University of Michigan Health Plan

“Sparrow health system (shs) is the parent and sole member of physicians health plan and has 100% ownership.”

“The non-enrollee members of the board of directors of physicians health plan are ratified by the board of directors of sparrow health system.”

“The non-enrollee members of the board of directors of physicians health plan are ratified by the board of directors of sparrow health system. The decisions of the physicians health plan board of directors may be subject to the approval of the board of directors of sparrow health system.”

“Copies of the 2015 form 990 are reviewed by management. Once management completed its review of the form 990 copies were provided at the september 2016 board meeting for all board members to review and comment on.”

“1) corporate compliance sends out the 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).”

“The process for determining compensation for the ceo involved the following: utilizing the compensation committee, using independent consultants, reviewing other similar organizations' 990s, using compensation surveys, and final approval by the shs board of directors, as well as finalizing the salary package with a written employment contract.”

“The process for determining compensation for officers or key employees of the organization involved the following: utilizing the compensation committee, using independent consultants, reviewing other similar organizations' 990s, using compensation surveys, and final approval by the shs board of directors, as well as finalizing the salary package with a written employment contract.”

“The governing documents, conflict of interest policy and financial statements are made available to the public as follows: the governing documents of php are submitted to the department of insurance and financial services (difs). Those are publicly available to interested parties. The conflict of interest is available through sparrow health system by requesting the policy from the sparrow compliance officer.”

“All lines left blank are not applicable to the organization.”

“Php no longer administers the temporary high risk insurance pool program that previously provided health insurance coverage to uninsured individuals with pre-existing conditions. This program was a temporary program set to terminate as of june 30, 2013. As of 12/31/14 there were no members enrolled in the program and no expenditures incurred after this date.”

“Clinton, shiawassee, montcalm, gratiot, ionia, and isabella. Phpic offers products across michigan. The sparrow php product is available to medicaid enrollees in eaton, clinton, ingham, ionia, montcalm, isabella, and shiawassee counties. As of december 31, 2015, there were approximately 34,000 enrollees in phps commercial hmo, 14,700 in tpa, 9,000 in phpic, and 21,600 enrollees in sphp. Php and sphp contract directly with physicians health network (phn), a wholly owned subsidiary of sparrow. The php network is approximately 1,030 primary care physicians, 1,816 specialty care physicians, 800 allied health professionals, and 1,180 organizational providers that include 45 hospitals. Php contracts with various hdns who provide healthcare services to members. Phps commitment is to develop and deliver quality managed care products at reasonable costs for its members. Phps 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 php to arrange for healthcare to patients covered by the state of michigans 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. Php 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 hdn, is not available within the hdns network. Php offers a variety of healthcare programs, or products, to groups and individuals. Php offers choices that provide coverage within the network of contracted hdn providers, limited coverage outside of the php network, various levels of deductibles, co-payments, and coverage limits, all of which are designed to be responsive to customer needs. 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.”

“Reclass between revenue & expense 973,475 aca taxes/fees -1,978,517 reinsurance -1,910,512 reclass between revenue & expense -973,475 aca taxes/fees 1,978,517 reinsurance 1,910,512”