Annual Meeting June 4, 2019 Annual Meeting Agenda Welcome & - - PowerPoint PPT Presentation
Annual Meeting June 4, 2019 Annual Meeting Agenda Welcome & Prayer Troy A. Tyner, DO, MMM, FACOI Objectives Local View Value Report for KPP & PHA National View Introduction of Speaker Mike McCullough,
Vision - toolbox that develops and prepares physicians and the network for the future, providing desirable resources for facilitating financially viable, quality driven and patient centered physician practices.
Measurement 2018
Claims Paid Through
Nov 2018
Contract Goal
HbA1c Determination
94.4% 80.0 %
Medical Attention for Nephropathy
89.7% 85.0 %
Nephropathy Screening
56.9% 50.0 %
Measurement 2018
Rate through December 2018
Contract Goal
HbA1c Determination
92.6% 80.0 %
Nephropathy Screening
91.4% 85.0 %
BMP, CMP or Renal Panel
97.1% 65.0 %
PCP Visit
79.9 % 75.0 %
KPP Payer Tracking Grid – Completed
Custom Design Benefits KHN Employee Plan UHC Medicare ACO MMO – Comm. MMO – MA Anthem Medigold Care Source Health Ohio Network MedBen Effective Date 11/1/2016 1/1/2017 1/1/2017 8/1/2017 – FFS 1/1/19 - Quality 8/1/2017 1/1/19 Incnt = 1/1/18 FFS = 1/1/19 1/1/19 1/1/19 1/1/19 Product Type Commercial Incentive Only Medicare Fee for Service Medicare
Medicare
Medicare Medicaid, Medicare, & Exchange
Commercial
Commercial Number of Lives KPN / Independent 16,000 15,000
3,574 (2,446 KPN / 1,128 Non- KPN)
4,161 (2,704 KPN / 1,457 Non- KPN) 415 12,000 8,400 (KPN) / 3,600 (Non- KPN) 2,000 20,000+ New New Incentive Type Fee for Service Only Upside Incentive Upside in years 1-2, downside in year 3 HEDIS
Measures & readmission
Fee for Service until & HEDIS
Quality/Share d Savings Upside years 1-2, downside year 3-mirror EPHC
Quality & Shared Savings Upside in all 3 years PMPM with Incentive for care gaps & readmission Fee for Service Only Fee for Service Only Incentive n\a PMPM PMPM & Shared Savings Care Mgt. PMPM for Quality PMPM
Care Mgt. PMPM & Shared Savings
Quality & Shared Savings
Quality & Shared Savings
n\a n\a Fee for Service Yes Yes No Yes Yes No Yes Yes Yes Yes
Kettering Physician Partners Payer Revenue and Disbursement Summary - March 2019
Revenue Earned Revenue Distributed 2017 2018 2019 2017 2018 2019 Undistributed Revenue Care Management $0 $230,540 $303,035 $230,540 $87,744 $215,291 Quality $584,454 $297,402 $0 $427,638 $454,218 $0 Shared Savings $1,044,550 $0 $0 $1,044,550 Total $1,629,004 $527,942 $303,035 $0 $658,178 $541,962 $1,259,841
Payer incentives payments are shown for the time period in which they were earned Distributions are shown for the time period dispersed to KPP members.
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Hig igh Performing Healthcare in in a Value and Risk Base sed World
Dave Amin, MD, MBA, FACEP, FAAP
Monj Health
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Dave, , te tell ll me me this this is s al all l goi going aw away, rig ight ht? Dr. Ronald “Hoppe” Hopkins, CMO Nor Lea Hospital District
Sorry Hoppe, the shift to value and risk in healthcare is quite real … … but it might not be as difficult to navigate as it seems
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Putt uttin ing the the Le Legos Tog
Each piece is necessary but not sufficient …
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Elements of success …
Clinica cal l lead eadersh ship and nd a st stud udent min mindset
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What’s in your warehouse? (da (data an anal alytic ics)
YOUR data warehouse is the source of all knowledge … … and it exists for YOU and no other reason
acceptable)
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Parameters:
Dates of service between 1/1/2016 & 12/31/2016 Patient Statuses include Active (WithClaims) & Deceased/Active (WithClaims) ED visit include those admitted as well as those treated & released Diagnoses are from ICD9 codes (DRGs not listed on outpatient claims) ED visits counted using revenue codes: 0450-0459, 0981 Community Avg HCC Attribution Total ED Cost ED PPPY ED PPPY Adj ED Visits ED per 1000 Weeks Medical Center 1.30223 1218 $2,098,583 $1,723 $1,323 1331 1092.8 Littleton (LRH+ACHS) 0.99385 2651 $3,262,146 $1,231 $1,238 2245 846.9 Berlin (AVH+CCFHS) 1.09917 2243 $2,052,413 $915 $832 2044 911.3 Colebrook (UCVH+ISHC) 0.97524 798 $740,391 $928 $951 577 723.1
$8,153,533 $1,180 $1,092 6,197 896.8 $404,422,401 $1,719 $1,585 198,109 842.2 North Country Totals: Caravan Overall:
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Parameters:
Dates of service between 1/1/2016 & 12/31/2016 Patient Statuses include Active (WithClaims) & Deceased/Active (WithClaims) ED visit include those admitted as well as those treated & released Diagnoses are from ICD9 codes (DRGs not listed on outpatient claims) ED visits counted using revenue codes: 0450-0459, 0981 Community Avg HCC Attribution Total ED Cost ED PPPY ED PPPY Adj ED Visits ED per 1000 Weeks Medical Center 1.30223 1218 $2,098,583 $1,723 $1,323 1331 1092.8 Littleton (LRH+ACHS) 0.99385 2651 $3,262,146 $1,231 $1,238 2245 846.9 Berlin (AVH+CCFHS) 1.09917 2243 $2,052,413 $915 $832 2044 911.3 Colebrook (UCVH+ISHC) 0.97524 798 $740,391 $928 $951 577 723.1
$8,153,533 $1,180 $1,092 6,197 896.8 $404,422,401 $1,719 $1,585 198,109 842.2 North Country Totals: Caravan Overall:
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Top 5 ED Diagnosis for NCH ACO Communities
Participant_Name # ShortDescription Claim Count % of all Claims Cumulative % 1 Urinary tract infection, site not specified 55 4.1% 4.1% 2 Chronic obstructive pulmonary disease w (acute) exacerbation 39 2.9% 7.0% 3 Other chest pain 32 2.4% 9.4% 4 Heart failure, unspecified 27 2.0% 11.5% 5 Weakness 26 1.9% 13.4% 1 Urinary tract infection, site not specified 73 3.2% 3.2% 2 Chronic obstructive pulmonary disease w (acute) exacerbation 71 3.1% 6.3% 3 Other chest pain 58 2.5% 8.8% 4 Pneumonia, unspecified organism 45 2.0% 10.8% 5 Chest pain, unspecified 39 1.7% 12.5% 1 Chronic obstructive pulmonary disease w (acute) exacerbation 58 2.8% 2.8% 2 Chest pain, unspecified 55 2.6% 5.4% 3 Syncope and collapse 45 2.2% 7.6% 4 Low back pain 38 1.8% 9.4% 5 Other chest pain 38 1.8% 11.2% 1 Other chest pain 21 3.6% 3.6% 2 Acute bronchitis, unspecified 13 2.2% 5.8% 3 Dyspnea, unspecified 13 2.2% 8.0% 4 Chest pain, unspecified 13 2.2% 10.2% 5 Pneumonia, unspecified organism 10 1.7% 11.9% Colebrook (UCVH+ISHC) Berlin (AVH+CCFHS) Littleton (LRH+ACHS) Weeks Medical Center
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LbPatientId MemberFullName BirthDate Patient_Status Participant_Name ER_Cost ER_ Visits 1 ROWELL JR, RUSSELL 11/2/1967 Active (WithClaims) Weeks Medical Center $25,814 46 2 STROBECK, MICHAEL 5/24/1978 Active (WithClaims) Littleton Hospital Association $5,922 25 3 STROBECK, MICHAEL 5/24/1978 Active (WithClaims) Littleton (LRH+ACHS) $5,922 25 4 Masiello, Joseph 8/23/1953 Active (WithClaims) Ammonoosuc Community Health Se $6,718 24 5 Masiello, Joseph 8/23/1953 Active (WithClaims) Littleton (LRH+ACHS) $6,718 24 6 ROY, JEAN 8/31/1961 Active (WithClaims) Ammonoosuc Community Health Se $14,176 22 7 ROY, JEAN 8/31/1961 Active (WithClaims) Littleton (LRH+ACHS) $14,176 22 8 MORIN, CARL 7/25/1977 Active (WithClaims) Weeks Medical Center $11,350 18 9 TOBIN, KATHI 12/19/1968 Active (WithClaims) Weeks Medical Center $7,871 16 10 NICHOLS, LEWIS 4/7/1936 Active (WithClaims) Littleton Hospital Association $81,373 16 11 NICHOLS, LEWIS 4/7/1936 Active (WithClaims) Littleton (LRH+ACHS) $81,373 16 12 SMITH, MARY 2/18/1964 Active (WithClaims) Littleton Hospital Association $4,497 15 13 SMITH, MARY 2/18/1964 Active (WithClaims) Littleton (LRH+ACHS) $4,497 15 14 LANGLOIS, TIMOTHY 11/13/1964 Active (WithClaims) Androscoggin Valley Hospital, Inc $4,313 15 15 LANGLOIS, TIMOTHY 11/13/1964 Active (WithClaims) Berlin (AVH+CCFHS) $4,313 15 16 BUTLER, CONSTANCE 4/13/1956 Active (WithClaims) Androscoggin Valley Hospital, Inc $11,215 15 17 BUTLER, CONSTANCE 4/13/1956 Active (WithClaims) Berlin (AVH+CCFHS) $11,215 15 18 BOUCHER, LENA 4/8/1967 Active (WithClaims) Coos County $5,251 14 19 BOUCHER, LENA 4/8/1967 Active (WithClaims) Berlin (AVH+CCFHS) $5,251 14 20 COMEAU, CORINNE 4/8/1933 Active (WithClaims) Weeks Medical Center $3,732 14 21 HUGHES, TERRANCE 5/31/1935 Active (WithClaims) Weeks Medical Center $7,973 14 22 THOMPSON, CAPPI 6/8/1976 Active (WithClaims) Coos County $5,918 14 23 THOMPSON, CAPPI 6/8/1976 Active (WithClaims) Berlin (AVH+CCFHS) $5,918 14 24 LEVESQUE, THERESA 10/14/1975 Active (WithClaims) Littleton Hospital Association $10,290 13 25 LEVESQUE, THERESA 10/14/1975 Active (WithClaims) Littleton (LRH+ACHS) $10,290 13 26 MARSH, LORRAINE 11/1/1933 Active (WithClaims) Monadnock Community Hospital $67,714 13 27 CHARLONNE, GERALD 7/21/1933 Active (WithClaims) Monadnock Community Hospital $20,274 13 28 MULAIRE, REBECCA 5/15/1955 Active (WithClaims) Cottage Hospital $15,947 13 29 ROSENBERG, DAVID 12/8/1929 Active (WithClaims) Upper Connecticut Valley Hospital A $12,891 12 30 ROSENBERG, DAVID 12/8/1929 Active (WithClaims) Colebrook (UCVH+ISHC) $12,891 12 31 ALBERT, RENEE 5/5/1976 Active (WithClaims) Monadnock Community Hospital $3,618 12 32 KOCH, RITA 2/15/1954 Active (WithClaims) Upper Connecticut Valley Hospital A $5,113 12 33 KOCH, RITA 2/15/1954 Active (WithClaims) Colebrook (UCVH+ISHC) $5,113 12 34 BENWAY, CAROLYN 6/27/1938 Deceased/Active (WithCl Littleton Hospital Association $6,650 12 35 BENWAY, CAROLYN 6/27/1938 Deceased/Active (WithCl Littleton (LRH+ACHS) $6,650 12 36 SMITH, JOAN 10/6/1929 Active (WithClaims) Weeks Medical Center $5,508 12 37 DERRINGTON, SHERYL 5/16/1972 Active (WithClaims) Androscoggin Valley Hospital, Inc $2,074 12 38 DERRINGTON, SHERYL 5/16/1972 Active (WithClaims) Berlin (AVH+CCFHS) $2,074 12 39 WHEATON, NATASHA 8/3/1991 Active (WithClaims) Littleton Hospital Association $5,163 12 40 WHEATON, NATASHA 8/3/1991 Active (WithClaims) Littleton (LRH+ACHS) $5,163 12 41 DE BRUYN, LISA 6/30/1961 Active (WithClaims) Coos County $58,616 12 42 DE BRUYN, LISA 6/30/1961 Active (WithClaims) Berlin (AVH+CCFHS) $58,616 12 43 JOHNSON, DEBRA 5/14/1970 Active (WithClaims) Weeks Medical Center $8,027 11 44 PHANEUF, SHIRLEY 1/19/1959 Active (WithClaims) Coos County $5,668 11 45 PHANEUF, SHIRLEY 1/19/1959 Active (WithClaims) Berlin (AVH+CCFHS) $5,668 11 46 TAYLOR, JEAN 8/19/1926 Active (WithClaims) Littleton Hospital Association $8,807 11 47 TAYLOR, JEAN 8/19/1926 Active (WithClaims) Littleton (LRH+ACHS) $8,807 11 48 COLLINS, GEORGE 10/19/1922 Active (WithClaims) Coos County $3,985 11 49 COLLINS, GEORGE 10/19/1922 Active (WithClaims) Berlin (AVH+CCFHS) $3,985 11 50 HOLMES, GERALD 1/4/1943 Deceased/Active (WithCl Ammonoosuc Community Health Se $10,514 11 51 HOLMES, GERALD 1/4/1943 Deceased/Active (WithCl Littleton (LRH+ACHS) $10,514 11 52 LEITGEB, ROBERT 11/12/1955 Active (WithClaims) Littleton Hospital Association $6,136 11 53 LEITGEB, ROBERT 11/12/1955 Active (WithClaims) Littleton (LRH+ACHS) $6,136 11 54 LABBE JR, KENNETH 2/3/1965 Active (WithClaims) Littleton Hospital Association $4,851 11 55 LABBE JR, KENNETH 2/3/1965 Active (WithClaims) Littleton (LRH+ACHS) $4,851 11 56 DONATO, ANGELA 2/3/1979 Active (WithClaims) Coos County $4,993 11 57 DONATO, ANGELA 2/3/1979 Active (WithClaims) Berlin (AVH+CCFHS) $4,993 11 58 CALISTRO, RALPH 4/22/1945 Active (WithClaims) Monadnock Community Hospital $11,692 11
Row Labels Sum of ER_Cost Sum of ER_Visits Berlin (AVH+CCFHS) $102,033 115 Colebrook (UCVH+ISHC) $18,004 24 Littleton (LRH+ACHS) $165,097 183 Weeks Medical Center $70,276 131 Grand Total $355,411 453
Parameters: Dates of service (for readmission) between 1/1/2016 & 12/31/2016 Patient Statuses include Active (WithClaims) & Deceased/Active (WithClaims) Readmission counted if admission within 30 days of a previous discharge All inpatient claims counted (claim type code= 60, 61); original claims only Community Attribution Admits Admits per K Readmits Readmits per K Weeks Medical Center 1,218 556 456.49 82 147.48 Littleton (LRH+ACHS) 2,651 645 243.30 81 125.58 Berlin (AVH+CCFHS) 2,243 674 300.49 81 120.18 Colebrook (UCVH+ISHC) 798 222 278.20 35 157.66 North Country Totals: 6,910 2097 303.47 279 133.05 Caravan Health Overall: 235,234 75,504 320.97 10,814 143.22 Other Reports: Breakdown of readmissions by Diagnosis Related Group (DRG) Breakdown of discharges leading to readmission by Diagnosis Related Group (DRG)
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Who’s on your team? (ca (care re man management nt)
YOUR team is your single biggest asset … … and they work for YOU
Enhance yo your ab abil ility to
are
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Where re ar are you you on
the bri bridge to to va valu lue an and d ris isk? (a (a bus business mo model for for al all ho horiz izon
YOU must win tod
… sustainability is critical to YOU
(this is your bridge to value and risk)
(all reimbursable today)
skyrockets (by a factor of 5x or more)
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January Cpt Code Provider Reimbursement Month Total Quarter 1 Quarter 2 Quarter 3 Quarter 4 Annual Annual Wellness Visit 99213 220.00 220.00 1928.00 1758.00 1733.00 1683.00 7102.00 Chronic Care Management 99490 43.00 68.00 Remote Patient Monitoring Initial Set Up 99453 55.00 85.00 IBT – Obesity (x4) G0447 37.00 59.00 Evaluation and Management w/-25 modifier (x4)99213 100.00 120.00 Smoking cessation counseling 99407 20.00 25.00 Medical Nutrition Therapy 99802 52.00 86.00 General Behavioral Health Integration 99484 48.00 50.00 *Behavioral Health Collaborative Care Model 99482 29.00 43.00 756.00
Olser Practice Roster Eligible Patients $ * Eligible Patients $ * Eligible Patients $ * Eligible Patients $ * Eligible Patients $ * $ *
A & S GENERAL PHYSICIAN 6 2,310 $ 6 3,240 $ 2 4,950 $ 6 6,912 $ 4 800 $ 18,212 $ ALLIED MEDICAL (NORTH HALEDON) 33 12,705 $ 44 23,760 $ 23 56,925 $ 50 57,600 $ 24 4,800 $ 155,790 $ CARLSTADT FAMILY PRACTICE 129 49,665 $ 163 88,020 $ 57 141,075 $ 211 243,072 $
521,832 $ CENTER FOR ADULT MEDICINE AND PREVENTATIVE CARE 1 385 $ 1 540 $ 1 2,475 $ 1 1,152 $
4,552 $ CLIFTON COMPREHENSIVE MEDICAL CENTER 2 770 $ 4 2,160 $ 1 2,475 $ 5 5,760 $ 4 800 $ 11,965 $ CLIFTON WALLINGTON MEDICAL GROUP 143 55,055 $ 293 158,220 $ 2 4,950 $ 315 362,880 $
581,105 $ COLUMBUS FAMILY PHYSICIANS 452 174,020 $ 1284 693,360 $ 593 1,467,675 $ 1525 1,756,800 $ 1043 208,600 $ 4,300,455 $ DENISE DAUB, MD 157 60,445 $ 247 133,380 $ 72 178,200 $ 260 299,520 $ 136 27,200 $ 698,745 $ FAIRFIELD PRIMARY DOCTORS 223 85,855 $ 354 191,160 $ 248 613,800 $ 399 459,648 $ 256 51,200 $ 1,401,663 $ FOREST HILLS FAMILY HEALTH 204 78,540 $ 449 242,460 $ 133 329,175 $ 484 557,568 $ 267 53,400 $ 1,261,143 $ HEIGHTS MEDICAL 787 302,995 $ 1,004 542,160 $ 305 754,875 $ 1,146 1,320,192 $ 602 120,400 $ 3,040,622 $ INTERNAL MEDICINE & GERIATRIC 3 1,155 $ 3 1,620 $ 1 2,475 $ 5 5,760 $ 1 200 $ 11,210 $ PREMIER FAMILY MEDICAL 124 47,740 $ 171 92,340 $ 109 269,775 $ 200 230,400 $ 109 21,800 $ 662,055 $ RIVERVIEW HEALTHCARE ASSOCIATES 479 184,415 $ 523 282,420 $
562 647,424 $
1,114,259 $
TAILOR ASSOCIATES 69 26,565 $ 98 52,920 $ 33 81,675 $ 136
156,672 $
65
13,000 $
330,832 $
Total Eligible Patients 2,812 1,518,480 $ 4,644 2,507,760 $ 1,580 3,910,500 $ 5,305 2,864,700 $ 2,511 502,200 $ 14,114,440 $
Osler 2019 CMS Program Opportunity Estimate
Annual Wellness Visit Chronic Care Management CMS - IBT Remote Patient Monitoring CMS DPP Total All Programs
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Revenue Summary By Provider Type and By Code Average Patients per Group 10 Enter Number of Patients per Group Total Potential Annual Revenue per Group $12,420 Hours per Group 83 Number of Groups per RDN 19 Enter Number of Groups per RDN Total Potential Annual Revenue per RDN $235,980 Total Potential Annual Revenue per Group $14,160 Hours per Group 60 Number of Groups per Provider 19 Total Potential Annual Revenue per Practice $269,040 Total Potential Annual Revenue per RDN $235,980 Total Potential Annual Revenue per Practice $269,040 Total Potential Annual Revenue $505,020 Total Potential Annual Revenue per Patient $2,658 RDN (MNT/RPM/CCM) Revenue Medical Provider (E&M/IBT) Revenue Total Revenue
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Where re ar are you you on
the bri bridge to to va valu lue? (a (a bu business mo model for for all all horizons)
YOU must win today, tom
and for
… sustainability is critical to YOU
(large incentive payments from payer)
(you compete on quality)
(patients, payers and employers love it)
eam RO ROI I goe goes up up (your annual PPPY spend goes down, maybe …) Single FQHC with just 532 commercial Anthem members… … $130K in bonus for care gap closure
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Ho How si sick ar are you your r pat patie ients? (ac (accura rate risk pr profile les)
YOUR coding determines your patient’s allotted annual spend (PPPY) … … millions and millions of dollars get left on the table every year by YOU
ecome an an act actuary in in min indset
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2017 data: Just 10,500 patients
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The patient as consumer? Really? (Really…) (a (a pat patie ient ce cent ntered ap appro roach to to car care)
YOU OUR patients are the reason we all exist … … and they are no longer just diseases
care about patient care
User exp experience (UX (UX)
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Are Are we tr treatin ing the the who hole le per person? (b (behavio iora ral hea healt lth h int ntegratio ion)
YOU have the ability to identify depression, anxiety, stress, and the social determinants
… because patient’s talk to YOU
ehaviorali lists ar are e a a cri ritical al par art of
he car are e tea eam
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What’s in your wallet? (al (aligned fi financial incentives)
YOU should understand and be in control of your
… your business manager will love YOU
artner wit ith you your bus usiness man anager !!! !!!
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Are Are we the the Lo Lone ne Ran anger? (st (stra rategic ic pa part rtnerships)
YOU can be in successful partnerships … … that improve patient health and put YOU
OU back in control of healthcare
…)
common (Dr Tyner)
Every par artner ership MUST dri rive e val value for
you
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“I need a doc docto tor, to bring me back to life…” Dr Dre, Eminem and Skylar Grey (cl (clinical leadership an and a a stu student mi mindset)
YOU are critical to your patients … … YOU are also critical to the healthcare system
colleagues
sk PHA/KPP to to sup support yo you
RE tha hat cri ritical to
success
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➢Visit KetteringPhysicianPartners.org and click the “Provider Portal” button in the top right corner. By monitoring your performance here on a weekly or monthly basis, you will be able to increase the quality of your patient care while ensuring that you are taking full advantage of the financial opportunities negotiated on your behalf. ➢Review QUALITY data and reports available through your EMR. ➢Ensure all Medicare Advantage patients have ANNUAL WELLNESS VISITS scheduled by June 20th.
➢ Tuesday, September 24th, 6:00 PM at the Austin Landing Learning Center ➢ Wednesday, October 2nd, 6:00 PM at the University of Dayton Marriott. ➢Please note that attendance at the above two sessions will be counted towards fulfillment of your 2019 education requirements. One physician per group or practice is needed to receive credit.