Sparrow Php

Programs: Sparrow php (sphp)is a non-profit health maintenance organization (hmo). Sphp uses a primary care concept for delivering health care in a health delivery network (hdn) structure. It arranges for the provision of comprehensive outpatient and inpatient medical and surgical services to members and their qualified dependents on the basis of a fixed prepaid sum without regard to the frequency or extent of services furnished to any particular member or qualified dependent. Sphp contracts with various hdns who provide healthcare services to members. Sphp's commitment is to develop and deliver quality managed care products at a reasonable cost for its members. Sphp's success in managing health care is due in part to the extensive network of participating providers in the hdn network. The hmo/hdn contractual arrangements allow sphp to arrange for healthcare to patients covered by the state of michigan's medicaid benefit plan. This arrangement allows the members to access a wide variety of independent providers within each hdn including physicians, hospitals, pharmacies, skilled nursing facilities, and allied health professionals. Sphp members may also receive care for services from a nonparticipating provider if such referral is recommended by a hdn participating physician and the service required for treatment, as determined by the hdn, is not available within the hdn's network. Sphp offers a variety of health care programs. Sphp offers choices that provide coverage within the network of contracted hdn providers, limited coverage outside of the sphp network, various levels of deductibles, co- payments, and coverage limits, all of which are designed to be responsive to payor needs. Sphp is owned by physician health plan (php). Physicians health plan (php) is owned by sparrow health system (sparrow) and holds a certificate of authority as an hmo in the state of michigan. Php is primarily a commercial hmo and also operates three subsidiaries, php insurance company (phpic), a commercial insurance company, sphp, and php service company (tpa) a third party administrator. All staffing functions and reporting are accomplished through the use of the same staff as php. Effective december 31, 2015 sparrow php sold 100 percent of its membership to an unaffiliated health plan. Php gained approval form the board of directors and commissioner of the department of insurance and financial services to merge sparrow php into php effective april 2017. Unless specifically noted, all references to php apply to php, phpic, sphp, and tpa. Php's service area includes the michigan counties of ingham, eaton, clinton, shiawassee, montcalm, gratiot, ionia, jackson, hillsdale, portions of isabella, saginaw, washtenaw, and lenawee. Phpic offers products across michigan. For the years ended december 31, 2015 and prior the sphp product was available to medicaid enrollees in eaton, clinton, ingham, ionia, montcalm, isabella, and shiawassee counties. As of december 31, 2016, there were approximately 36,000 enrollees in php's commercial hmo, 15,700 in tpa, 5,500 in phpic, and 0 enrollees in sphp. One hundred percent of sphp's membership was sold to an unrelated health plan effective december 30, 2015. Php and sphp contract directly with physicians health network (phn), a wholly owned subsidiary of sparrow. The php network is approximately 684 primary care physicians, 1,085 specialty care physicians, 532 allied health professionals, and 572 organizational providers that include 31 hospitals. Php measures the quality of care provided to its enrollees through annual review of indicators such as: - disease management program participation and outcomes, - quality of care concerns, and - hedis measures: the health plan effectiveness data and information set (hedis) is a group of nationally recognized measures of health plan performance in a variety of clinical and non-clinical areas. Php uses the effectiveness of care measures to determine progress and improvement in areas such as: diabetes, asthma, depression and follow-up after mental health admissions, breast and cervical cancer screenings, use of beta- blockers after heart attacks, child and adolescent immunizations, cholesterol management, controlling high blood pressure, smoking cessation, prenatal and postpartum care, and treatment of childhood respiratory infections. Php measures the quality of service provided to its enrollees by the review of performance measures related to: - access and availability of providers, - enrollee complaints and appeals, - customer service telephone access performance, and - member assessment: the consumer assessment of healthcare providers and systems (cahps) survey gives a general indication of how well the organization meets members expectations. The php qi program is ultimately accountable to the board of directors. In 2015 php received "full accreditation" status from urac for both health plan accreditation and health plan accreditation with health insurance marketplace. Urac accreditation signifies an issuer has undergone and passed a rigorous and independent review of its operation, including the quality of care and level of service provided to enrollees. Accreditation health plan standards incorporate market trends and address major policy issues while aligning with core requirements found in the affordable care act. Php has been accredited by urac under the health plan standards since 2012. The next accreditation will occur for the year ended december 31, 2018.