Monday, December 18, 2017

OCMA Blog

Blue Shield Recontracting Effort Expanding to Orange County

Earlier this year, Blue Shield began recontracting with physicians across the state. The California Medical Association (CMA) has learned that physicians in Orange County will be next to see the new contracts.

Blue Shield has assured CMA that if a physician chooses not to sign the new agreement, his or her participation status with Blue Shield will not be affected.

The reason for the recontracting initiative, according to Blue Shield, is twofold: 1) Blue Shield has not done a large scale recontracting with physicians in over a decade, so the new contracts will allow Blue Shield to ensure consistency and compliance with new laws and regulations; and 2) Blue Shield is offering various tiered networks based on price point in anticipation of possible participation in California's Health Benefit Exchange.    

CMA continues to work with exchange stakeholders to address significant concerns regarding the exchange grace period, monitoring of network adequacy and clinician-level performance measurement in qualified health plans offered in the exchange.

Exhibit A of the new Blue Shield contract allows physicians to designate which products they are willing to participate in by product type.

While Blue Shield did update its fee schedule statewide on July 1, there is no fee schedule change associated with this recontracting initiative, with the exception of the Direct Contract HMO Medicare Advantage product.

Physicians are encouraged to carefully review and understand the vast range of legal and practical implications associated with the execution of any new contract and new product types. To assist physicians, CMA has completed an  analysis of the new Blue Shield contract, which is available to members in CMA's online resource library at  http://www.cmanet.org/resource-library.

For additional information on evaluating and negotiating complex managed care contracts, see CMA's contracting toolkit, "Taking Charge: A step by step guide to evaluate and prepare for negotiations with managed care payors."The toolkit is also available free to members in CMA's resource library.

The notice  directs physicians with questions about the new contract terms to contact Blue Shield Provider Services at (800) 258-3091.

Questions: CMA at (888) 401-5911 or economicservices@cmanet.org.


The OCMA is Under New Leadership!

"Helping You Navigate Change"

The OCMA would like to announce the installation of the new

OCMA President, Standiford Helm II, MD 

Dr. Helm is available for one-on-one meetings with individual physicians to discuss relevant issues and concerns. If you would like to schedule a meeting with the new OCMA president, please contact Linda Johansen:

(949) 398-8100 ext. 102 or ljohansen@ocma.org

Standiford Helm II, MD, MBA, President

Standiford Helm II, MD, MBA, serves as OCMA's president. Dr. Helm is the medical director of The Helm Center for Pain Management in Laguna Hills. He is board-certified in anesthesiology and pain medicine. Dr. Helm joined OCMA/CMA in 1986. He has served on the Board of Directors since 2007. He has served on the OCMA Delegation to the CMA from 2005 - 2011, at which time he was elected to the CMA Board of Trustees. He previously served on the OCMA Nominating Committee. In addition, Dr. Helm served as president of OCMA Services, Inc. from 2002-2008 and previously served as a member of the OCMA Services Board from 1998-2002. Dr. Helm has been a member of the AMA since 2003.  

In addition to his memberships in AMA, CMA and OCMA, Dr. Helm belongs to the American Society of Interventional Pain Physicians (where he is currently the immediate past president), California Society of Interventional Pain Physicians (where he served as president from 2002 through July 2008, and currently serves as president emeritus), California Society of Industrial Medicine and Surgery (where he has been a member of the board of directors since 2007), the American Neuromodulation Society and the World Institute of Pain.

Dr. Helm received his medical degree from Tufts University in 1977. His internship in Internal Medicine was completed at Boston City Hospital in 1978. Dr. Helm's residency in anesthesiology was completed at UCLA in 1980. Dr. Helm received his M.B.A. at Pepperdine University in 1988.

Dr. Helm is a member of the following medical staffs: Mission Hospital Regional Medical Center, Saddleback Memorial Medical Center (Laguna Hills and San Clemente campuses), California Specialty Surgery Center, Mission Ambulatory Medical Center, and Saddleback Valley Outpatient Surgery.

Dr. Helm and his wife, Noel, reside in San Clemente. They have three children, one living in Boston, another living in Dallas, and the third living in London. His term of office runs from July 2012 - June 2013.


2012 - 2013 Executive Committee:

President - Standiford Helm II, MD
President-Elect - Thomas C. Kockinis, MD
Secretary-Treasurer - Sudeep Kukreja, MD
Past-President - Joanna K. Tan, MD


2012 - 2013 Board of Directors:

District I - Christian Lising, MD
District II - Rakesh K. Bhola, MD
District III - George Garcia, MD
District III - James E. Pierog, MD
District III - Paul B. Yost, MD
District IV - Quynh D. Kieu, MD
District IV - Smita B. Tandon, MD
District V - Abhay Parikh, MD
District V - William M. Thompson IV, MD
District VI - William E. Callahan Jr., MD
Southern California Permanente - Darla Holland, MD
St. Jude Heritage - Ramesh Rathod, MD
Resident Representative - Deena Ibrahim, MD

 

CEO / Executive Director:

Robert McCann, MHA


Home   |   About Us   |   Membership   |   For Physicians   |   News   |   For Patients   |   Advocacy   |   Events
Copyright (c) 2017 Orange County Medical Association