webinar: integrating physician practices into your network

Welcome...

Today’s topic

Integrating Physician Practices Into Your Network

During today’s discussion, feel free to submit questions at any timeby using the questions box. A follow-up e-mail will be sent to all

attendees with links to the presentation materials online.

Patricia RichesinVice president, Physician Strategies and Services, VHA,Irving, Texas

Christopher LloydCEO, Memorial HermannPhysician Network,Houston

Dr. Charles KellyPresident and CEO,Henry Ford PhysicianNetwork,Detroit

HousekeepingHousekeeping1. Viewer Window 2. Control Panel

Maureen McKinneyEditorial programs manager,

Modern Healthcare

Now speaking...Please use the questions box on your webinar dashboard

to submit comments to our moderator

Patricia RichesinVP, Physician Strategies and Services

VHA



************************************THE PATIENT****************************

Creating a Community of CareFundamentals of Integrated System Risk Management

Employers • Payers • Providers • Hospitals

Right Providers Right Specialties Right Access Right Services

Optimal Outcomes Optimal Utilization Optimal Cost

Big Data Effective Networks New Knowledge New Expertise

1 |

Value-based care is forcing more hospitals and health systems to explore clinical and physician integration strategies

2 |

Assessment

Acculturation

Alignment

Assimilation

Creating a Community of CareKey steps to successful integration

3 |

Assessment

Acculturation

Alignment

Assimilation


Lack of due diligence to ensure a match between hospitals and physician networks can derail long-term strategy

Assess demand for services across continuum, primary care and specialists, as well as places of service

4 |

Assessment

Acculturation

Alignment

Assimilation


Not being aligned upon entering an agreement might lead to misunderstanding of value proposition and expectations for the relationship

Align incentives for clinical quality, patient access, financial outcomes; create structures that fit including employment models

5 |

Assessment

Acculturation

Alignment

Assimilation


Resistance to change may ultimately result in conflict and misalignment of long-term vision/goals

Decide if you’re going to build or adopt a culture; share best practices while moving from a team of individuals to individuals on a team

6 |

Assessment

Acculturation

Alignment

Assimilation


Without strong network and physician leadership, systems break down and progress is slowed

Need a team approach to care – not only across providers (primary, specialists, hospitalists), but within a practice (providers, nurses, techs)

7 |

Assessment

Acculturation

Alignment

Assimilation


SuccessfulIntegration

8 |

Physician Integration Strategies

Appendix

7 keys to creating an efficient onboarding process

As new physicians and practice groups join your organization, a thoughtful, standardized approach can make onboarding and orientation go more quickly and efficiently.

Below are seven keys to creating an efficient onboarding process that enables a smooth transition for physicians and staff joining the new organization and assimilating into the new culture.

1. Due diligence: Create a check list of items typically required for due diligence such as by-laws, articles of incorporation, shareholder or partnership agreements, real estate documents, an asset list, all contracts, insurance documentation, pending litigation, financial documents, employee roster and regulatory compliance documents.

2. Document exceptions: Develop a template to document exceptions to the standard agreement. These might include medical directorships, additional assets or monetary arrangements or anything that is not typically part of the standard agreement.

10 |


3. Develop a master onboarding list with a timeline. Identify responsible staff for each section and tie together sequential processes. Provide central access to the list so that each department can access it as needed.

4. Communicate. Communication and coordination is the key to ensuring that all items are completed prior to the provider beginning employment. Missing key deadlines can be costly to the organization. Setting up a realistic timeline, which is minimally 60 to 90 days is essential.

5. Appoint a project manager/owner. The project manager/owner serves as the key contact for administrators and practitioners to ensure the process goes smoothly and remains on schedule. Regularly scheduled meetings with key players helps keep the project moving and holds people accountable.

11 |


6. Establish an orientation plan. During the first year of employment, assign a physician mentor and hold regular meetings with the medical director to ensure engagement and integration into the new group and culture.

7. Continually review the process. Create a physician survey related to the onboarding process as part of the master plan to help identify areas for improvement.

In our rapidly-changing environment, a well-planned onboarding process that serves as a structural compass before, during and after the partnership deal is done is critical to success. When a plan is in place, the organization as a whole benefits through improved employee morale and a vibrant culture that works together to put the needs of the patient first.

12 |

Dr. Charles KellyPresident and CEO,

Henry Ford Physician Network



Henry Ford Physician Network

• Clinically integrated as defined by FTC

• Operational April 2010

• Approximately 1700 physicians total– 1100 member Henry Ford Medical Group

– 100 non-HFMG, regionally employed physicians

– 500 private practice physicians

– Footprint in 3 county market, SE Michigan, 7 competitive Health Systems.

• Marketing as Narrow Network/Population Manager– Provider-owned Health Plan

– Direct to employer

• Application pending for CMS MSSP for 2015

On-boarding Process

• Practice Interest and Application completion

• 120 day period of pre-Qualification

membership

• Achieving Qualified membership

• Practice Orientation

Application period

• Clinical Integration is hard work and not for

everyone

• Initial contact regarding “interest” generally

triggered by news of peer receiving incentives

or desire to participate in a premium contract

• Little knowledge of the extra work and

commitment required of a CI Citizen

Application Period

• Following our notification, application and

copy of participation agreement forwarded

• If completed and returned within 2 weeks the

provider and practice enter a 120 day pre-

Qualification phase.

• We follow up with the practices in 2 weeks if

we have not received any information

• Status change to “ declined” and process ends

120 day pre-Qualification

• All the following elements must take place within

120 days or our agreement is void

– Establish data connectivity and continuous reporting

– W9 on file

– Approved credentials

– Executed participation agreement

• Your worst case scenario is having providers enter

into patient assignments without commitment to

CI process thus leading to beneficiary disruptions

Qualified Membership

• Orientation scheduled-designed for Office Mgr and key staff- helpful if physician attends– Actually begins during installment of data aggregator tool

– Physician portal registration/userID and password

– Metrics toolkits provided for appropriate specialty

– Contract summaries provided

– MSO offerings explained and process to acquire

– General overview of value of the Network and Clinical Integration

– Assist with practice workflow solutions

– Description of required coding and integrating with billing practices

– Leadership review, ie. Board members, Regional Medical Director and HFPN team.

• Physicians enrolled in all contracts

• Physicians achieve eligibility for incentives and benefits

• Office Manager Forum schedules and invitations

Metric Toolkits

• Essentially designed to inform participant on what they will be measured, what the source of data will be, how they will be informed of the outcomes and frequency of reports.– Press Ganey satisfaction surveys distribution by PN

– Data collection across ALL patients, not just contracted beneficiaries

• It also links these measures to our “Value Campaign” which also describes eligibility and scoring for earning incentives

• Introduction to the data dashboard that allows individual and specialty specific and regional comparisons.

• Choosing Wisely Campaign outline and requirements for members

MSO Offerings

• Subsidized IT offerings- supported by training, install and ongoing maintenance.

• Access to Group Purchasing discounts

• Affordable Malpractice coverage

• Privacy and security compliance for the practice

• Ford X Plan and other employee discounts offered to HFHS workforce

• Revenue cycle assistance with private vendor that generates robocalls and securely stores credit info

Christopher LloydCEO,

Memorial Hermann Physician Network



Complexion of the Physician Network

• MHMD

– 4000 practicing physicians

• 1950 CI physicians in MHACO (single signature representation)

• 300 Advanced Primary Care Practices (PCMH)

• 250 additional PCPs

• Evolving High Performance Specialty Physicians (500)

• 200 are employed (MHMG)

• University of Texas Physicians

– 800 physicians

– CI and ACO affiliates

– Some UT faculty participate in advanced and high performance practices

Memorial Hermann Corporate Structure

Memorial

Hermann Health

System

Children’s

Governance

Audit

System Quality

Finance

Physician Council

Corporate

Members

Memorial

Hermann

FoundationMHMDHePIC

MH Medical

Group

MH Health

Solutions, Inc.

MH Community

Benefit Corp.

MH Accountable

Care

Organization

MH Information

Exchange

CPCs: Connecting to the System Board and the Hospital Medical Staffs/MECs

MH Hospital Board

System Quality Committee

MHMD Board of Directors

Clinical Programs Committee

H&V Neuro

Woman/ Child

Surgery

Medicine Oncology

Path/Rad Primary Care

Nursing Councils

Operating Councils

Executive Liaisons

Service Lines

HOSPITAL MECs

Katy MEC MC MEC

NE MEC NW MEC

SE MEC SW MEC

SL MEC TMC MEC

TWL MEC

MH Medical Staffs (MHMD Members)

MHMD Clinical Programs Committees Physician Governance of Quality and Safety

MHMD Board of Directors

Clinical Programs Committee

H&V

Cardiology

CV Surgery

Neuro

Neurology

Neurosurgery

Woman/Child

Neonatal

OB/Gyn

Surgery

Anesthesia

Bariatrics

Orthopedics

ENT

Allergy

Medicine

Critical Care

Emergency

Ad hoc

Hospital Medicine

Post Acute

Oncology

Oncology

Contract

Imaging

Pathology

Primary Care

Adult PCP

Peds

Peer Review

Clinical Ethics & Palliative Care

Order SetEditorial Board

Informatics

Acute Surgery

DVT/PE JOC

End of Life Care JOC

Pediatric Head CT JOC

Surgical Home JOC

4

Memorial Hermann

Regional Medical Home Structure

Central Region• Hospitals - 4 (CMHH, TMC, TIRR, NW)• ASC - 3• MHDL PSC - 6

204 PCPs

•51 APCP (11 MHMD, 7 MHMG/Phytex, 33 UT)

•9 APP (5 MHMD, 4 MHMG/Phytex) •144 CI PCPs (inc UT)

757 Specialists• 21 MHMG/Phytex• 736 CI Specialists (inc UT)

• OPID - 7• SMR - 4

Northeast Region• Hospitals - 1 (NE)• ASC - 2• CCC - 1

33 PCPs


•0 APP•13 CI PCPs (inc UT)


• MHDL PSC - 1• OPID - 3• SMR - 2

North Region• Hospitals - 1 (TWL)• ASC - 4• FSER - 1

91 PCPs




• MHDL PSC - 3• OPID - 3• SMR - 6

West Region• Hospitals - 3 (KT, KT Rehab, MC)• ASC - 4• MHDL PSC - 6

163 PCPs




• OPID - 8• SMR - 5

Southeast Region• Hospitals - 1 (SE)• ASC – 2• MHDL PSC – 3

97 PCPs




•OPID - 6• SMR – 8

Counts as of 7/22/2014Physician counts do not include physician extenders *Includes UT Pediatricians, some specialty Pediatricians, and some IM and FP’s with a secondary subspecialty

Southwest Region• Hospitals - 2 (SL & SW)• ASC - 4• MHDL PSC - 6

174 PCPs




• OPID - 5• SMR – 8 (add’l 1 pending)

1 Additional SMR in Nederland

3 Additional MDs in Bay City: 1 MHMG PCP, 1 MHMG Specialist, 1 CI Specialist.

5

PCP Regional Leaders

Dr. Jeff Sweeney

Medical School

at USC and

residency at Kaiser

Permanente

Captain in

medical corps

Board certified in family medicine

North Northeast West Southwest Southeast Central

Dr. TejasMehta

Temple University School of Medicine

Residency at Penn State

College of Med

Board certified in Internal

medicine and

primary care

Dr. AnkurDoshi

University of Texas Medical

Branch Med

School

Board certified in Internal

Medicine

Founder of Prime Care Medical

Group

Dr. John Vanderzyl

University of Texas Health

Center – Houston

Board certified in family medicine

Named “Top Doctors in

America”

Dr. Adnan Rafiq

St. George

University

Medical School

and University of Medicine – New

Jersey

Board Certified in internal

medicine

Physician of the Year 2012

Dr. Kevin Giglio

UT Health

Houston medical

school

Residency at MH Family medicine program

Board certified family medicine

The MHACO

� Shared Savings and Aligned Incentives

� More flexibility in ACO “related” quality,

safety and efficiency program incentives

� MHMD contracting capability

MHACO

Promoting Evidence Based Medicine

Promoting Beneficiary Engagement

Internally Reporting On Quality And Cost Metrics

Promoting Care Coordination

POPULATION MANAGEMENT

Quality Assurance And Improvement Program Processes

Commercial Medicare

7

DocbookMD App

1. Go to the App Store or Google Play from your mobile device

2. Search for and download “DocbookMD”

3. Tap “Create Account” and complete the registration process

iOS

• Create Account – select to

register for 1st time

• Existing users

• Enter email and

password setup during

registration

• Click Log in - app will

store details

• Forgot Password – select to

receive email link to reset

• Help icon (?)

Android

• Create Account – select to

register for 1st time

• Existing users

• Enter email and

password setup

during registration

• Click Log in – app will

store details

• Forgot Password – select to

receive email link to reset

• Help icon (:)

Today’s panelists...Integrating Physician Practices Into Your Network

During today’s discussion, feel free to submit questions at any time by using the questions box.

Maureen McKinneyEditorial programsmanager,Modern Healthcare

Christopher LloydCEO,

Memorial Hermann Physician Network,

Houston

Dr. Charles KellyPresident and CEO,

Henry Ford PhysicianNetwork,

Detroit

Patricia RichesinVice president, Physician Strategiesand Services,VHA,Irving, Texas

TODAY’S MODERATOR

Thank you...

... for attending today’s editorial webinar on integrating physician practices into your provider network.

We also thank our panelists, Dr. Charles Kelly, president and CEO of Henry Ford Physician Network, Detroit;

Christopher Lloyd, CEO of Memorial Hermann Physician Network, Houston;

and Patricia Richesin, vice president of physician strategies and services, VHA, Irving, Texas.

Expect a follow-up e-mail within two weeks. For more information,

send an e-mail to [email protected]

Our next editorial webinar, “Patient Engagement: A Key Strategy for Population Health Management,”

is set for Wednesday, Sept. 17. For more information, please visit modernhealthcare.com/webinars