT IF MY PRACTICE IS DETERMINED TO NOT BE READY?
If not ready, PCM will provide information and services if needed to close gaps in readiness if desired by practice.
MUST I HAVE AN EMR?
It is not a requirement at this time.
DO I HAVE TO PURCHASE ANOTHER INFORMATION SYSTEM?
No, PCM will provide the population health technology platform as part of its services.
DOES IT HAVE TO INTEGRATE WITH MY EMR?
Over time that would be ideal, but is not a condition required for participation.
WHAT ABOUT MY PRACTICE? DOES PCM TAKE OVER MY PRACTICE?
No, we help your practice actively participate in population health and collaborate with other independent physicians. In addition, if you choose, we can support you in chronic care management and care planning activity to grow and retain your patient base.
WILL ALL OF MY CONTRACTS COME THROUGH PCM?
No, PCM will not have all insurance contracts in the market. For those contracts that PCM does not offer, a physician can contract as they wish.
DO I KEEP MY TAX ID?
IF I AM A GROUP, DO ALL OF THE DOCTORS HAVE TO JOIN?
Yes, all the PCPs under the groups tax id.