Our Vision:


© Copyright San Juan Independent Practice Association, 2018. All Rights Reserved.


Recent News: UPDATED 11/26/2018
  1. To ensure that a heath care delivery system is in place, which provides available, accessible and adequate numbers of facilities, locations, and personnel for the provision of health care services.
  2. To ensure that a health plan members are provided covered services without regard to race, color, creed, sex, religion, age, national origin, ancestry, marital status, sexual preference or physical or mental handicap.
  3. To ensure that the SJIPA has in place the organizational and administrative systems capable of messaging medical services contracts between providers and third party vendors
  4. To ensure that the quality of care to all patients continues at the highest level of  care possible.  
  5. Provide support for community health education and wellness.


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The San Juan IPA was founded in 1986 by a group of 21 community physicians to partner with

insurance companies with the goal of improving the quality of care to patients while simultaneously

decreasing the cost of care to those payers. Originally formed with a “Quality Assurance Committee”,

the San Juan IPA has grown to over 450 members representing 39 specialties and sub-specialties

in 70+ offices across New Mexico, a HEDIS quality review function, a Credentialing Committee,

and a care management committee component.


As an NCQA-accredited organization, San Juan IPA’s core services of contracting and

credentialing are complemented by an array of expanding resources for the physician office,

helping keep practice costs low and quality of care high.  We continually look for ways to

promote new quality initiatives both within and outside the practice walls for patients and employers.

                          

The information contained within this message is for your use, in order to inform you of any changes that may be occurring at the San Juan IPA, or within the medical community. Please read each message carefully, as they contain important information that may directly affect your practice.


All San Juan IPA Contracted Members: Contract Updates & Centennial Care 2.0 Update


Presbyterian: San Juan IPA has concluded the contract negotiations with Presbyterian and has executed the new contract.  Members can expect to see ballots from the IPA next week for that line of service.


Western Sky/Centene: San Juan IPA has just completed the redline for the base contract, Centennial Care, and Medicare lines of business for this MCO and have returned the contracts to them for review and further negotiations.  The payer has been very good to work with and we’re optimistic that this will be done before the first week of December.


BCBSNM: The MCO has placed, in writing, that it is their position that providers should not control their own contracting.  As our members are well aware, it is San Juan IPA’s absolute position that providers should control their own contracting as our response to BCBSNM demonstrates:


San Juan IPA absolutely believes that the provider has the ultimate right to contract with the payer as they see best for their facility or practice.  Or, to put it another way: the provider sees the patients, in their facilities, within legal, medical and ethical boundaries.  There is an agreement between parties that those patients will be seen for agreed-upon reimbursement terms and other terms that are consistent with those boundaries.  Within that framework BCBSNM is ultimately a third party entity that reimburses for those services, and, without a doubt, every provider should have the ultimate right to evaluate that third party, determine if contracting with that party is of benefit to the facility, and under what terms they should contract.  Equally, BCBSNM has the right to evaluate the provider and determine if the provider meets the quality standards and needs of its Members. “


(Emailed to BCBSNM 10/29/2018)


San Juan IPA has not received any further communication from BCBSNM.  We are very aware that current members and new members coming on with the IPA are watching this situation closely, and we have made it clear to BCBSNM that we stand ready to move forward with Centennial Care 2.0 as soon as the payer recognizes the provider’s right to contract under the IPA.  In the meantime, we have been informed by the New Mexico Office of the Superintendent of Insurance (OSI) that our complaint has been referred to their Civil Investigative Division.  We see this as an important and positive step in getting this issue resolved.  Relative to our new providers, we are also aware of BCBSNM provider reps being particularly aggressive with our newest members, telling them that they “don’t see what the problem is, just sign the contract” and (one of my favorites) “just sign the contract, we’ll negotiate later”.  The IPA is working with these providers to help them understand their options, outcomes, and risks associated with any particular course of action.  Of course we are here as a resource to all members so please let us know if you have any questions.


Casey Crotty

Chief Executive Officer

San Juan IPA and Affiliates