4
sahtak - June 2010
By M. Kay Siblani
Editor
T
here's good news in the healthcare
reform legislation for patients and
providers, says Dr.Yasser Ham-
moud, Medical Director of United Out-
standing Physicians (UOP), a physician
organization in Dearborn that has been
practicing since 2002 what the legislation
is now urging all physicians to do.
And Michigan needs all the help it can
get.More than a million Michigan resi-
dents are without insurance; one in six
people in the state is enrolled in Medicaid.
Every Michigan family with insurance pays
$730 per year for emergency room care
for the uninsured, the most expensive
form of care available.Health care costs
contribute $1200-$1600 to the price of
every vehicle made by our domestic auto
industry. Foreign automakers pay a frac-
tion of that, resulting in an uneven playing
field forAmerican manufacturers.And
1,040 citizens in Michigan will lose their
insurance every week until 2011,making
the whole situation worse.
"The reform legislation is very good
for the country, for the patients and I be-
lieve for the doctors," said Hammoud in
an interview. "InWesternWayne County,
it will provide coverage for up to 115,000
uninsured residents, improve existing cov-
erage for 1,293,000 residents, provide
credits to 451,000 families and 33,900
small businesses to help pay for health in-
surance, improve Medicare for 285,000
beneficiaries, and allow 155,000 young
adults to obtain coverage on their par-
ents' insurance plans." Hammoud also
talked about the need to save Medicare.
"In 2010, our population is 310,000,000
with 13% being above the age of 65. In
2040, our projected population is
406,000,000 of which 20% will be over
65." Hammoud says by fixing Medicare
the government will save $9 trillion.
Accountable Care Organizations
(ACO) and Patient Centered Medical
Homes (PCMH) are the new buzz-
phrases in the complex world of health-
care in the United States.ACOs are
groups of healthcare providers, including
physicians and other members of the
healthcare team,which accept responsibil-
ity for the total cost of service provided
to their patient populations,while also
maintaining excellent standards of care.
While managed care by insurance compa-
nies was the mainstay of the 1990s,man-
aged care by physician groups is the here
and now.ACO opportunities to reduce
costs include prevention care and teach-
ing, early diagnosis, elimination of unnec-
essary testing and emergency room visits,
prevention of hospital admissions due to
early intervention, control of infections
and other adverse hospital events, lower-
ing the rate of readmissions to hospitals
and providing lower cost treatments.
Quality control is stringently monitored
and care is delivered according to evi-
dence-based guidelines.Medical records
are electronically stored and available to
all the healthcare providers interacting
with a particular patient.
A PCMH is the natural outgrowth of
the primary care philosophy,wherein each
patient has a primary care general in-
ternist who treats the patient for every-
thing not requiring a specialist, refers the
patient to specialists as the need arises,
admits to a hospital as needed and main-
tains contact with all the other physicians
and healthcare providers throughout that
patient's lifetime, preferably with an elec-
tronic database accessible to all the
healthcare providers.There is a whole-
person orientation.There is enhanced ac-
cess to care and payment to physicians
and others recognizes the added value
provided to patients who have a Patient
Centered Medical Home.
Neither of these concepts is new to
UOP,which represents some 1000 doc-
tors inWesternWayne County, and came
into being in 2002 as the brainchild of
Hammoud. As members of the health-
care community,UOP physicians realized
the need for industry professionals to re-
gain the control being held by insurance
companies, improve the quality of health-
care given to patients and control spiraling
costs.
UOP has, in fact, redefined the delivery
of healthcare by working directly with
their member physicians and hospitals de-
livering patient-centered care. PutACO
and PCMH together and you get a feel for
the way UOP works for its members' pa-
tients. UOP's physicians collaborated to
create an integrated system that upheld
and enforced revolutionary practice stan-
dards.The partnership ensured up-to-
date procedures, reduced unnecessary
tests, and minimized utilization variation
across the board.The end result? Higher
quality and efficiency in the delivery of
healthcare which should result in cost
containment over time.
It sounds like a dream to those who
work in the healthcare system and to
those who have been treated in the sys-
tem and have witnessed the ravages of
disconnected caregiving, diagnostic dupli-
cation and communications chaos among
the people who are supposed to be saving
lives. Imagine having one primary care
physician of your choice who knows all
about you and your family,who coordi-
nates all care including prevention screen-
ing and education,who uses known
specialists and maintains communication
with them all and who knows when
someone calls in with a sore throat is also
diabetic and that needs to be taken into
consideration as well. Such personalized,
integrated care spells better health for
Americans. It also puts control back into
physicians' hands,where it should be.
The major difference between man-
aged care byAPOs and managed care by
insurance companies? Primary care doc-
tors inACOs like UOP are not rewarded
financially for skimpy use of testing and re-
ferrals, as was the case in insurance-run
managed care, nor is fee for service the
exclusive basis for reimbursement.Now
what matters is the highest quality patient
outcomes,which are measurable. Physi-
cians are thus incentivized to do what it
takes to make the patient healthy and are
financially rewarded for doing so.ACOs
and PCMHs are encouraged by the new
healthcare reform legislation
Physicians benefit from membership in
physician associations as well.UOP assists
its physicians with administrative manage-
ment, quality care and disease manage-
ment, pharmacy benefit management and
corporate wellness programs.
Using its exclusive physician perform-
ance software,UOP has developed an ef-
fective and technologically advanced
utilization review process that allows it to
examine health care provider behavior to
ensure quality and exclude potentially
large and unnecessary medical expendi-
tures. UOP has established preferred rela-
tionships with select providers whose
healthcare management philosophy is
consistent with UOP's mission to deliver
quality healthcare at an affordable price.
UOP also assists with quality care and
disease management. Its individualized and
comprehensive disease and chronic care
management programs consider the total
health of the patient.The focus is to edu-
cate and assist providers in behaving in a
manner to minimize adverse disease out-
comes by focusing on those processes
which most efficiently manage chronic dis-
eases. Control and improvement of
chronic conditions and employee health
can save employers millions of dollars in
health care costs. It is proven that a
healthier workforce results in lower
healthcare costs and higher earnings.
Pharmacy benefit management is an-
other service. Prescription drugs account
for approximately 20% of total healthcare
costs and this number is increasing rapidly.
UOP meets the business and professional
needs of its clients and patients with plan
design administration, personal account
management, customer service and a full
spectrum of clinical services.This includes
extensive drug utilization review pro-
grams and formulary management.
The number of participating physician
members gives UOP the power to nego-
tiate the best managed care contracts,
physician fee schedules that are the high-
est in the market and risk pool profitabil-
ity and distributions are among the
highest as well.UOP can credential and
contract its physicians in shorter periods
of time than other networks,with a yearly
auditing score of 100% NCQA compli-
ance.
UOP also offers its physician members
services in banking,management and legal
affairs, telecommunications,medical sup-
plies, office supplies, personal malpractice
insurance and other such perks. For more
information on joining the UOP family of
healthcare providers or becoming a pa-
tient of a physician belonging to UOP, con-
tact 313.240.9867.
UOP: Wave of the healthcare future
Dr. Hammoud: "The reform legislation is very good for the country, for
the patients and I believe for the doctors.
