Top 10 Things You Should Know About SecureCare
Check Your Dashboard, Find Your Clinical Profile, and View Your Rolling 12-Month Data
By: Dan Spencer, DC, Chair, MAC Legal Affairs Committee
As Chair of the MAC Legal Affairs Committee, I serve as part of the MAC team that is representing our interests as Blue Cross Blue Shield of Michigan implements their new utilization management company, SecureCare. I am proud to be working with Dr. Ken Murkowski, II, Chair of the MAC Insurance Relations Committee, and the MAC’s esteemed Executive Director, Kristine Dowell, on this critical issue.
Utilization management… everyone’s favorite topic, right?!
I get it…none of us want our care to be scrutinized in any way and we certainly don’t want any interference with our doctor-patient relationships. I think it’s also safe to say that we DEFINITELY don’t want any extra work for us and our staff, either! We completely understand.
Dr. Murkowski and I practice under the same set of circumstances with Blue Cross as you do.
The reality is that Blue Cross has the right to have utilization management whether we like it or not. You may recall just a few years back when Blue Cross planned to contract with another UM company (let’s call them “EviltotheCore!”).
We owe a HUGE debt of gratitude to Kris Dowell, as her work was really the reason why Blue Cross doesn’t currently employ a UM company that has six-visit per year caps on all patients, regardless of their condition.
That would have been disastrous for patients and doctors alike.
If you want to participate in the networks that Blue Cross has available, you WILL be subject to utilization management... that is simply a fact. Our goal is to ensure that it is done appropriately and fairly.
I remind you that we’ve certainly had issues over the past few years with the Blues’ previous UM company, as you would be immediately disaffiliated if your average cost was significantly higher than your peers. You had no chance to explain WHY your costs may be higher, such as having a specialized practice that cares for the worst of the worst cases.
As of July 5th, that has all changed.
With this in mind, and with apologies to David Letterman… this article will outline the Top 10 Things You Need to Know About SecureCare!
#10 – SecureCare is NOT a Network in Michigan
SecureCare is ONLY performing utilization management services in Michigan. In other states, they do serve as a network, so our situation is different from what your colleagues across the nation may have in place.
It is important to remember that the SecureCare UM team is comprised of practicing chiropractors and that we are not being charged by BCBSM for this particular element of the process. (Surprisingly, BCBSM did want to charge us, but thanks to the persistence of Kris Dowell, they agreed to absorb these costs without passing them on to us.)
Also important is the fact that SecureCare is wholly owned by the Nebraska Chiropractic Physician’s Association.
#9 – There Are No Preauthorizations or Takebacks
Doctors are evaluated on the services that are approved by Blue Cross each month. Every calculation that goes into your profile is only AFTER services have been rendered and the claim has been processed.
#8 – There Are No Visit Caps Outside of the Patient’s Policy Limits
Remember that other UM vendors often utilize visit caps for ALL patients, regardless of their health status. Also important is that even if a policy includes “UP TO 24 medically necessary visits per calendar year,” that doesn’t mean that 100% of your patients meet the criteria of necessity, according to BCBSM’s provider manual.
#7 - Only Three BCBS Networks Are Evaluated
Only the Trust Network (PPO), BCBS Medicare Advantage (NOT including supplemental plans), and Federal plans are included. Out-of-state and MESSA plans are not subject to this UM program.
#6 – Check Your Dashboard Every Month
You should all be registered to access your personal portal, available at https://portal.securecarecorp.com. If not – or you need some help understanding the process – please contact SecureCare at their website, Securecarecorp.com.
More On Your Personal Portal
- On or around the 15th of each month, your rolling 12-month data is available.
- You can easily find your clinical profile and see the trendline over the past year.
- Your profile is the average amount of approved services from all of that specific network’s beneficiaries for the past year.
- Approved charges under Federal Blue Cross/Blue Shield are calculated with the regular PPO report.
- The dashboard will help you understand if you are in compliance or not.
- A simple ‘stoplight’ approach is used so you can tell right away what your status is.
- Green – you are good to go!
- Yellow – you are close to the clinical benchmark.
- Red – you are over the benchmark.
#5 – If You Have a Multi-Doctor Clinic, Also Check Your CLINIC Profile Monthly
To be a fair comparison between multi-doctor clinics and single-doctor clinics, SecureCare’s process essentially follows the patient in your clinic. To give you an example of what this means, say a patient visits a single practitioner eight times over the course of a year.
Now, if that same patient visits a clinic where there are three doctors and sees each of them eight times, that is a total of 24 visits for the year for that patient in that clinic.
So, the single-doctor’s 8 visits and the multi-doctor’s 24 visits are not the same thing at both clinics, as the PATIENT was seen three times as often in the multi-doctor clinic.
#4 – Uplifts Are NOT Penalized
If you are receiving an uplift in your payments from BCBSM, this will not penalize you when weighing your profile against the clinical benchmark.
- The PPO has 5 and 10% uplifts possible if you participate in the PO program.
- MIBAC has separate 2% and 5% uplifts that also may apply to you.
In short, you may be receiving up to a 17% uplift in your payments, and that is not an issue if the benchmark is exceeded.
As for a Medicare Advantage plan, you may be receiving a 10% uplift in HPSA’s (Health Professional Shortage Areas) in either rural or urban locations.
#3 – DCs Are Still Contracted With BCBSM
BCBSM is the organization you have a contract with, not SecureCare. Any decisions on network participation are made by BCBS.
SecureCare is a consultant for BCBS that performs only utilization management services.
Additionally, SecureCare is not undertaking any audits—that is still something done by BCBSM.
#2 – Clinical Benchmark Is Not the Only Factor
The clinical benchmark is not an amount at which you will be “cut off.”
Approximately 90% of our doctors have a profile that is currently under that benchmark. The benchmark is the amount that SecureCare uses as a baseline to ensure that necessary services are being provided to patients.
- If your profile exceeds the benchmark, you may need to send in your records for a subset of patients for chart review.
- If your records don’t show necessity of care, you will be required to receive additional education (or potentially face disaffiliation from BCBSM).
- If your records show that the care you provide is justified, we have been assured that you will, not have an issue with network participation.
The bottom line is that we should not fear a number like we did with previous UM companies – We should fear poor documentation.
And the #1 Thing You Should Know About SecureCare is….
The MAC is always working for YOU!
MAC Executive Director Kristine Dowell, Insurance Committee Chair Ken Murkowski, and I have been meeting regularly with the SecureCare team to ensure that all our collective concerns as a profession are addressed and all questions answered.
I have found it refreshing to be able to actually communicate with the utilization management company, as this was definitely NOT the case previously.
Finally, I believe we are off to a good start with the SecureCare team. I can tell you that SecureCare has heard our concerns regarding unfair BCBSM payment policies, diagnosis codes allowed, and more. We believe we can work well together to help resolve these issues.
Thank you for listening, and please do not hesitate to contact the MAC at Kris@chiromi.com or (517) 367-2225 if you have any questions or concerns.
Palmer graduate Dr. Dan Spencer is Chair of the MAC’s Legal Affairs Committee. He was also just recently elected to serve as Chair of the Chiropractic Summit, the national organization created in September 2007 in recognition of the profession’s desire for unity. He is Immediate Past President of ChiroCongress, and he serves on the Future of Chiropractic Strategic Plan’s Government Affairs Workgroup. A member of a chiropractic family – his father, brother, and sister are all Palmer grads – Dr. Spencer has been active in his state association since graduating from Palmer in the Centennial Class of 1995. Dr. Spencer served on the transition executive committee during the historic merger of the previous associations in forming the MAC, and he served as President of the MAC in 2011–2012 and Chairman of the Board in 2013–2014. He was honored as MAC “Chiropractor of the Year” in 2012 and was presented MAC President Dr. Lisa Olszewski’s President’s Award earlier this year.