Imagine going to see your doctor and receiving some potentially devastating news about your health. On top of that, the doctor is recommending you go out of state for more tests and treatment. You panic and your mind is whirling with countless concerns and questions.
“We had a case like that recently,” says Gail Doran, chief operating officer for Physicians Health Plan of Northern Indiana (PHP). “We were asked by an employer group if we could help one of their employees in that situation. The patient wanted to stay local – they did not want to leave the state for care. So we were able to step in and coordinate the doctors that person needed to see and identify the facilities where they needed to go for treatment. It wasn’t done with a lot of paperwork or a report or a number. To us, it’s a name and a person and a medical diagnosis. And we have case managers who step in and help them, talking with the member and the doctor all the while.”
“Being a local health insurance company offers us a huge advantage,” says Dr. Mark King, DO, FAAFP, who practiced family medicine in Fort Wayne for 31 years before joining PHP last winter as associate medical director. “Helping our members becomes personal to us. Because of my background, I know most of the medical professionals in town and we can collaborate with them to find answers for patients. At PHP, it’s not a matter of authorizing or denying care to a patient. It’s about helping that person to navigate through a difficult process.”
PHP was founded 35 years ago as a physician-sponsored, nonprofit health insurance company, headquartered in Fort Wayne. Over the last three decades, it has earned a well-respected reputation for providing local assistance to meet the specific insurance needs of Indiana residents.
Dr. King says one of the most unique qualities about PHP is the team of nurses and social workers who make up the case management team.
“People who are dealing with a life-changing medical diagnosis need help and hope. With PHP, you’re not dealing with a big insurance company.”
– Dr. Mark King, DO
“I am constantly amazed by our team of case managers that will go as far as visiting a member’s house to help them in person. People who are dealing with a life-changing medical diagnosis need help and hope. With PHP, you’re not dealing with a big insurance company and talking on the phone to people who are far away and having to go through several layers of management to get answers. We are right here in Fort Wayne for our members, which is really nice.”
That local connection not only exists when it comes to visits to a physicians’ office, but also pharmacy visits.
“It’s not at all uncommon for one of our members to be at a pharmacy and have a question about the prescription they’re getting and for the pharmacy staff to say ‘you need to talk to Dale’,” says Dale Bultemeier, PD, director of pharmacy at PHP. “I personally answer the phone and make return calls to members, too. A lot of people are surprised to hear directly back from a pharmacist. Again, it’s just that local flavor that you wouldn’t get if you were using a mail order pharmacy. It’s standard etiquette to us, but it doesn’t seem to be the norm anymore.”
“Health care is confusing and complex, but there are ways to use us as a resource to help guide and direct things both to the member’s benefit and also to the physicians who are directing care,” says Dr. James Wehrenberg, PHP Medical Director. “It’s a win-win situation for both parties.”
“Health care is very personal, but health insurance is seen as a commodity where price drives everything,” says Doran. “What the industry deems as cost savings is frequently portrayed as saving money by denial of care. We have found just the opposite to be true. Our mantra is, ‘The right person, the right care, the right time, the right place.’ Those are the words we truly honor and offer at PHP.”
This article was originally written and formatted for BusinessPeople Magazine and published on September 7, 2018. The article written by Jennifer Blomquist with photography by Jeff Crane.
