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WELCOME TO THE SPECIAL ALL PHYSICIANS MEETING October 10, 2017

WELCOME TO THE SPECIAL ALL PHYSICIANS MEETING October 10, 2017. AGENDA 2018 MCPIPA Incentive Program The IPA Today…Our Opportunity. HOUSEKEEPING. Did you sign in? Use your cell phone or iPad to respond to questions.

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WELCOME TO THE SPECIAL ALL PHYSICIANS MEETING October 10, 2017

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  1. WELCOME TO THE SPECIAL ALL PHYSICIANS MEETING October 10, 2017 AGENDA • 2018 MCPIPA Incentive Program • The IPA Today…Our Opportunity

  2. HOUSEKEEPING • Did you sign in? • Use your cell phone or iPad to respond to questions. • Remember to complete the comment card. We appreciate your responses and will share the detail with the MCPIPA Board of Directors for help in their decision making about the future of MCPIPA

  3. MCPIPA 2018 INCENTIVE PROGRAM • Each year the incentive measures are designed by physicians – your colleagues. The Incentive Design and Development Committee includes: • Ivan Alkes, M.D. • Matthew Donaldson, M.D. • Dan Harris, M.D. • Steve Heil, M.D. • Sandy Horvath-Dori, M.D. • Logan McDaneld, M.D. • Tom Motz, D.O. • Education will be shared to all practices January 2018

  4. MCPIPA 2018 INCENTIVE PROGRAM • Main Focus on Safe Opioid Prescribing. Goal: To standardize opioid prescribing in this community • Administrative Measure - Technology and Referral Process • Value at 25% • Completed at a practice level. Accessing the PDMP; Utilizing QHN subscription; Uploading and/or searching Pain Contracts in QHN; and Auditing and Improving the Referral Process. • Quality Measure - Safe Opioid Prescribing – • Value at 75% • Completed at a physician level. Attend education sessions on CDC Pathways; PDMP use; safe opioid prescribing; and practice policy on opioid prescribing.

  5. WELCOME NEW MCPIPA MEMBERS Richard Cappiello, M.D. Rheumatology Arthritis Center of Western Colorado Bjorn Irion, M.D. Sports Medicine Western Orthopedics and Sports Medicine Ryan Jackman, M.D. Family Medicine St. Mary’s Family Medicine

  6. WELCOME NEW MCPIPA MEMBERS Elisabeth Scalva, M.D. Ob/Gyn Women’s Health Care of Western Colorado Karlynn Sievers, M.D. Family Medicine St. Mary’s Family Medicine

  7. MCPIPA STAFF CHANGES • Welcome to Carolyn Farrow, Administrative Assistant • Farewell to Donna Neste, Clinical Programs Coordinator

  8. The Direction MCPIPA Takes Moving Forward The changing healthcare environment in Mesa County… MCPIPA’s role Make MCPIPA Great Again

  9. The Direction MCPIPA Takes Moving Forward DECISIONS: • Board of Directors has spent past 12 months on Strategic Planning in response to changes in Mesa County – the discussions continue • To expand our continued capabilities for network contracting and broad physician participation in Quality Improvement and Value Based Payment opportunities

  10. Why is Redesign Necessary? The Changing Health Care Market • Desire to Lower Health Care Costs • Employer Groups Need Options • Creation of Narrow Networks • Community Hospital created their own narrow networks – Grand Valley Preferred Network, CHPO, Community Health Partners, Mountain Enhanced • Monument Health created aligning RMHP with SMH

  11. Why is Redesign Necessary? The Changing Health Care Market Continued • United HealthCare Acquired RMHP • Payer demands are changing • Payer mix has changed • Medicaid expansion • Increasing self-insured market • Fewer traditional plans • Potential to Increase Medicare Advantage Plans

  12. Why is Redesign Necessary? Structure of MCPIPA is Changing • Shifting balance from independent physicians to hospital employed and aligned physicians • MCPIPA membership changes • IPA revenue balance is shifting

  13. CURENT MCPIPA MEMBERSHIP246 PHYSICIANS • SMH Employed 69 28.05 • SMH Aligned 13 23.05% • CH Employed 30 12.30% • CH Aligned 7 2.87% • FHW Employed 12 4.88% • FHW Aligned 1 0.41% • Non-Employed 114 46.34% or Aligned

  14. MCPIPA MEMBERSHIP DETAIL Total Membership 246 • Primary Care Physicians 57 23.17% • Specialty Care Physicians 189 76.83%

  15. KEEP THE IPA • Yes • No

  16. KEEP THE IPA Given the current market forces it may be time to consider that MCPIPA has run its course. • Disadvantages of our current IPA • Physician must meet requirements for Clinical or Financial Integration. • Reporting burden for physicians • Administrative cost for physicians • Time burden • Withhold or incentive funding

  17. KEEP THE IPA • Advantages of an IPA • Referral patterns with fellow IPA members • Centralized support for quality measures • IPA pays QHN dues • Effective physician collaboration • Access to care for patients with commercial and government plans • Contracting with payers • Broad based quality of patient care • Unified physician voice on how health care is delivered in Mesa County

  18. KEEP THE IPA Did we miss anything on the advantages or disadvantages? Keep the IPA • Yes • No *IPA leadership does not consider disbanding the IPA as a viable option

  19. Audience Engagement System • The polling system you are participating in this evening is only a tool for this meeting. • This is not a formal vote of the membership in a legal sense. • This process will allow the Board to understand the wants and needs and thinking of the membership • It is possible that the members may say they want something and for the board to go in a different direction due to factors of which the membership is not aware.   

  20. How to Participate with Poll Everywhere System To Access the Poll Everywhere System Please Follow the Following Link. PollEv.com/MCPIPADOCS150 Having trouble? Raise your hand and we will have someone come and assist you.

  21. SHOULD THE IPA CHANGE? • A =DON’T CHANGE • B = IPA OF ONLY THE INDEPENDENT PHYSICIANS • C = RESTRUCTURE

  22. Reasons for Change • Loss of membership • Decrease in funding • Affordable Care Act • Shifting needs of health plans • Monument Health

  23. Option A: DON’T CHANGE Maintain the existing structure and membership requirements • PROS • Infrastructure is built • Incentive Programs are in place, valuable, and help physicians and practices meet other regulatory requirements • Fair contract with RMHP

  24. Option A: DON’T CHANGE Maintain the existing structure and membership requirements • PROS, continued • IPA pays QHN dues for IPA Members • Maintains physician collaboration in Mesa County • Best access for Medicare and Medicaid patients

  25. Option A: DON’T CHANGE • CONS • Beholden to RMHP • Funding mechanism is worsening and not likely to improve • Hospitals have veto power on how their employed providers participate in contract(s) • Difficult to quickly adapt to market forces, i.e., impact on budget • We don’t know how long the current RMHP contract is sustainable

  26. Option B: IPA OF ONLY THE INDEPENDENT PHYSICIANS • An Independent Physician is a physician who is not employed or closely aligned with one local hospital • Aligned - more than 90% of business is with one entity • For effective integration to occur physicians would participate in the IPA’s joint contracts.

  27. Option B: IPA OF ONLY THE INDEPENDENT PHYSICIANS • PROS • Most flexible, much smaller • No hospital veto power over contracts • Less costly to administer • Could take more risk and be more robust as a Clinically Integrated Network. • Tightening of the Clinically Integrated Network

  28. Option B: IPA OF ONLY THE INDEPENDENT PHYSICIANS • PROS, continued • Joint Contracting • Physicians benefit from the IPA’s ability to contract • Most payers like this aspect • More focused payer engagement • We don’t know how long the current RMHP contract is sustainable

  29. Option B: IPA OF ONLY THE INDEPENDENT PHYSICIANS • CONS • Less collaboration between independent physicians and hospital employed or aligned physicians • Carriers may not find a smaller network as appealing • Medicaid chaos • Loss of economies of scale for funding the IPA • We don’t know how long the current RMHP contract is sustainable

  30. Option C: RESTRUCTURE Keeps the Membership Intact Maintain the membership which supports both the independent physicians and the hospital employed and aligned physicians. • As a CIN, a redesign of the structure is necessary • Support MCPIPA’s quality programs • Joint contracting • Moving physicians direct contracts to an IPA contract • Sanctions for lack of participation • Different categories of membership

  31. Option C: RESTRUCTURE Keeps the Membership Intact • PROS • Increased flexibility • Allows Independents to contract without hospital veto power • No tiering of IPA members • Hospital employed and aligned physicians remain as IPA members • Continues community wide effort on Medicaid • Continues the collaboratives efforts among physicians • We don’t know how long the current RMHP contract is sustainable

  32. Option C: RESTRUCTURE Keeps the Membership Intact • CONS • Provider Network: • Is fluid • Could be smaller • More difficult to define • Lessened contractual alignment due to hospital employment status • Hospitals may not buy-in or resist some of the IPA’s programs • Administratively complex • We don’t know how long the current RMHP contract is sustainable

  33. Option C: RESTRUCTURE Keeps the Membership Intact Hospital Employed and Hospital Affiliated Physicians Membership Model Independent Physicians.

  34. Option C: RESTRUCTURE Keeps the Membership Intact Total Membership 246 • Primary Care Physicians 57 23.17% • Specialty Care Physicians 189 76.83%

  35. Option C: RESTRUCTURE Keeps the Membership Intact Total Membership 246 • Independent 114 46.34% • Employed 111 45.12% • Aligned 21 8.54%

  36. SHOULD THE IPA CHANGE?OUR OPTIONS • A =DON’T CHANGE • B = IPA OF ONLY THE INDEPENDENT PHYSICIANS • C = RESTRUCTURE

  37. HOW CAN THE IPA SERVE YOU, OUR MEMBER? Now that you know about the different options, PRIORITIZE THE FOLLOWING: • A = DON’T CHANGE • B = IPA OF ONLY THE INDEPENDENT PHYSICIANS • C = RESTRUCTURE

  38. HOW CAN THE IPA SERVE YOU, OUR MEMBER? Which Would You Prefer? • A = IPA of Only the Independent Physicians • B = Do Not Change

  39. HOW CAN THE IPA SERVE YOU, OUR MEMBER? Which Would You Prefer? • A = Restructure • B = Do Not Change

  40. The Direction MCPIPA Takes Moving Forward QUESTIONS OR COMMENTS FROM THE AUDIENCE

  41. WE VALUE YOUR INPUT AND APPRECIATE YOUR PARTICIPATION IN TONIGHT’S MEETING. PLEASE TAKE A FEW MINUTES TO COMPLETE THE COMMENT CARD

  42. R4P MEETING CALENDAR • Tuesday November 14, 2017 IS CANCELLED • 2018 Dates • Tuesday February 13, 2018 • Tuesday May 22, 2018 • Tuesday August 14, 2018 • Tuesday November 13, 2018

  43. Thank You Physicians Cooperating to Deliver High Quality Health Care to Our Community

  44. THE OPPORTUNITIES WE HAVE FORFUNDING OF THE IPA

  45. WHY THIS IS IMPORTANT Why We Need to Change • ANNUAL REVENUE • Monthly Stipend $270,000 on Target • Administrative Fee Down • Grant from University of Colorado Down • Investment Income from Western Health Care Alliance on Target • Revenue for 2017 down $63,400

  46. FUNDING THE IPA As a member of MCPIPA are you willing to fund the IPA? Funding of the IPA could result in a combination of the following. • DUES – all members pay flat rate monthly dues • SUBSIDY OR STIPEND FROM HEALTH PLAN – negotiate with payers • ADMINISTRATIVE FEE – deducted from claims submitted to RMHP by IPA members

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