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Thomas Simmer

last updated 7/29/2018

Thomas L. Simmer

Senior Vice President and Chief Medical Officer at Blue Cross Blue Shield

Location:
600 E. Lafayette Blvd., Detroit, Michigan, United States
HQ Phone:
(313) 225-6668

General Information

Experience

President, Chief Executive Officer and Board Chair - Michigan Department of Community Health

Director of Medical - Health Alliance Plan

Associate Program Director for the Internal Medicine Residency Program - Henry Ford Hospital

Education

Wayne State University's School of Medicine

M. D.

bachelor's degreeUniversity of Michigan

Affiliations

Board Member - Center for Healthcare Research & Transformation

Board Member - Michigan Health Information Network

Fellow - American College of Physicians

Member - Michigan State Medical Society

Member - American Medical Association

Board Member - The Jonah Group Ltd

Recent News  

Officers - Blue Cross Blue Shield of Michigan

Thomas L. Simmer, M.D., Senior Vice President and Chief Medical Officer
Thomas L. Simmer, M.D. Senior Vice President and Chief Medical Officer

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Insurance Committee - Michigan Psychological Association

Thomas Simmer, M.D., Senior Vice President for Health Care Value and Provider Affiliation, and Chief Medical Officer for Blue Cross and Blue Shield of Michigan (BCBSM) - who, importantly, had paid close attention to Dr. Miller's presentation on payment reform - spoke on "The Changing Dynamics of Healthcare: Expanding Coverage and Managing Population Health.
These initiatives depend heavily on sharing information across levels of care, and Dr. Simmer described the "clear chain of trust" in the transmission of healthcare data. The Physician Group Incentive Program (PGIP) and tiered fee payment model is the mechanism that BCBSM has developed to reward practitioners for supporting practice transformation and for improving population-level performance. Specialty practices (such as psychologists') function as PCMH "neighbors," maintaining effective communication, coordination and integration with PCMHs, ensuring appropriate and timely consultations and referrals, and participating efficiently in information sharing. The PGIP operates in the context of Michigan's Physician Organizations (POs), and Dr. Simmer spearheaded BCBSM's efforts, beginning in 2013, to open the POs to psychologists. He noted, however, that despite BCBSM's offer of "bounties" (a $500 premium to POs for each psychologist recruited), the response of the POs has been disappointing. Dr. Simmer noted further that, even when we are part of POs, we face additional challenges in reaping the benefits of the PGIP. Mental health benefits for BCBSM subscribers are often "carved out" to non-BCBSM products, preventing an integrated care model; we are subject to a stricter standard for information sharing of sensitive mental health data; and, because of the nature of our practices, the size of our patient loads is typically very small compared to those of other health care providers, reducing their population-level impact. During the panel discussion, Dr. Nordal challenged Dr. Simmer on BCBSM's practice of applying a portion of our reimbursements to an incentive program from which so many of us cannot benefit, and Dr. Simmer did not dispute her critique.

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