Why is it important for physicians to participate in a physician health plan?

Across America, a national debate is raging about healthcare: who should have it, how it should be paid for, and what level of it should be provided to each citizen. The unique issues faced by physicians are not often discussed in the media, but through the use of Physician Health Plans and Physician Health Programs, medical professionals themselves are doing something to make affordable, accessible care a reality for people across the country who might not otherwise have the ability to have their medical issues treated.

WHAT IS A PHP?

In this context, a PHP is a Physicians Health Plan – a form of insurance where a network of practitioners agree to offer a full continuum of care, becoming the backbone of a doctor-driven medical service available to low-income and otherwise vulnerable populations. These organizations exist in a number of states, and are organized with the goal of giving high-quality, affordable health care to their members. An insurance company oriented to PHPs is able to give their members choice between PPO (Preferred Provider Organizations), HMOs (Health Maintenance Organizations) and even tax-advantaged HSAs (Health Savings Accounts). 

WHY PHPs?

Because of their close links with the medical community, an insurance company that offers a Physicians Health Plan does not approach insurance the same way as larger commercial firms, where decisions are driven by financial concerns and the bottom line. In a PHP, the physicians who sponsor the program are also owners in the community served by the program. The company is answerable to its members, not to a board of directors. Coverage is generally restricted to those who are from a lower income bracket and who do not have access to other health care options. 

WHY ARE PHPs A NECESSITY?

Traditional insurance companies have become more involved in the health care decisions accessible to their patients in recent years – and more and more, physicians are seeing this degrade the quality of care available to both their patients and themselves. Because a PHP takes its direction from its members, it acknowledges the importance of allowing doctors the autonomy to practice good medicine that serves the best interests of their patients’ good health. By providing first-dollar health care to their members and giving all subscribers the opportunity to choose from any doctor in their network, Physician Health Plans allow their members to receive the standard of care they deserve. Their commitment to providing care over making increasing profits also means that most PHPs do their best to keep costs – both to their company and to their members – down while also compensating the medical professionals involved fairly for their services. In an era when health care costs are spiraling higher and higher – monthly premiums for non-PHP health care services can now cost as much as $900 per individual covered – having a company that’s committed to making sure their members continue to be able to afford medical care is a necessity both practically, in the short term, and socially, as the world looks for ways to make good care available to wider populations at affordable prices. 

WHO USES PHPs?

Eligibility for PHPs varies state to state, but there are some general eligibility requirements that can be assumed. They typically are available for those who are unable to access other forms of coverage through partners, parents or government programs. Because the organizations are often based in a given state or region, members are required to also be legal residents of those states in many cases. Individual programs contain requirements which will preclude the inclusion of some applicants, but these also vary from one PHP to the next. Some PHPs – one in Indiana, for example – are not available to families who are pregnant or in the process of adopting a child. 

The people who use PHPs are diverse, but generally have one thing in common: they need care from physicians who are willing to operate outside traditional Health Insurance companies to deliver care to people who need it. Users of PHPs are those who, for whatever reason, are excluded from access to care but want to maintain their physical health and protect themselves in the event medical care is needed.

WHO ARE THE BEST PHP PROVIDERS?

PHPs are a relatively new form of health insurance entity, and nationally-recognized information about them is difficult to obtain, but two of the most notable companies in the field are PHP of Mid-Michigan, and PHP of Northern Indiana. While research into PHPs in other areas turns up some companies, such as HIP in New York (part of Emblem Health), these group- and network-based plans do not appear to be connected to genuine PHPs, where doctor-driven health care is delivered through a system answerable to its members. 

A SUMMARY OF BENEFITS

As outlined above, the benefits of PHP-based insurance include a high standard of care crafted by doctors, not healthcare administrators. Unlike insurance companies, they are not motivated by their bottom line, but by providing the best possible care to their members. 

WHAT MAKES PHPs A GOOD CHOICE?

In addition to their affordability, PHP plans make care available to the economically disadvantaged. They give doctors a role and a real say in how their patients are treated. They strengthen the professional relationships between doctors in a geographic area, creating a more tightly-knit medical community. In terms of accountability, because the members of the PHP are the ones who it answers to, both patients and physicians can be confident that the PHP company is prioritizing medical care and a limiting of waste in the system.

IS THERE A LOT OF COMPETITION BETWEEN PHPs?

At present, there does not appear to be a great deal of competition between PHPs, but this may be in part due to their geographic and collaborative nature. Where there is competition is between large insurance companies and smaller alternative operations – co-operatives, PHPs and more. While some physicians prefer to operate under the established system, others seek ways to change the face of medicine’s practice through extending availability of coverage outside their traditional bounds.