MONTHLY MEETING RECAP July 2015
Board of Managers
ICD-‐10 Dr. Stuart provided an update on ICD-‐10 and the upcoming changes. One of the variables is the hospital can be prepared, however, the payers might not be. EvergreenHealth has shared information, including test claims, to get a sense of how ready they are, however, we can’t prep them completely.
Dr. Stuart also provide a handout of the September training schedule. There is no need to register for a training class, you are welcome to attend on the date/time that works best for your schedule.
30-‐Day Readmissions Dr. Palazzo provider an overview of our 30-‐day readmission stats, including an overall history of how we have progressed. The best way to we have found to decrease readmission rates is to publicize each provider’s stats. Provider’s want to do the right thing and are also competitive so if you post stats, they will want to improve on their own. PSHVN – HCA Accountable Care Program Mr. Martin provided an update on the PSHCN/HCA contract as follows: • Signed the contract in early June • Are now deep into the implementation phase • Anticipate 5,000 lives – 30% will convert • 30% premium discount, $0 cost for PCP visits • Gearing up for open enrollment – call center, website, marketing materials, rosters • Quality Care Transformations is in place • Started process to make PSHVN as its own LLC -‐ organizational elements of operating agreement are in place • There are still several unanswered questions we are working through
Executive Director / Quality Committee Update In Ms. Ruyle’s absence, Mr. Martin provided an update as follows: • Benefits Captive -‐ started a process of looking at a captive, your practice manager received an email from Tiffanie • If we put EH we may be enough to make it beneficial Medical Director Update Dr. Buehrens provided an update as follows: It has been close to a year we have had an RN Care Coordinator. As Debi visits practices, she is hearing that the provider’s feel very disconnected from information regarding EHP.
Dr. Buehrens also reviewed the PCP/Specialist compact. Should the BOM review and provide feedback or would you like the Quality Committee to edit and bring a final version back to this group? Have the Quality Committee review and bring back a final version for review in September.
Quality Committee
Quality Initiatives Dr. Russell and Ms. Rutherford provided an update as follows: 2015 Aetna Targets: We expect to have a meeting with Aetna within the next few weeks to set 2015 the targets. There are 8 quality measures, 2 are double weighted. We need additional information from Aetna before we can accurately set the targets. Dr. Buehrens met with Dr. Bartholomew earlier in the year to discuss targets, however, no one seems to remember what they are.
2015 First Choice Improvement Strategy Confirmed the measures chosen. Now, how can Debi & I help the practice managers wrap their minds around this? How do we communicate this information in a meaningful way? Do we have any data we can show them so they can see where each provider stands so we can work to improve? Can we ask for strategies of providers who are doing well?
Cigna Update To answer the coronary artery disease questions that came up last month, we only have 7 unique patients in the denominator.
Can we somehow negotiate to remove the category if we only have xx number of patients?
Nurse Care Coordinator Update Ms. Jefferson provided an update as follows: We have a new high risk number of patients -‐ 279 70% of those have been presented to the providers they are attributed to Currently, this information is provided to the practice manager who sends it to the MA or MD.
Nurse Care Coordinator Update Dr. Buehrens discussed the Primary Care / Specialist compact. Tiffanie will send the draft to the committee for review, edits and comments. An updated draft will be brought to the August meeting for discussion.
Payer Committee
Mr. Martin provided an update from the Payer Committee meeting as follows: D2B -‐ Now that we are 1 ½ years into payer contracts and are seeing positive data trends, we can approach potential employers about opportunities to partner with us. Examples of potential partners are: • Windham Hotels – regional office in Renton, 340 employees locally of which 72 are attributed to us, hosted a Be Well Day
and invited us to join in. Will continue to talk to them. • Blue Print Consulting Group – with Cigna and we plan to meet with them next week. • City of Kirkland – with First Choice, 1,400 lives, value = Tiered benefit design, can steer patients into EHP and lower costs. • EHP Active Care – Regence -‐ we met with them today to discuss how we can expand this program. • Master Builders Association – with Regence – we think we can save them money. • Denali Advanced Integration – with Regence, 250 employee group • Canyon Creek Cabinets, Monroe • Premera ACO contract – Alaska Airline, Microsoft – longer lead times but an opportunity
Medicare Advantage Several months ago, we asked The Polyclinic to come and present their medical advantage plan. The Payer Committee has reviewed it and decided that we aren’t ready to take that on in 2016, so we deferred to approaching those contracts until 2017. EvergreenHealth is looking at those contracts in 2016 and we will either build or buy the infrastructure.
EvergreenHealth Incentive Bonus Payout – Memo from Gregg Aoyama below Last year, EvergreenHealth offered EvergreenHealth Partners (EHP) an incentive bonus performance plan. Its purpose was to reward the physician participants of EHP in the “adoption, implementation and adherence to the Quality Program…in an effort to improve quality and costs for healthcare delivered to EvergreenHealth beneficiaries.”
According to the 2014 EvergreenHealth Self-‐Insured Employee Benefits Program Incentive Bonus Performance Plan document: “For purposes of determining the savings achieved, EvergreenHealth will compare the “2014 Projected Medical Expense Budget” with the “2014 Actual Medical Expenses” on a risk adjusted basis to yield a savings amount…EvergreenHealth will share half (50%) of the saving achieved for the 2014 benefit plan year with EHP as a bonus to be distributed to participating EHP providers.”
As of today, I wanted to report to the Board of Managers the following: • As planned, we have obtained the final reports from First Choice for plan year 2014; those reports allowed for 5 months of
claims run-‐out into the beginning of 2015. • On a risk-‐adjusted per member per month (PMPM) basis, the plan generated an annualized savings of $780,696, which
would result in a payout to EHP in the amount of $390,348. • These figures, shown on Page 2, are close to the projections provided at the beginning of 2015 before the applicable
claims run-‐out. • They still need to be reconciled by the EvergreenHealth Finance Department and confirmed by AON/Hewitt (EH’s benefits
consultant) – this is currently in process. • At this point, we remain on schedule of expecting EHP distribution to physicians/groups by the end of July.
Please let me know if you have any questions or concerns.
If you would like a copy of the full minutes, please reply to this email with the request.
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