Transcript Mesa County Physician`s IPA Accountable Care for Mesa County

Mesa County Physician’s IPA
Accountable 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
4/13/2015
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-ofcare 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”.
Mesa County Physician’s IPA
Price adjusted Medicare
Payments/Enrollee 2008
National
Colorado
Grand Junction
$9,021.00
$7,854.00
$6,683.00
Mesa County Independent
Physicians Association
35 Year History
• Risk contracting
• Clinical Integration
• 295 Members
– 40% Primary Care
Mesa County Physician’s IPA
 Lines of business:
HMO
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



HCO


Private Pay (Commercial)
Medicaid (ASO Contract)
Medicare (Cost Contract)
Dual Eligible (Medi/Medi)
CHP+
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
Mesa County Physician’s IPA
Commercial
Medicare
Medicaid
HCO(PPO)
HMO
CHP+
Profit Sharing Pool
Profit Sharing Pool
Profit Sharing Pool
Gross operating Income +
Gross Withold
Gross operating Income +
Gross Withold
Gross operating Income +
Gross Withold
Total Profit Sharing
Pool
45%
RMHP
55%
MCPIPA
Mesa County Physician’s IPA
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Historical Withhold Return
Mesa County Physician’s IPA
+ 53%
What the Evidence Shows
• Delivery System Reform Without
Payment Reform Does Not Work
• Investing in Primary Care Works
• Cost Accountability Works
What Do We Mean by Payment Reform?
What Do We Mean by Payment Reform?
Isn’t This Capitation? No.
Mesa County Physician’s IPA
Thank you