Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| ADDITIONAL INFORMATION | FORM 990 | ALL LINES LEFT BLANK ARE NOT APPLICABLE TO THE ORGANIZATION. |
| FIRST ACHIEVEMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4A | CONTRACT WITH PHN TO PROVIDE A PANEL OF HEALTHCARE PROVIDERS TO DELIVER THE HEALTHCARE SERVICES. PHN, PHPMM, AND PHPMM-FC ARE COMMITTED TO THE DEVELOPMENT AND DELIVERY OF QUALITY MANAGED CARE PRODUCTS AT A REASONABLE COST FOR THEIR MEMBERS. PHPMM AND PHPMM-FC'S SUCCESS IN MANAGING HEALTHCARE IS DUE IN PART TO THE EXTENSIVE NETWORK OF PARTICIPATING PROVIDERS IN PHN. THE HMO/HDN CONTRACTUAL ARRANGEMENT ALLOWS PHPMM AND PHPMM-FC TO ARRANGE FOR HEALTHCARE TO PATIENTS COVERED BY PHPMM'S AND PHPMM-FC'S BENEFIT PLAN. THIS ALLOWS THE MEMBERS TO ACCESS A WIDE VARIETY OF INDEPENDENT PROVIDERS WITHIN THE HDN INCLUDING PHYSICIANS, HOSPITALS, PHARMACIES, SKILLED NURSING FACILITIES, AND ALLIED HEALTH PROFESSIONALS. PHPMM AND PHPMM-FC MEMBERS MAY ALSO RECEIVE CARE FOR SERVICES FROM A NONPARTICIPATING PROVIDER IF SUCH A REFERRAL IS RECOMMENDED BY A PHN PARTICIPATING PHYSICIAN AND IF THE SERVICE REQUIRED FOR TREATMENT, AS DETERMINED BY PHN, IS NOT AVAILABLE WITHIN PHN'S NETWORK. PHPMM AND PHPMM-FC OFFER A VARIETY OF HEALTHCARE PROGRAMS, OR PRODUCTS, TO GROUPS AND INDIVIDUALS. PHPMM AND PHPMM-FC OFFER CHOICES THAT PROVIDE COVERAGE WITHIN THE PHN NETWORK OF CONTRACTED PROVIDERS, LIMITED COVERAGE OUTSIDE OF THE PHPMM AND PHPMM-FC NETWORK, VARIOUS LEVELS OF DEDUCTIBLES, CO-PAYMENTS, AND COVERAGE LIMITS, ALL OF WHICH ARE DESIGNED TO BE RESPONSIVE TO PAYOR NEEDS. PHYSICIAN HEALTH NETWORK AND PHYSICIANS HEALTH PLAN OF MID-MICHIGAN ARE WHOLLY OWNED BY SPARROW HEALTH SYSTEM. PHPMM CONSISTS OF A COMMERCIAL HMO CALLED PHYSICIANS HEALTH PLAN OF MID-MICHIGAN (PHPMM), A COMMERCIAL INSURANCE COMPANY (PHPMM-IC), AND A MEDICAID HEALTH PLAN THAT OPERATES THROUGH A SEPARATE CORPORATION. PHYSICIANS HEALTH PLAN OF MID-MICHIGAN FAMILYCARE (PHPMM-FC) IS ALSO A LICENSED HMO AND A WHOLLY OWNED SUBSIDIARY OF PHPMM. ALL STAFFING FUNCTIONS AND REPORTING ARE ACCOMPLISHED THROUGH THE USE OF THE SAME STAFF AS PHPMM. UNLESS SPECIFICALLY NOTED, ALL REFERENCES TO PHPMM APPLY TO PHPMM-IC, AND PHPMM-FC AND ALL REFERENCES TO PHP INCLUDE THE ENTIRE PHP AFFILIATED GROUP OF PHPMM AND PHN. PHPMM'S SERVICE AREA INCLUDES THE MICHIGAN COUNTIES OF INGHAM, EATON, CLINTON, SHIAWASSEE, GRATIOT, IONIA, MONTCALM AND ISABELLA. PHPMM-IC OFFERS PRODUCTS ACROSS MICHIGAN. THE FAMILYCARE PRODUCT IS AVAILABLE TO MEDICAID ENROLLEES IN EATON, CLINTON, INGHAM, IONIA, MONTCALM AND SHIAWASSEE COUNTIES. AS OF DECEMBER 31, 2010, THERE WERE 35,129 ENROLLEES IN PHPMM'S COMMERCIAL HMO, 12,208 IN TPA, 2,993 IN PHP-IC, AND 18,789 ENROLLEES IN FAMILYCARE. PHP CONTRACTS DIRECTLY WITH 719 PRIMARY CARE PHYSICIANS, 1269 SPECIALTY CARE PHYSICIANS, 365 ALLIED HEALTH PROFESSIONALS, AND 308 ORGANIZATIONAL PROVIDERS THAT INCLUDE 29 HOSPITALS. PHP WAS ALSO RANKED AMONG THE TOP 50 OF AMERICA'S BEST HEALTH PLANS BY U.S. NEWS AND WORLD REPORT/CONSUMER REPORTS FOR THE 5TH CONSECUTIVE YEAR. NCQA USES AN ALGORITHM COMPOSED OF HEDIS, CAHPS AND ACCREDITATION SCORING TO CREATE THESE NATIONAL RANKINGS. THE GOAL OF THE QUALITY IMPROVEMENT PROGRAM IS TO CONTINUOUSLY IMPROVE HEALTH OUTCOMES AND LEVEL OF SERVICE PROVIDED TO ENROLLEES. PHPMM PURSUES ITS GOALS THROUGH IMPLEMENTATION OF THE QUALITY IMPROVEMENT MODEL: -MEASUREMENT OF THE OUTCOMES OF CARE AND SERVICE, INCLUDING BEHAVIORAL HEALTH SERVICES. -ANALYSIS OF BARRIERS TO CARE AND SERVICE. -DEVELOPMENT AND IMPLEMENTATION OF INTERVENTIONS. -FORMAL EVALUATION OF THE EFFECTIVENESS OF THE INTERVENTIONS. PHP MEASURES THE QUALITY OF CARE PROVIDED TO ITS ENROLLEES THROUGH ANNUAL REVIEW OF INDICATORS SUCH AS: -DISEASE MANAGEMENT PROGRAM PARTICIPATION. -QUALITY OF CARE CONCERNS. -HEDIS MEASURES - THE HEALTH PLAN EFFECTIVENESS DATA AND INFORMATION SET (HEDIS) IS A GROUP OF NATIONALLY RECOGNIZED MEASURES OF PERFORMANCE IN A VARIETY OF CLINICAL AND NON-CLINICAL AREAS. PHPMM 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 SCREENING. -USE OF BETA-BLOCKERS AFTER HEART ATTACKS. -CHILD AND ADOLESCENT IMMUNIZATIONS. -CHOLESTEROL MANAGEMENT. -CONTROLLING HIGH BLOOD PRESSURE. -SMOKING CESSATION. -PRENATAL AND POSTPARTUM CARE. -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. -ENROLLEE COMPLAINTS AND APPEALS. -CUSTOMER SERVICE TELEPHONE ACCESS PERFORMANCE. -MEMBER ASSESSMENT: THE CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (CAHPS) SURVEY GIVES A GENERAL INDICATION OF HOW WELL THE ORGANIZATION MEETS MEMBERS' EXPECTATIONS. PHYSICIANS HEALTH PLAN OF MID-MICHIGAN RECEIVED THE HIGHEST RATING OF "EXCELLENT" FROM THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA). THIS STATUS IS GRANTED TO HEALTH CARE PLANS THAT HAVE DEMONSTRATED CONTINUOUS QUALITY IMPROVEMENT IN THEIR PROGRAMS WHILE MEETING OR EXCEEDING NCQA'S RIGOROUS ACCREDITATION STANDARDS. PHP FAMILY CARE RECEIVED A COMMENDABLE RATING. PHPMM AND PHPMM-FC WERE REVIEWED BY NCQA IN 2009. THE SERVICE EXCELLENCE PROGRAM HAS A MISSION OF: PROVIDING FOCUSED LEADERSHIP TO CREATE AND MAINTAIN A CULTURE OF WORLD CLASS CUSTOMER SATISFACTION. IN 2010 PHPMM WAS RANKED ABOVE THE 90TH PERCENTILE IN SATISFACTION WITH CUSTOMER SERVICE AND WAS THE HIGHEST RANKED HEALTH PLAN IN MICHIGAN. THIS WAS YEAR FOUR OF A HIGHLY STRUCTURED AND GOAL ORIENTED APPROACH TO MEMBER SATISFACTION AND EMPLOYEE ENGAGEMENT. THE PROGRAM IS A "TOP DOWN BOTTOM UP" APPROACH TO CHANGING THE CULTURE OF SERVICE. SERVICE EXCELLENCE ADVISORS ARE FRONT LINE STAFF TRAINED TO PRESENT A TWO HOUR CLASS TO ALL ASSOCIATES IN THE HEALTH PLAN. THE BOOK A COMPLAINT IS A GIFT BY JANELLE BARLOW WAS THE BASIS FOR THE 2010 TRAINING. -CAPITALIZING ON COMPLAINTS -HOW TO SAY NO AND REMAIN FRIENDS -BUILDING A CUSTOMER TOLERANCE ZONE -THE GIFT FORMULA OUR 2010 CAHPS SCORES FOR THE COMMERCIAL PRODUCT RESULTED IN A RANKING OF 1 IN MICHIGAN FOR CUSTOMER SERVICE AND 4 FOR THE OVERALL HEALTH PLAN RANKING. NATIONALLY, PHPMM'S COMMERCIAL PRODUCT WAS RANKED 40TH FOR OVERALL HEALTH PLAN RANKING. CUSTOMER SATISFACTION AND ASSOCIATE ENGAGEMENT ARE CLOSELY RELATED. WEBSTER DEFINES ENGAGEMENT AS "EMOTIONAL INVOLVEMENT OR COMMITMENT." EVERY CUSTOMER WANTS SOMEONE TO PARTNER WITH THEM, TO SHOW CONCERN AND BE COMMITTED TO THEIR ISSUE AT HAND. MAINTAINING AN ENGAGED WORKFORCE IS THE FOUNDATION FOR DELIVERING COMPASSIONATE AND EXCEPTIONAL SERVICE. PHP PARTICIPATES IN A HEALTH SYSTEM WIDE ANNUAL ASSOCIATE ENGAGEMENT SURVEY CONDUCTED BY KENEXA. THE NATIONALLY RECOGNIZED SURVEY MEASURES ELEVEN DIMENSIONS OF THE WORKFORCE AND PROVIDES REPORTS TO DEPARTMENT TEAMS. THE 2010 SURVEY REPORTED PHP ASSOCIATE ENGAGEMENT LEVEL IN THE 93RD PERCENTILE. FOLLOWING THE ANNUAL SURVEY, PHP INVITES ALL ASSOCIATES TO PARTICIPATE IN GROUP DISCUSSIONS LED BY FRONT LINE STAFF WHERE RESULTS ARE REVIEWED AND IDEAS FOR IMPROVEMENT ARE WELCOMED. TEAMS MAKE RECOMMENDATIONS, THE BEST OF WHICH ARE IMPLEMENTED. OVER THE YEARS, CHANGES HAVE OCCURRED THAT HAVE BECOME PART OF THE PHP WAY OF DOING BUSINESS. SOME OF THOSE INCLUDE: CROSS FUNCTIONAL COMMUNICATION TEAMS, MONTHLY ALL STAFF MEETING UPDATES, ENHANCED ON-LINE ACCESS TO INFORMATION, NEW APPROACHES TO TRAINING, IMPROVED REFERENCE RESOURCES AND MANY MORE. COMMITMENT AND INVOLVEMENT DESCRIBE OUR EXPECTATION FOR STAFF. MAINTAINING A HIGH LEVEL OF ASSOCIATE ENGAGEMENT IS A VERY IMPORTANT PART OF PHP'S DEDICATED EFFORT TO PROVIDE OUTSTANDING SERVICE AND TO ACHIEVE NATIONAL RANKINGS IN OVERALL CUSTOMER SATISFACTION. PROCESS IMPROVEMENTS DESIGNED TO ENSURE THAT PHP MAXIMIZED THE AUTOMATED CAPABILITIES OF ITS CLAIMS PAYMENT SYSTEM WERE THE FOCUS FOR THE INFORMATION TECHNOLOGY DEPARTMENT. AS A RESULT OF THESE EFFORTS, PHP EXPERIENCED EXCELLENT ELECTRONIC DATA INTERCHANGE (EDI) AND AUTO-ADJUDICATION RATES AS WELL AS A REDUCTION IN CLAIM TURNAROUND TIME. PHP ENDED 2010 WITH AN AUTO ADJUDICATION RATE OF 76%, AND AN EDI RATE OF 92%. DAYS RECEIPT ON HAND OF CLAIMS WAS REDUCED FROM 2.4 TO 1.96. MAJOR INITIATIVES: -COMPLETED IMPLEMENTATION OF MENTAL HEALTH PARITY LEGISLATION. -DETERMINED PRODUCT DIRECTION NECESSARY TO SUPPORT HEALTH CARE REFORM LEGISLATION. -IN-SOURCED OUR ID CARD GENERATION PROCESS, RESULTING IN FEWER ERRORS AND MORE FLEXIBILITY IN CARD DESIGN. -BEGAN UPGRADE OF CORE SYSTEM AND WEB PRESENCE TO INCREASE INFORMATION SHARING AND IMPROVE CONSTITUENT EXPERIENCES. -IMPLEMENTED WRAP PRODUCTS TO SUPPORT SALES OF HIGH DEDUCTIBLE HEALTH PLANS. -IMPLEMENTED THE HIP MICHIGAN PRODUCT, A FEDERAL PROGRAM TO PROVIDE COVERAGE TO PEOPLE WHO OTHERWISE WOULD NOT QUALIFY FOR INSURANCE. PHP'S QUALITY IMPROVEMENT PROGRAM CONTINUES TO BE HIGHLY EFFECTIVE AND HAS DEMONSTRATED SIGNIFICANT RESULTS YEAR AFTER YEAR. QI STRUCTURE AND SUPPORT THE QUALITY IMPROVEMENT STRUCTURE REMAINS STRONG. ADEQUATE RESOURCES HAVE BEEN ALLOCATED TO SUPPORT THE INITIATIVES FOR THE CURRENT AND UPCOMING YEAR. THE QUALITY AND MEDICAL RESOURCE MANAGEMENT COMMITTEE RECEIVES |
| MATERIAL DIFFERENCES IN VOTING RIGHTS EXPLANATION | FORM 990, PAGE 6, PART VI | SPARROW HEALTH SYSTEM IS THE SOLE MEMBER OF BOTH PHYSICIANS HEALTH NETWORK AND PHYSICIANS HEALTH PLAN OF MID-MICHIGAN. THE COMPOSITION OF THE BOARD OF DIRECTORS FOLLOWS PHYSICIANS HEALTH PLAN OF MID-MICHIGAN. |
| CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PAGE 6, PART VI, LINE 6 | SPARROW HEALTH SYSTEM IS THE SOLE MEMBER OF PHYSICIANS HEALTH NETWORK AND HAS 100% OWNERSHIP. SPARROW HEALTH SYSTEM IS ALSO THE SOLE MEMBER OF PHYSICIANS HEALTH PLAN OF MID-MICHIGAN. PHYSICIANS HEALTH NETWORK AND PHYSICIANS HEALTH PLAN OF MID-MICHIGAN ARE SEPARATE NOT-FOR-PROFIT ENTITIES BUT ARE OPERATED ON AN INTEGRATED BASIS, AS ONE BUSINESS UNIT. |
| ELECTION OF MEMBERS AND THEIR RIGHTS | FORM 990, PAGE 6, PART VI, LINE 7A | THE BOARD MEMBERS ELECTED BY THE BOARD OF DIRECTORS ARE RATIFIED BY THE BOARD OF DIRECTORS OF SPARROW HEALTH SYSTEM. |
| DECISIONS SUBJECT TO APPROVAL OF MEMBERS | FORM 990, PAGE 6, PART VI, LINE 7B | THE BOARD MEMBERS ELECTED BY THE BOARD OF DIRECTORS ARE RATIFIED BY THE BOARD OF DIRECTORS OF SPARROW HEALTH SYSTEM. DECISIONS BY THE BOARD OF DIRECTORS OF PHYSICIANS HEALTH NETWORK MAY BE SUBJECT TO THE APPROVAL OF THE SPARROW HEALTH SYSTEM BOARD OF DIRECTORS. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 WAS PROVIDED TO THE FINANCE COMMITTEE FOR REVIEW AND COMMENT. UPON COMPLETION OF THIS REVIEW, THE FINANCE COMMITTEE RECOMMENDED RATIFICATION OF THE FORM 990 AND COPIES OF THE COMPLETED FORM WERE PROVIDED TO THE BOARD OF DIRECTORS OF PHYSICIANS HEALTH NETWORK. BASED UPON THIS RECOMMENDATION, THE BOARD APPROVED THE FILING OF THE FORM 990. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | 1) CORPORATE COMPLIANCE SENDS OUT CONFLICT OF INTEREST POLICY AND QUESTIONNAIRES TO ALL VOTING BOARD MEMBERS AND THE EXECUTIVE TEAM ANNUALLY. 2) ALL DISCLOSURES ARE RECEIVED AND REVIEWED BY CORPORATE COMPLIANCE. 3) ALL DISCLOSURES ARE GIVEN A RESOLUTION CODE AND PRESENTED TO THE CEO AND GOVERNANCE COMMITTEE OF THE BOARD. 4) ALL BOARD/COMMITTEE LEVEL DISCLOSURES ARE PROVIDED TO THE RESPECTIVE BOARD CHAIR AND EXECUTIVE LIAISON TO ENSURE ISSUES CAN BE ADDRESSED ON A TRANSACTIONAL LEVEL (I.E. IF A VOTE IS REQUIRED ON A TRANSACTION INVOLVING AN INTERESTED PERSON). |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | THE PROCESS FOR DETERMINING COMPENSATION FOR THE CEO OF THE ORGANIZATION INVOLVED THE FOLLOWING: UTILIZING THE COMPENSATION COMMITTEE, INDEPENDENT CONSULTANTS, REVIEWING OTHER SIMILAR ORGANIZATIONS' 990S, COMPENSATION SURVEYS, AND FINAL APPROVAL BY THE BOARD OF DIRECTORS, AS WELL AS FINALIZING THE SALARY PACKAGE WITH A WRITTEN EMPLOYMENT CONTRACT. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | THE PROCESS FOR DETERMINING COMPENSATION FOR OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION INVOLVED THE FOLLOWING: UTILIZING THE COMPENSATION COMMITTEE, INDEPENDENT CONSULTANTS, REVIEWING OTHER SIMILAR ORGANIZATIONS' 990S, COMPENSATION SURVEYS, AND FINAL APPROVAL BY THE BOARD OF DIRECTORS, AS WELL AS FINALIZING THE SALARY PACKAGE WITH A WRITTEN EMPLOYMENT CONTRACT. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS. THE CONFLICT OF INTEREST POLICY IS AVAILABLE THROUGH SPARROW HEALTH SYSTEM BY REQUEST TO THE SPARROW COMPLIANCE OFFICER. FINANCIAL STATEMENTS FOR PHYSICIANS HEALTH NETWORK ARE AVAILABLE THROUGH REQUEST MADE DIRECTLY TO THE CEO OF PHYSICIANS HEALTH NETWORK. |
| RELATED ORGANIZATIONS | FORM 990, PAGE 7, PART VII | SPARROW HEALTH SYSTEM IS AN INTEGRATED NON-PROFIT ORGANIZATION AND IS THE PARENT CORPORATION FOR PHYSICIANS HEALTH NETWORK AND OTHER RELATED ENTITIES - SEE SCHEDULE R. DENNIS SWAN IS THE PRESIDENT & CHIEF OPERATING EXECUTIVE OF SPARROW HEALTH SYSTEM AND THEREBY SERVES AS THE PRINCIPAL OFFICER WITH ULTIMATE RESPONSIBILITY FOR IMPLEMENTING THE DECISIONS OF THE GOVERNING BODY OR SUPERVISING THE MANAGEMENT, ADMINISTRATION, OR OPERATION OF ENTITIES WITHIN THE SYSTEM. THE FOLLOWING OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES PROVIDE SERVICES TO BOTH PHYSICIANS HEALTH NETWORK AND RELATED ORGANIZATIONS. BELOW IS THE AVERAGE NUMBER OF HOURS DEVOTED TO THE RELATED ORGANIZATIONS: SCOTT WILKERSON - 39 HOURS LARRY RAWSTHORNE - 39 HOURS DENNIS SWAN - 39 HOURS PAULA REICHLE - 40 HOURS DAVID VIS - 35 HOURS HOWARD BURGESS - 39 HOURS CRAIG LESLIE - 39 HOURS JULIA GRIFFITH - 39 HOURS SANDRA WINCHELL - 39 HOURS MARY ANN SESTI - 39 HOURS KEVIN ESSENMACHER - 39 HOURS ANN HUNT-FUGATE - 39 HOURS |
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