Physicians Health Plan of South Michigan will be transitioning its membership to Priority Health, subject to regulatory approval.

Physicians Health Plan of South Michigan Named One of the Best in The Nation by U.S.News & World Report/NCQA “America’s Best Health Plans” 2006

For the second year in a row, Physicians Health Plan of South Michigan has been named one of the best commercial health plans in the nation by the U.S.News & World Report/NCQA "America's Best Health Plan"* 2006.

iSave

PHPSM is proud to offer you iSave - our six new high deductible health plans (HDHP's). iSave features low premiums and first dollar coverage for preventive care. iSave helps you get your healthcare spending back on track. For more information, please click the title link above.

Leapfrog

Leapfrog is a program to provide information about health care safety, quality and customer value. Click the title above for more details.

Physicians Health Plan of South Michigan's Members Area

Care Management

Physicians Health Plan of South Michigan has been proactively improving the healthcare experience for patients, doctors, employers, and pharmacists — which often redefines how the rest of the industry approaches healthcare. We’ve listened to our members and developed patient advocacy and education programs that give decision-making power back to patients and their physicians. We call this exciting new approach Care Management.

At Physicians Health Plan of South Michigan, we believe that the people best qualified to make decisions about healthcare are our patients and their doctors. We believe that Care Management will promote positive health experiences for members and restore the joy of practicing medicine for physicians.

Care Management is just one part of our evolution. We continue to ask, "What works for you?" and respond with programs that address your needs.

What is the Care Management Approach?

The Care Management Approach is redefining Medical Management. Physicians Health Plan has broken down the "prior authorization barrier" and introduced Care Management as the new approach—and the new era—in modern healthcare. In listening to our members tell us what works for them, we've seen that the former medical management model is inadequate. PHPSM has addressed these concerns, and we believe that what works for our members and physicians also works for us.

We prefer to spend our time preventing delays in care rather than denying the treatment patients need. The result? A positive outcome for patients and physicians, who keep their decision-making powers every step of the way.

What are the Program Components?

Care Management improves relationships between doctors and patients by offering more resources than traditional healthcare programs, and makes it easy for patients to access the information they need about medical concerns.

Health education with a personalized approach.

Through convenient toll-free numbers and personalized web sites, we can help with any questions or concerns patients have around the clock. We also have reminder programs in place for routine check-ups including flu shots, pap smears, immunizations, and mammograms.

Admission counseling made simpler.

PHPSM supports patients before they're even admitted by offering information about their diagnosis, treatment and what they can expect during an inpatient stay. This pre-admission outreach will also address the important elements of proactive discharge planning, consider treatment options and review qualified physicians.

Inpatient care advocacy gives patients the care they deserve.

Everyone deserves an advocate when receiving inpatient care. We'll facilitate access to specialists, help to make treatment plans more timely, and prevent delays in patient procedures and tests whenever possible. Care Management also provides services for planning discharges.

Comprehensive disease management that empowers members.

We'll help empower members who have conditions like asthma and diabetes by providing the information they need—everything from self-care education materials to health status tracking.

Readmission prevention provides a safe transition home.

After leaving the hospital, our Welcome Home Program nurses will call members to make sure medications, self-care information, and supplies are easily accessible.

Complex illness support offers all the resources patients need.

Chronic conditions are difficult enough without worrying about coordinating long-term outpatient treatment programs. Our IMPACT Program focuses on stabilizing long-term outpatient care for members with complex conditions.

Pharmacy Management ensures clear communication about medications.

When medication is prescribed, it is vital for pharmacists to be equipped with the information they need to avoid complications or dangerous drug interactions. Pharmacists participating in the Care Coordination approach receive information on:

Duplicate drug therapy
Drug-disease interactions
Drug-drug interactions
Drug allergies
Dosing and drug issues

Clinical Profiles from the Care Coordination Program

Clinical Profiles lead to a best-practices approach for all our physicians.

Clinical Profiles accumulate medical and pharmacy data, and provide personalized reports to participating physicians about their current practice patterns. These reports compare individual practice performance to nationally-accepted best practice standards. Equipped with this information, doctors are able to measurably improve the quality of care they offer. The Clinical Profiles Program evaluates Primary Care Physicians and select specialist groups.

Since this program began, our program physicians have shown significant improvements in their measured performance. For example, physicians are now prescribing more beta-blocker drugs for heart attack survivors. More patients with diabetes are getting regular hemoglobin A1c tests, and mammography rates for women over 40 are rising.