Page 30 - 2013-mar-apr

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d i a l ogu e
30
MAR / APR 2013
I 
Healthcare Journal of NEW ORLEANS  
departments. So obviously the thought of a 2000
page law brings a lot of work with it. Sometimes
I would have to be honest and say it’s frustrating
because there are things you do anyway, but now
you have to make sure you document themwell so
if you have an audit you can show exactly how it’s
being done. On the other hand, I think there a lot of
things, although the transition is going to be pain-
ful for us and everyone, where the ultimate out-
come is going to be better.
I think a lot of the things that are being dis-
cussed in the Accountable Care Act are things we
as payers have been wanting to do and provid-
ers have been wanting to do. I got together with
a group of providers recently—some from LSU
and some from the community—about a particu-
lar chronic care program we were working on and
they said, “We’ve beenwanting to do this, but it’s so
difficult trying to work out how to get paid for it.” I
think the payment methodologies moving toward
more of a “Here’s how much money we are going
to give you to accomplish this…do it the best way
you can,” approach is really going to bring about
the right kind of change with the focus being on
better outcomes.
Editor
Can you tell us about some of the goals
and objectives of Peoples Health? Is it to increase
membership, improve the network—what are the
things you would like to see happen?
Carol Solomon
Well we are obviously always looking to grow. We
started in 1997 with the Medicare program and we’ve had moder-
ate growth throughout. We have not grown through acquisitions;
we’ve not tried to grow overnight. Our intent has always been to
make sure we don’t bring in so many folks at one time that we are
not ready to absorb them and aren’t able to give them all the atten-
tion the rest of our members get. We want to make sure that when
we enroll a member that they have access to all of our programs.
This year we brought in about 5000 new members. Our goal is
that within the first 90 days we see all of these members. We do a
health risk assessment over the phone within the first 30-60 days
and those that score high risk we want to get them in as quickly as
possible to their primary care physician. If their physician doesn’t
have the time, we can offer help with one of our nurse practitio-
ners to get them into the systemandmake sure they are in the right
chronic care program and they get the services they need. We also
always want to make sure we have capacity within our primary
care network so we are not putting too many patients in a prac-
tice that’s so full they can’t absorb them. So there’s a great deal
of attention to the network and we want to grow the network and
infrastructure first and then bring in the membership, rather than
do it the other way around. We think that brings us better relation-
ships with the physicians, because we haven’t overwhelmed their
practices, and with the patients, because we want their first expe-
rience to be a good experience.
Editor
You have been with insurance companies for a while so
maybe you can describe how shifts have taken place internally
to address the changing market, perhaps growth or downsizing
of certain departments, increased use of utilization nurses, etc.
Carol Solomon
 I think one of the biggest changes for us has been
in the health services department. We’ve had a good number of
nurses and social workers working for us since the beginning and