Transcript Continuum Provider Partners IPA Formation and Clinical Integration

Continuum Provider Partners IPA
Formation and Clinical Integration
July 2012
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Continuum Provider Partners IPA
Purpose
Continuum Health Partners, Inc. (“CHP”), - Beth Israel Medical Center,
St. Luke’s Hospital, Roosevelt Hospital, and New York Eye and Ear
Infirmary – in collaboration with its voluntary and employed providers,
is establishing a clinically integrated network to address the future of
health care delivery.
Through the establishment of this network by means of an
independent practice association, the IPA will improve the quality and
efficiency of care provided to our communities and offer meaningful
value to payers.
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Continuum Health Partners Goals for IPA Formation
Goal
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To achieve a high-performing, seamless system of care across the IPA
network in partnership with payers and other providers.
Why?
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To improve performance on the key dimensions of quality, cost and
patient and provider satisfaction.
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To prepare for the emerging healthcare environment:
 Value-based purchasing (pay for performance, shared savings)
 Bundled payments
 Financial penalties for avoidable care
 Formation of accountable care organizations (“ACOs”).
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To strengthen our ability to attract patients.
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Steering Committee Members
Name
Title
Organization
John Collura
EVP/CFO
Continuum Health Partners
Gail Donovan
EVP/COO
Continuum Health Partners
Beth Essig, Esq.
EVP, General Counsel
Continuum Health Partners
Frank Cracolici
President
St. Luke’s/Roosevelt Hospital
Harris Nagler, M.D.
President
Beth Israel Medical Center
Nina Brodsky
Senior Associate, General Counsel
Continuum Health Partners
Richard Amiraian, M.D.
Medical Director CMG/Co-director MHI
St. Luke/Roosevelt Hospital
Brendan Loughlin
SVP, Finance
Continuum Health Partners
Gary Burke, M.D.
Vice Chair of Internal Medicine, SLR/Co-director MHI
St. Luke/Roosevelt Hospital
D. McWilliams Kessler
President/CEO
New York Eye and Ear Infirmary
Adam Henick
SVP, Ambulatory Care and Medical Enterprises
Continuum Health Partners
Michelle Leone
SVP, Revenue Cycle Operations and Managed Care
Continuum Health Partners
Ed Lucy
VP, Managed Care, Physician Contracting
Continuum Health Partners
John Aljian, M.D.
Attending, Department of Ophthalmology
New York Eye and Ear Infirmary
Alan Santos, M.D.
Chair, Anesthesia
St. Luke’s/Roosevelt Hospital
Maurice Alwaya, M.D.
Attending, Pulmonology
Beth Israel Medical Center Brooklyn
Russell Berdoff, M.D.
Attending, Cardiology
Beth Israel Medical Center
John Cornwall, M.D.
Sr. Attending, Internal Medicine
St. Luke’s/Roosevelt Hospital
Susan Boolbol, M.D.
Chief, Breast Surgery
Beth Israel Medical Center
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Clinical Integration
Definition
“An active and ongoing program to evaluate and modify the clinical
practice patterns of the physician participants so as to create a high
degree of interdependence and collaboration among the physicians to
control costs and ensure quality.”*
Components of Clinical Integration
• Mechanisms to monitor utilization, control costs, and assure quality
of care.
• Population health management across the continuum of care.
• Use of common IT to ensure exchange of all relevant patient data.
• Development and adoption of clinical protocols.
• Care review based on and adherence to implemented protocols.
*FTC/DOJ Statements of Antitrust Enforcement Policy in Health Care, #8.B.1 (1996)
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What the FTC looks for (No Cookie-cutter Approach)
Components of CI
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Mechanisms to monitor utilization, control costs, and assure quality of care.
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Selectivity of physician participants.
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Significant investment of monetary and human capital.*
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Use of common IT to ensure exchange of all relevant patient data.
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Development and adoption of clinical protocols.
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Care review based on the implementation of protocols.
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Mechanisms to ensure adherence to protocols.**
FTC Tests for CI
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Is the CI “real”: authentic initiatives actually undertaken?
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Are the initiatives of the program designed to achieve improvements in
healthcare quality and efficiency?
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Is joint contracting with fee-for-service plans “reasonably necessary” to
achieve the efficiencies of the CI program?**
*FTC/DOJ Statements of Antitrust Enforcement Policy in Health Care, #8.B.1 (1996)
**FTC/DOJ, Improving Health Care: A Dose of Competition Ch. 2, p.37 (July 2004)
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Messenger Model For Managed Care Organizations
Participation Overview
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While clinical integration is under development, IPA may serve
as messenger for voluntary physicians.
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As messenger, IPA may coordinate and analyze information
and communicate with payers on behalf of individual voluntary
physicians, but it cannot negotiate on behalf of them or make
recommendations about participation.
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IPA must communicate with each voluntary physician
individually about acceptable contract terms, including fees.
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Messenger Model For Managed Care Organizations
Participation Overview
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Each voluntary physician must make his or her own
independent and unilateral decision whether to accept a
contract.
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Competitively sensitive information, which includes but is not
limited to rates, obtained by IPA as messenger is confidential
and cannot be shared with other physicians, even with those
acting in their capacity as IPA officers and directors.
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IPA’s directors, officers, and members cannot query IPA’s staff,
officially or unofficially, about IPA’s contracting activities as
messenger, except whether the activity has commenced, is in
progress, or has concluded.
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Each voluntary physician and payer retains the right to contract
with one another without IPA participating as a messenger.
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Provider Participation
Eligible Providers
Physicians, podiatrists, dentists, behavioral health professionals,
hospitals, ambulatory surgery centers, diagnostic and treatment
centers, FQHCs, and other ancillary providers.
Qualifications
• Licensed/Certified/Registered providers or accredited facilities.
• Member of the medical staff (in any capacity) of at least one CHP
member hospital.
• Board certified in declared primary specialty (unless waived by IPA’s
credentialing committee).
Process
• Complete and sign IPA application.
• Review and sign Provider Participation Agreement.
• Pay annual membership dues.
• Be credentialed by the IPA.
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How to Join
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Beginning in July, CHP will send electronic and hard copy mailings of
an introduction package to potential provider participants.
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The application and provider participation agreement will be included.
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A central communication line will be staffed to provide additional
information and to answer any questions providers have.
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A website is being established to facilitate online enrollment in the
IPA; additional details and links to the website will be announced in
July.
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Providers will complete the documentation either online (preferred)
or in hard copy and mail it back to the IPA.
https://sharepoint.thecamdengroup.com/Clients/Continuum_Health_Partners/Steering_Committee_Materials/Camden_CHP_IPA_CI_LongFormPresentation_6_19_2012.pptx
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IPA Key Facts and Milestones
• IPA established as an LLC and approved by NYS: August 2012.
• Initial provider enrollment period: July to September 2012.
• IPA operable for messenger model contracting: September 2012.
• IPA operable for clinical integration contracting: 2013.
• Initial membership dues: $250 per year.
• Continuum Health Partners Hospitals provide initial capitalization.
• Balance of physician and hospital leadership on Board of Managers.
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