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This MAHP award series, launched in 2001, was created to document the innovative change and quest for measurable quality improvement among Michigan managed care plans. The Mercy PHO received the award with GLHP for a collaborative resolution designed to address and resolve an issue affecting the relationship and workload of providers. Every day in every hospital across the country, health plans are denying payment to hospitals for covered care, states MAHP in an award release document. Often full-time nurses are engaged in a struggle to win a payment decision for their organization. Mercy Hospital and GLHP decided to stop the madness. Mercy and the health plan physicians developed a plan to reach consensus on payment at the time of the hospital stay, reducing workload and offering a returned emphasis for staff nurses to focus on safe and timely transition for the patient back into the community. Since its inception, there has not been one appeal from Mercy Hospital regarding reimbursement for patient care. “This is an excellent example of Mercy Hospital’s utilization and case management staff, and local physicians working collectively to ensure high-quality patient care while meeting the Mercy value of stewarding the resources entrusted to us,” comments Marianna Webb, Mercy PHO Executive Director. “Great Lakes Health Plan has been instrumental in working with Mercy in this collaborative effort.” Mercy PHO also was recognized, with a MAHP Best Practice
Nomination, in conjunction with GLHP. Mercy PHO, in cooperation
with orthopedic surgeons on staff at Mercy Hospital, developed
a model that ensured better access for GLHP patients seeking
orthopedic services. This model has been so successful that
it is now being utilized by other GLHP contracted groups
across the State of Michigan.
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