Mesa County Physician’s IPA Accountable Care for Mesa County

1. Mesa County Physician’s IPAAccountable Care for Mesa County Physicians Cooperating to Deliver High Quality Health Care to Our Community Gregory Reicks, D.O., FAAFP President Mesa County Physician's IPA

2. Mesa County Physician’s IPA “One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare’s highest quality-of-care scores” “Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care”.

3. Mesa County Physician’s IPA Price adjusted Medicare Payments/Enrollee 2008

4. Mesa County Independent Physicians Association 35 Year History • Risk contracting • Clinical Integration • 295 Members • 40% Primary Care

5. Mesa County Physician’s IPA • Lines of business: HMO • Private Pay (Commercial) • Medicaid (ASO Contract) • Medicare (Cost Contract) • Dual Eligible (Medi/Medi) • CHP+ HCO • PPO • Self-funded • Initial claims paid net of a withhold: • 15% of allowed for HMO, Medicare, HCO-PPO plans • 15% of allowed RMHP Medicaid fee schedule • 0% of allowed for HCO-self funded plans • Withholds released on a profit-sharing formula: • MCPIPA/RMHP share 55 / 45 in first ~$9 million • Balance shared at 80 / 20 until full W/H returned

6. Mesa County Physician’s IPA

7. Mesa County Physician’s IPA Historical Withhold Return

8. Mesa County Physician’s IPA + 53%

9. What the Evidence Shows • Delivery System Reform Without Payment Reform Does Not Work • Investing in Primary Care Works • Cost Accountability Works

10. What Do We Mean by Payment Reform?

11. What Do We Mean by Payment Reform?

12. Isn’t This Capitation? No.

13. Mesa County Physician’s IPA Thank you