University of Michigan Health Medicare

“Physician health plan (php) is the sole member of php medicare. Php holdings is the parent and sole member of php and has 100% ownership. Php holdings is owned by sparrow health system (shs) at 75% and michigan medicine at 25%.”

“The board members elected by the board of directors are ratified by the sparrow health system board of directors. Decisions of the php medicare board of directors are subject to approval by the sparrow health system board of directors.”

“The board members elected by the board of directors are ratified by the sparrow health system board of directors. Decisions of the php medicare board of directors are subject to approval by the sparrow health system board of directors.”

“Copies of the 2020 form 990 will be reviewed by management. Once management has completed its review of form 990 copies will be provided at the fall board meeting for all board members to review and comment on.”

“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).”

“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 the officers and 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 medicare 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 (parent of php which is parent of php medicare) by request to the sparrow compliance officer.”

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

“Php medicare is a non-profit health maintenance organization (hmo). Php medicare uses a primary care concept for delivering health care in a health delivery network (hdm) structure. It arranges for the provision of comprehensive outpatient and inpatient medical and surgical services to members on the basis of a fixed prepaid sum without regard to the frequency or extent of services furnished to any particular member. Php medicare's commitment is to develop and deliver quality managed care products at a reasonable cost for its members. Php medicare is wholly owned by php. Php is primarily a commercial hmo. Along with php medicare, php operates php insurance company (phpic), a commercial insurance company and php service company, a third party administrator. All staffing functions and reporting are accomplished through the use of the same staff as php. Unless specifically noted, all references to php apply to php, phpic, and phpma. Phps service area includes the michigan counties of ingham, eaton, clinton, shiawassee, montcalm, gratiot, ionia, jackson, hillsdale and portions of isabella, saginaw, washtenaw, and lenawee. Php ic offers products across michigan. As of december 31, 2020, there were approximately 30,500 enrollees in phps commercial hmo, 17,200 in tpa, 3,200 in php-ic, and 3,600 enrollees in phpma. Php contracts directly with physicians health network (phn). The php network is approximately 870 primary care physicians, 1,366 specialty care physicians, 834 allied health professionals, 1,202 behavioral health providers and 648 organizational providers that include 36 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 an 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. -hedis measures the health plan effectiveness data and information set (hedis) is a group of nationally recognized measures of health plans 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 screening, - 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 ass”

“Capital contributions 8,600,000”