2014 necomg annual meetingfiles.ctctcdn.com/aaa72ae3201/0fe3bd2f-0d18-4626-afae-201df8be6… ·...
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C O N F I D E N T I A L PLEASE DO NOT DISTRIBUTE
2014 NECoMG ANNUAL MEETING
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AGENDA
WELCOME – Dr. Ezzi
Nominating Committee Report – Dr. DiLillo
Northeast PHO Overview– Nicole DeVita
Strategic Vision – Dr. Ezzi
Election Results – Dr. DiLillo
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Nominating Committee Report: Dr. DiLillo
Nominating Committee members: Louis DiLillo, M.D. (Chairperson), Daniel McCullough M.D., Curtis Ersing, M.D.
Nominees
• Class P/PCPs: Two Open Seats
• Pierre Ezzi, M.D. (Incumbent)
• John Malolepszy, M.D. (Incumbent)
• Class S/SCPs: One Open Seat
• Steven Hollis, M.D. (Incumbent)
• Robert Cipolle, M.D.
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Physician Hospital Organization
PHO
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Organizations
NEPHO (Northeast Physician Hospital Organization)
Northeast Health System
50% Owner
NECoMG
(New England Community
Medical Group)
50% Owner
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Northeast PHO Board of Directors
Pierre Ezzi, M.D., President
Gary Marlow, Treasurer
Louis Di Lillo, M.D., Secretary
Suzanne F. Graves, M.D. , Director
Steven C. Hollis, M.D., Director
Francis X. Cleary, M.D., Director
Peter Short, M.D., Director
Denis Conroy, Director
Phil Cormier, Director
William Medwid, M.D., Director
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New England Community Medical Group, Inc. Board of Directors
Pierre A. Ezzi, M.D., President
Steven C. Hollis, M.D., Treasurer
Suzanne F. Graves, M.D., Secretary
Stephen A. Barrand, M.D.
Louis Di Lillo, M.D
Erin Heiskell, M.D.
John Malolepszy, M.D.
William Medwid, M.D.
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NEPHO BOARD OF DIRECTORS
ORGANIZATION CHART
Executive Director, Nicole DeVita
Director,Transitional & Ambulatory Care Management
(Pat Noonan, RN, MBA, CCM, CH-GCN)
Administrative Assistant
(Cheryl Clocher)
Care Manager
(Ken King, RN)
Care Manager
(Diane Hannify Broughton, RN, BS, CCM, CH-GCN)
Geriatric Social Worker
(Jessica Webb, MSW, LCSW)
Care Manager
(Amy Gibbs, RN, BSN, CH-GCN)
Care Manager
(Karen Richard, RN, BSN, CCM)
Care Manager
(Audrey Fraser, RN. BSN, CCM, CH-GCN)
Care Manager
(Patty Drozdowicz, RN, BSN, CCM, CH-GCN)
Managed Care Pharmacy Coordinator
(Carol Freedman, RPh)
Quality Analyst
(Jennifer Andersen)
Director, Clinical Director, Ambulatory Performance Improvement (Liz Isaac, PharmD)
Medical Director, Leslie J. Sebba, MD
Director of Contracting & Operations
(Stacey Keough)
Manager, Provider Relations
(Ann Cabral)
Executive Assistant
(Lisa Driscoll)
Office Clerk
(Krista Jones)
Referral Coordinator
(Michelle Costanza)
Provider Relations/Credentials
(Lisa Enderle)
Referral Coordinator
(Jean Servizio)
Data Entry Specialist
(Open)
Financial Analyst
(Maureen Von Zweck)
Sr. Business Analyst
(Brian Doucette)
Healthcare Analyst
(John Manyiel)
Administrative Secretary II
(Judith O’Leary)
Project Manager
(Ellen Kenyon)
Care Manager
(Susan Wambolt, RN, CDE)
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Funding Sources
36%
32%
32%
Health Plans
NECoMG
Hospital
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Shareholders and Service Fees
All physicians are credentialed as Shareholders
Shareholders must purchase 1 share • ($2,000: NECoMG will buy back share when
the physician leaves the organization)
NECoMG Service Fee for 2014: $900
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Physician Membership: May 2014
Total: 307
• PCPs:63
• SCPs:244
5 IM PCPs expected to join by August
1 Pediatrician will be joining in July
2 Pediatricians will be joining in January
5-6K additional covered lives expected
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Contracting Medical Management
Administration/ Provider Relations
Data/Analytics Program Development
• Health Plans • Providers • Reinsurance • Vendors
• Case Management
• Quality Improvement • HPHC
Honor Roll
• Clinical Pharmacist
• Performance Improvement Projects – DVT, Breast MRI
• Referral Management
• Appeals • Audits • Surplus
Distribution • Accounting • HPHC Grant • NP/PA Meetings • Office Staff
Meetings
• Data Warehouse
• Opportunity Reporting
• MD Score Cards • EMR Extracts
• Patient Centered Medical Home
• Accountable Care Organization
PHO Services
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Negotiated Contracts
COMMERCIAL
• TAHP
• HPHC
• Fallon
• HMO Blue
MEDICARE
• Tufts Medicare Preferred
• ACO
OTHER
• NETWORK HEALTH
• BOSTON MED CTR/HEATLH NET
• CELTICARE
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PHO Risk Contracting Performance
WH
Return
Budgeted Efficiency
Quality
Total Return
PMPM Savings
2010 100% $2,080,051 $5,887,407 $7,967,458 $15.55
2011 100% $2,597,141 $6,273,163 $8,870,304 $18.72
2012 100% $5,787,793 $6,410,815 $12,198,608 $28.38
2013 Projected
100% $4,269,409 $4,927,267 $9,196,676 $21.99
TOTAL $14,734,394 $23,498,652 $38,233,046
PHO Investment 2010 – 2013 :$3,848,166 PLEASE NOTE THIS DOES NOT INCLUDE INCREASED FEE SCHEDULES
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Rates “ Big 3”
BCBS
• 125% of Statewide/158% of Medicare
HPHC
• 146% of Statewide/175% of Medicare
Tufts
• 170% of Statewide/190% of Medicare
Please note these rates do not include Surplus Dollars
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AQC Quality Performance
2010 = 3.5
2011 = 4.0
2012 = 4.2*
Projected 2013 = 4.4
* Highest Gate Score of AQC Groups in 2012
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Management Service Organization (MSO)
MSO
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Lahey Medical Center & Community Group Practices
NHC NECoMG
LAHEY HEALTH SYSTEMS
NEPHO LAHEY Accountable Care Unit
NEW RISK UNIT MSO / ACO
LAHEY CLINICAL PERFORMANCE LCPN
Confidential Do Not Distribute
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Contracting Medical Management
Administration/ Provider Relations
Data/Analytics Program Development
• Health Plans • Providers • Reinsurance • Vendors
• Case Management
• Quality Improvement • HPHC
Honor Roll
• Clinical Pharmacist
• Performance Improvement Projects – DVT, Breast MRI
• Operations & Oversight
• Referral Management
• Appeals • Audits • Surplus
Distribution • Accounting • HPHC Grant • NP/PA Meetings • Office Staff
Meetings
• Data Warehouse
• Opportunity Reporting
• MD Score Cards • EMR Extracts
• Patient Centered Medical Home
• Accountable Care Organization
PHO/LCPN Services
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Collaboration Offers:
MSO PHO
• Economies of Scale
• Increased Covered Lives
• Protection from downside risk
• Stronger Negotiations
• Clinical Integration
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Tufts Health Plan 2013
NEPHO projecting a $542K deficit
Lahey ACU projecting a $916K surplus
LCPN projecting a $364K surplus
Tufts Share is 50%
LCPN projected surplus is$182K
Based on LCPN Funds Flow NEPHO would receive 100% WH return and an $ 88K surplus
Lahey ACU would receive a $75K surplus
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NEPHO Strategic Planning
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Overview
Health Care Market Landscape is Changing
The merger with Lahey was a by-product of the economic climate in health care
Consolidation of hospitals/systems continues to occur across Massachusetts and the Country
There is also a shift from private practice to employment by physicians
Success of the NEPHO will be dependent upon developing a strategic plan that will allow us to be “steady at the helm” and
respond to the above changes.
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Role of the PHO
“Back to Basics” Best in Class Performance
• Make sure all PHO participants are performing at the highest level possible
• Refined data/analytics opportunity reporting
• Targeted performance improvement program
• Redefine physician incentive program for CY 2015
• Work with LACU leadership to implement physician incentives
Contracting
• Strong Representation on LCPN Board & Committees to help drive contract strategy
• Strategy includes:
• Determining minimum reimbursement required for financial success of our practices
• Select contracts that are consistent in terms/measures/risk
• Expansion of contracts to include PPO and other Exchange insurers
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Role of the PHO Maintain/Grow Covered Lives
• Meet with Lahey Health leadership to agree upon a geographic strategy for all ACUs
• Move to include the Beverly, Danvers, Hamilton and Ipswich CGP practices to the PHO
• Guarantees for NMP to remain in the PHO
• Expand the number of contracts the PHO currently takes to include more exchange insurers and PPO where appropriate
• Attract new PCPs
• Improvement to the PHO website
Leadership Development
• Specialty Council
• “PHO” course development/training
• Increased exposure and participation of Board Members
• Potential Term Limits for Board of Directors
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Role of the PHO Mixed Medical Management/Performance Improvement Model
• Potential for slightly different approach models for private and employed physician practices
• Private Practice • More hands on from the PHO
• Employed Practice
• Work more closely with practice leadership and “hand off” some medical management/performance improvement activities
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Results