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MPact Physician Education
John D. Owen, MD, FACEP, FAAFP
Chief Medical Officer, MPact Health Medical Director-Mosaic Emergency Dept. Physician Dyad, Secondary Service Area-Mosaic Brig Gen, USAF, Retired
MPact Physician Education John D. Owen, MD, FACEP, FAAFP Chief - - PowerPoint PPT Presentation
MPact Physician Education John D. Owen, MD, FACEP, FAAFP Chief - - PowerPoint PPT Presentation
MPact Physician Education John D. Owen, MD, FACEP, FAAFP Chief Medical Officer, MPact Health Medical Director-Mosaic Emergency Dept. Physician Dyad, Secondary Service Area-Mosaic Brig Gen, USAF, Retired Drivers of Change High cost of care
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- High cost of care
- Insurance costs and lack of value added
services
- Inconsistent quality of care
- Employers looking for other options
Drivers of Change
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Physician expectations
- Practice High Quality Medicine
- Work with similarly minded high quality
individuals
- Receive reasonable compensation
- Minimize interruptions and hassles when doing a
good job
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- Multi-state Clinically Integrated Network (CIN)
- Meets the FTC and DOJ definitions of clinical
integration.
- Single-signature value-based contracting
- “Chapter-Centric” CIN
- Hogan Marren Babbo & Rose-proven case law
What is MPact?
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Physician Joint Ventures that do not involve the sharing of substantial financial risk may also involve sufficient integration to demonstrate that the venture is likely to produce significant efficiencies. Such integration can be evidenced by the network implementing an active and ongoing program to evaluate and modify practice patterns by the network's physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality. This program may include: (1) establishing mechanisms to monitor and control utilization of health care services that are designed to control costs and assure quality of care; (2) selectively choosing network physicians who are likely to further these efficiency objectives; and (3) the significant investment of capital, both monetary and human, in the necessary infrastructure and ability to realize the claimed efficiencies.
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Our experience indicates that in order to qualify as legitimately clinically integrated pursuant to this definition, the following conditions must exist: 1. a network of physicians willing to demonstrate “a high degree of interdependence and cooperation,” through 2. a program of initiatives designed to “control costs and ensure quality,” which 3. is supported by an infrastructure that allows the physicians to “evaluate and modify practice patterns.”
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The 3-part legal analysis for Clinical Integration
An analysis of any physician network’s clinical integration program is essentially a three-part test which asks: 1. Whether the network’s clinical integration program is “real” containing authentic initiatives, actually undertaken by the network, which involve all physicians in the network, and apply to the physicians’ practice patterns relative to patients who obtain health benefits under fee-for- service health plans; 2. Whether the initiatives of the program are designed to achieve likely improvements in health care quality and efficiency; and 3. Whether joint contracting with fee-for-service health plans is “reasonably necessary” to achieve the efficiencies of the clinical integration program.
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MPact: More than a Legal Entity
Facilitates….
- Clinical Integration
- Quality Improvement
- Contracting
- Care management
- Data analytics
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Composition of Network
- 4000+ physicians
- 50+ hospitals
- 250+ clinic locations
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As of 1.13.17
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Clinical Integration Network Board, LLC
Quality Improvement Committee - IT Committee Insurance Strategy Committee - Care Management Committee
Payers Employers Government
Organizational Structure
Alliance Chapters
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As of 1.13.17
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- How does our Chapter’s Quality metrics
compare to MPact overall and to the national benchmarks?
- Which metrics are weakest to target the QI
work?
- Do we have providers not meeting the
Quality threshold?
Work of the Chapters
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- Physician-led quality improvement
committee
- Measure 5-7 metrics per specialty
- “Evaluate and modify” physician,
chapter, and MPact level performance
- Leverage shared reporting platform
Quality Improvement CIN Requirements
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Quality Improvement Reporting
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Today’s Database
- 3 million patient lives in our database
- 3,600 active physicians sharing data
- Measuring 44 unique clinical metrics
across specialties
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The Result: The reasons we went into medicine
- Work with likeminded quality collegues
- Take great care of our patients
- Help others deliver great care, as well
- Do so with fewer time and process interruptions
- Remain competitive
- Be recognized for the good job that we do
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