MCPIPA Quarterly Meeting: Enhancing Medical Services in Mesa County

1. WELCOME TO THE FIRST OF THE QUARTERLY R4P MEETINGS MAY 19, 2015 AGENDA • MEET YOUR BOARD MEMBERS • 2014 YEAR END FINANCIAL UPDATE • CHANGE IN REIMBURSEMENT • CMS AUDIT UPDATE • INCENTIVE PROGRAM • CLINICALLY INTEGRATED NETWORKS IN MESA COUNTY • MEDICAID

2. HOUSEKEEPING • Did you sign in? • Do you have your name tag that directs you to the appropriate breakout sessions? • Remember to complete your survey

3. Survey • Suggestions for R4P Quarterly Meeting topics • Suggestions for the 2016 MCPIPA Incentive Program • Volunteer!!!

4. The Shape of Things - this will direct you to the appropriate Breakout Sessions Name Badges are Color Coded by Category of Board Representation Procedural Specialists Primary Care Physicians Non-Procedural Specialists Hospital Based Physicians

5. This Meeting Benefits YOU The IPA Member Mission - Physicians Cooperating to Deliver High Quality Health Care to Our Community Goals of MCPIPA • To improve the affordability and efficiency of health care in this community • To work together to negotiate risk sharing contracts and other arrangements that reward our membership fairly for the delivery of medical services

6. This Meeting Benefits YOU The IPA Member Goals of MCPIPA, continued • To supply the information technology infrastructure to our members that will support integration of services between healthcare providers • To be committed to strategic partnership with RMHP • To expand the base of patients which are treated by our members through clinical integration

7. This Meeting Benefits YOU The IPA Member Goals of MCPIPA, continued • To provide patient education about quality services and cost effective choices that promote informed medical decision making • To promote programs that improve access to care and quality of care for the indigent, uninsured, and underinsured of Mesa County and to maintain the RMHP Medicaid initiative

8. MEET YOUR BOARD MEMBERS Primary Care Physicians Korrey Klein, MD President Family Medicine Josh Campbell, MD Vice-President, Family Medicine Stephanie Shrago, MD, Family Medicine Michael Whistler, MD, Pediatrics

9. MEET YOUR BOARD MEMBERS Joel Dean, DO, Neurology Non-Procedural Specialists David Scott, MD, Allergy/Immunology

10. MEET YOUR BOARD MEMBERS Charles Breaux, Jr., MD Pediatric Surgery Procedural Surgical Specialists Kirk Clifford, MD, Orthopedics

11. MEET YOUR BOARD MEMBERS Todd Hegstrom, MD, Radiology Procedural Hospital Based

12. MEET YOUR CHIEF MEDICAL OFFICER • Greg Reicks, DO • Member of MCPIPA since 1989 • Board Member 2004 – 2013 • Past President of Board • Select, prepare, and train future leaders of MCPIPA • Assist MCPIPA staff and President in agenda development and preparation for Board and Executive Committee Meetings • Serves as MCPIPA Representative for outside entities

13. MCPIPA Updates • Financials • Medicare Audit – where do we stand? • Medical Services Agreement • Changes to Performance Payments • Medicaid Contracting

14. RMHP / MCPIPA's Gross Operating December 31, 2014

15. RMHP/MCPIPA 2014 FinancialsProfit Sharing Calculation by Business Category

16. RMHP/MCPIPA 2014 FinancialsProfit Share

17. CMS Audit Results • Update on current status

18. MCPIPA / RMHP MEDICAL SERVICES AGREEMENT EFFECTIVE JULY 1, 2015 • WITHHOLD NO LONGER APPLIES • CMS AUDITS - The IPA will have no contractual Medicare cost contract audit responsibilities for dates of service beginning July 1, 2015.

19. MCPIPA / RMHP MEDICAL SERVICES AGREEMENT EFFECTIVE JULY 1, 2015 REIMBURSEMENT • COMMERCIAL • Primary care physicians - 165% of current RBRVS • Specialty physicians - 175% of current RBRVS • OB delivery carve out now paid at these rates • MEDICARE • Primary care physicians - 165% of current RBRVS • Specialty physicians - 175% of current RBRVS • Sequestration applies - the rate for ambulatory claims is 5% less

20. MCPIPA / RMHP MEDICAL SERVICES AGREEMENT EFFECTIVE JULY 1, 2015 INCENTIVE PROGRAM AND FUNDING • Funded and designed by MCPIPA physicians • Based on claim submission • Eight Percent (8%) of allowed amount withheld at claim level • Modeling done based on the 165%/175% • $2.4M could be available in the revised Incentive program • about $1M more than is currently available • MCPIPA determines measures, monitors physicians’ progress and distributes the incentive funds on a quarterly basis.

21. MCPIPA Incentive Program • The incentive fund is comprised of three components:

22. Quarterly Comparison - MCPIPA Incentive Program

23. MCPIPA INCENTIVE PROGRAM VALUE OF R4P QUARTERLY MEETING • Meeting And Collaborating With One Another Change to R4P is a result of the 2014 Focus Groups when IPA physicians found value in coming together • Provides forum for updates on current events • Dollar value of Annual Meeting January 27, 2015 based on 1Q2015 incentive funds is • Dollars Available $64,511.00 • Cost of Meeting $13,971.83 • Amount to distribute $50,539.17 • 141 Attendees $358.43

24. 1Q2015 Incentive Measure Results Referral Measure • 1Q2015 Conduct SELF-assessment • SELF = YOU • Results • PCP 80 of 103 or 79% • Specialist 133 of 196 or 68% • Shared Comments • Just this simple exercise has allowed me to see areas for improvement in our EMR templates which are much better! • I learned from IT how to better document “reason for consultation in our EMR. • Talk with lead MA and my MA about sending office notes with plan, stating why referral was made instead of chart summaries that do not contain that information. • I will respond back to the PCP sooner - at least within 48 hours of the visit 75% of the time -currently at 30%

25. 2015 Incentive Reminders • 2Q2015 due July 15, 2015 • PCP – Peer review • Specialist – Second SELF-assessment to compare results of 2Q assessment to goal identified in 1Q2015 • 3Q2015 due October 15, 2015 • PCP – Second SELF-assessment to compare results of 2Q Peer Review to goal identified in 1Q2015 • Specialist – Peer Review • 4Q2015 due January 15, 2016 • PCP – Pre-Visit Collaboration working with Specialist • Specialist – Referring physician review

26. CLINICAL INTEGRATED NETWORK MCPIPA Position • MCPIPA Board of Directors reviewed and determined: • Innovation is needed to help control healthcare costs. • The success of these models depend on physicians and hospitals working together to deliver higher quality care at lower costs.

27. CLINICAL INTEGRATED NETWORK MCPIPA Position, con’t • To allow for exploration of innovative payment methodologies by allowing MCPIPA members to participate in: • The clinical integrated networks being created by both St. Mary’s Hospital and Community Hospital. • The IPA does not waive the contractual restriction prohibiting side agreements for services contracted through the IPAand is not stating that the restrictions do not apply here. • The IPA reserves the right to withdraw the exception at any time it determines the mission of the IPA is not being met by IPA members’ involvement in the networks. • The IPA has tried to remain neutral and has not approached any specific hospital to participate in their CIN.

28. CLINICAL INTEGRATED NETWORKTiered Network

30. MCPIPA / RMHP MEDICAL SERVICES AGREEMENT EFFECTIVE JULY 1, 2015 REIMBURSEMENT • ACC MEDICAID PRIME • Two year pilot remains through June 30, 2016 • Primary care physicians – current rates remain • Monthly Global Payment for attributed patients; risk adjusted by patient condition and based on 125% of State Medicaid Fee Schedule + $4 PMPM; covers E & M codes • All other codes reimbursed at 125% of State Medicaid Fee Schedule • Specialty physicians - 100% of State Medicaid Fee Schedule, decrease from 130% • State Fee Schedule for E & M codes for all providers based on December 2014 Medicare rate • 99213 at 100% is $73.31

31. Mesa CountyShared Saving Potential ACC Medicaid Prime Program

32. Monthly Production Report Example of Risk Score on The Monthly Global Payment Low Risk Score High Risk Score

33. IMPACT OF MONTHLY GLOBAL PAYMENT TO PRIMARY CARE • $339,180.57 • Through March 2015

34. Pre-Auth Elite Program REMINDER • The goals of the Pre-Auth Elite Program are: • To reduce pre-authorization requirements. • Provide support for physicians in making decisions on imaging studies. • Effective January 1, 2015: • Physicians who HAVE obtained Pre-Auth Elite status must recertify each year by reviewing/reading the annual updates to the appropriateness criteria on the ACR web sight. • Physicians who HAVE NOT obtained Pre-Auth Elite status must watch the video. • Once Physicians have watched the video or read the articles an attestation email must be sent to MCPIPA in order to complete your status.

35. Pre-Auth Elite Program REMINDER TO MEET YOUR 2015 PRE-AUTH ELITE REQUIREMENTS As of May 15, 2015, 59 or 20% of MCPIPA members have met the 2015 Recertification requirement.

36. Pre-Auth Elite Program • Go to WWW.mcpipa.org • User name and Password is mcpipadoc - lower case

37. SAVE THE DATE AUGUST 18, 2015 • 3Q2015 R4P QUARTERLY PHYSICIANS MEETING • Share your ideas for topics • More details to come

38. Breakout Sessions Name Badges are Color Coded by Category of Board Representation Primary Care Physicians Procedural Specialists Non-Procedural Specialists Hospital Based Physicians

39. Thank you Physicians Cooperating to Deliver High Quality Health Care to Our Community

40. Questions?