University of Michigan Health Plan

What it reported doing in 2024

Physician health network (phn) is a non-profit health delivery network (hdn). In conjunction with its sister corporation university of Michigan health plan healthcare services are delivered to its members using a primary care concept in an hdn structure. University of Michigan health plan is a licensed health maintenance organizations (hmo) and arranges for the provision of comprehensive outpatient and inpatient medical and surgical services to members and their qualified dependents on the basis of a fixed prepaid sum without regard to the frequency or extent of services furnished to any particular member or qualified dependent. Phn and university of Michigan health plan are committed to development and delivery of quality managed care products at a reasonable cost for its members. Physician health network and university of Michigan health plan are wholly owned by university health system. University of Michigan health plan is primarily a commercial hmo and also operates three subsidiaries, university of Michigan health insurance company, a commercial insurance company, university of Michigan health medicare, a Michigan medicare plan, and university of Michigan health service company a third party administrator. All staffing functions and reporting are accomplished through the use of the same staff as university of Michigan health plan. Unless specifically noted, all references to uofm health plan apply to uofm health plan, uofm health insurance company, uofm health service company and uofm health medicare. Uofm health plan's service area includes the Michigan counties of ingham, eaton, clinton, shiawassee, montcalm, gratiot, ionia, jackson, hillsdale and portions of isabella, saginaw, washtenaw, and lenawee. Uofm health insurance company offers products across Michigan. As of december 31, 2023, there were approximately 28,100 enrollees in uofm health plans's commercial hmo, 25,300 in tpa, 2,300 in uofm health insurance company, and 8,300 enrollees in um health medicare. The uofm health plan network is approximately 3,068 primary care physicians, 5,503 specialty care physicians, 3,906 allied health professionals, 3,482 behavioral health providers and 746 organizational providers that include 60 hospitals. Uofm health plan contracts with various hdns who provide healthcare services to members. Uofm health plan's commitment is to develop and deliver quality managed care products at reasonable costs for its members. Uofm health plan's 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 uofm health plan to arrange for healthcare to patients covered by the state of Michigan's 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. Uofm health plan 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 hdn's network. Uofm health plan offers a variety of healthcare programs, or products to groups and individuals. Uofm health plan offers choices that provide coverage within the network of contracted hdn providers, limited coverage outside of the uofm health plan network, various levels of deductibles, co-payments, and coverage limits, all of which are designed to be responsive to customer needs. Uofm health plan 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-cli

Financial Efficiency

• Mission deployment rate: 93.6%; rating input score 94
• Program expense ratio: 100%; rating input score 100
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 100%; rating input score 100; 68th percentile among comparable filings
• Pay-setting controls: 6 of 6 controls in place; rating input score 100
  • Compensation committee: Pass
  • Independent consultant: Pass
  • Other Form 990s reviewed: Pass
  • Written employment contract: Pass
  • Compensation survey or study: Pass
  • Board or committee approval: Pass
• Foreign activity oversight: Limited
• Grant itemization coverage: Limited
• Major donor itemization: Limited
• Related-party transparency: Yes; rating input score 100

Accountability

• Independent voting board: 44.4%; rating input score 44; 12th percentile among comparable filings
• Governance controls: 9 of 9 controls in place; rating input score 100
  • Conflict-of-interest policy: Pass
  • Whistleblower policy: Pass
  • Document-retention policy: Pass
  • CEO compensation review process: Pass
  • Other executive compensation review process: Pass
  • Form 990 shared with the board: Pass
  • Board meeting minutes documented: Pass
  • Audit committee oversight: Pass
  • Independent financial-statement audit: Pass

Sustainability

• Operating margin: 6.4%; rating input score 62; 62nd percentile among comparable filings
• Total-asset coverage ratio: 0.02; rating input score 1; 1st percentile among comparable filings
• Liabilities to assets ratio: 3.66; rating input score 1; 1st percentile among comparable filings
• Officer compensation ratio: 0.9%; rating input score 75; 75th percentile among comparable filings

Growth

• Program expense growth: -4.1% per year; rating input score 0; 3rd percentile among comparable filings
• Revenue growth: -2.9% per year; rating input score 0; 2nd percentile among comparable filings
• Asset growth: -8.7% per year; rating input score 0; 1st percentile among comparable filings