PIC Physician Membership Options
Currently, Physicians are joining Partners In Care through one of three ways: through the United Medical Group, through a special affiliation with the United Medical Group, or through a Large Network Partnership.

United Medical Group Membership

Individual physicians or group practices may join as members of the United Medical Group, PC, a large multi-specialty group practice without walls. This allows the preservation of individual group and solo practice models. The United Medical Group members share in one risk pool that utilizes well-documented algorithms by which surpluses/deficits are handled.

The United Medical Group has been working with Aetna since 1995 and Horizon since 2000.  Each of the arrangements is a somewhat unique but they share the common thread of Shared Performance Based Rewards in conjunction with Data Sharing to assist in improving care.

Recently, Partners In Care has added two local employers and a regional brokerage firm to the mix of entities to whom the Unite Medical Group provides services.  We are currently working on relationships with a Third Party Administrator and a Reinsurance Company as well as holding discussions with several of the regions other plans.

United Medical Group Members qualify for the Partners In Care Provider Distribution if annual corporate and delivery system performance meets criteria set by the Board of Directors.

The Partners in Care Internal Provider Distribution Program contains three risk pools with respect to the AUSHC contract: primary care, specialty care, and facility care. For primary care physicians/groups, such distributions are based upon the number of members enrolled with them as a percentage of total PIC members (calculated on a member-month basis). For specialists, distributions are made based upon the number of patient referrals. A patient referral is defined as all encounters with a single patient for a single diagnosis.

United Medical Group Affiliation

Partners In Care created this special category of membership in the United Medical Group to afford a flexible way for physicians to participate directly with local Self Funded Employers in cases where Physicians were no longer interested in participating directly with some or all of the Insurance Companies and/or Health Plans.  This provides a unique mechanism for physicians to provide local businesses, in other words their neighbors, in-network access to their services while not granting discounts to the large national insurers on a broad basis.

Large Network Partnership

LNP's have been specifically designed to enable currently organized physician groups and networks (e.g. IPA's, MSG's) to participate in risk contracts through Partners in Care. Our large network Partners will remain semi-autonomous and will have complete responsibility for their own population. Their relationship to the United Medical Group will be that of an equal - under the same risk contract parameters and management, but with completely segmented populations and funds. The chief distinction from "physician practice management schemes" in this innovative model is that Partners In Care does not wish to acquire a group's assets or take control of the group. We understand our core business and we will structure the relationship with a physician group so that PIC's return is based principally upon our ability to assist in improving the group's performance.

It is the performance of the LNP's physician panel that drives the surplus or deficit of the risk pool. Under the direction of the LNP board of directors, PIC will advise the group on various aspects of fund management and distribution, but the final decision of what the best method for the particular LNP to handle the surplus or deficits will rest with the LNP board.

It is important to remember that the actual services to be provided and the fee for service rates reimbursed to the LNP providers are in accordance with those providers' direct agreement(s) with health plans.

As you can see, there are both similarities and differences between joining Partners in Care through a Large Network Partnership and the United Medical Group. The following chart highlights these points.

Large Network Partnership - United Medical Group Comparison