Clinical Integration & ACO Contracting

Transcription

1 & Clinical Integration & ACO Contracting 1

2 The First TXCIN ACO Contract: Cigna Collaborative Accountable Care (CAC) Benefits of ACO Contract Participation: 1. Patients Attributed to PCPs (IM, FP, PEDS, OB/GYN) 2. TXCIN Support for Referrals 3. New Technology Delivers Quality & Cost Reports 4. Care Coordination Support for High-Risk Pts. 5. Quarterly Care Coordination Fee Payments for each Attributed Patient 6. End of Year Shared Savings Payments 2

3 The First TXCIN ACO Contract: Cigna Collaborative Accountable Care (CAC) Steps for GPG Member s Participation: 1. Review & Sign TXCIN Physician Participation Agreement (PPA) 2. Complete Cigna ACO Contract Election-to- Participate (ETP) Form 3. Fax PPA & ETP Signature Pages to TXCIN (FAX #: ) 4. Schedule TXCIN On-Boarding Mtg. when contacted by TXCIN Staff 3

4 The First TXCIN ACO Contract: Cigna Collaborative Accountable Care (CAC) GPG/TXCIN Cigna CAC - ACO Contract Financial IMPACT Summary Based on 100 Patients seen 2 times per year (200 visits), billing & (one each) *AVERAGE # OF PRIMARY CARE VISITS PER YEAR AGE = 2.1 ORGANIZATION REVENUE REVENUE IMPACT GENESIS CIGNA FFS $19,425 CIGNA FFS = 106% OF MEDICARE TXCIN ACO CCF $1, % INCREASE IN REVENUE *CCF = PMPM for ACO Patients GENESIS IPA/TXCIN COMBINED $21,189 REVENUE IMPACT = 115% OF MEDICARE FOR 2 VISITS PER PATIENT Plus: Additional End of Year Shared Savings Distribution 4

5 The Second TXCIN ACO Contract: BCBS Commercial Benefits of ACO Contract Participation: 1. Patients Attributed to PCPs (IM, FP) 2. TXCIN Support for Referrals 3. New Technology Delivers Quality & Cost Reports 4. Care Coordination Support for High-Risk Pts. 5. Quarterly Care Coordination Fee Payments for each Attributed Patient 6. End of Year Shared Savings Payments 5

6 The Second TXCIN ACO Contract: BCBS Commercial Steps for GPG Member s Participation: 1. Review & Sign TXCIN Physician Participation Agreement (PPA) 2. Fax PPA to TXCIN (FAX #: ) 3. Schedule TXCIN On-Boarding Mtg. when contacted by TXCIN Staff 6

7 The Second TXCIN ACO Contract: BCBS Commercial GPG/TXCIN BCBS - ACO Contract Financial IMPACT Summary Based on 100 Patients seen 2 times per year (200 visits), billing & (one each) *AVERAGE # OF PRIMARY CARE VISITS PER YEAR AGE = 2.1 ORGANIZATION REVENUE REVENUE IMPACT GENESIS BCBS FFS $18,981 BCBS FFS = 104% OF MEDICARE TXCIN ACO CCF $1, % INCREASE IN REVENUE *CCF = PMPM for ACO Patients GENESIS IPA/TXCIN COMBINED $20,745 REVENUE IMPACT = 113% OF MEDICARE FOR 2 VISITS PER PATIENT Plus: Additional End of Year Shared Savings Distribution 7

8 Frequently Asked Questions Q: Do I have to leave Genesis or my Genesis contracts to participate? A: No, your FFS contracts will remain in Genesis. In fact, you must have a contract thru a participating IPA to participate in TXCIN ACO contracts.* Q: What happens if I m already in GAPN? A: GAPN members will be automatically transitioned to TXCIN membership. We believe it is important for members to review the TXCIN Physician Participation Agreement (PPA) Q: Can I participate in TXCIN and other local ACOs? A: Yes, except physicians can only have attributed patients from one ACO for each individual contract. *Genesis physicians contract directly with United if they elect to participate, they will move to United s ACO contract rates. 8

9 Frequently Asked Questions Q: How much will the quarterly Care Coordination Fee payment supplement the average PCP contracted FFS rates? A: The average will be 10% of your FFS rate for each contract. Q: What does TXCIN participation cost? A: There are currently NO membership fees for TXCIN participation. TXCIN retains 10% of care coordination fee payments to offset cost of clinical integration software and management services. Q: Do I have to participate in all of the contacts offered? A: No, You can choose which ACO contracts you want to opt-in to. 9

10 Frequently Asked Questions Q: Do TXCIN specialists receive financial rewards for care coordination? A: Yes, TXCIN specialists are paid a CCF for each patient they see after referral from a TXCIN participating physician Avg. = $56 per patient seen Q: Do TXCIN specialists pay a fee for TXCIN patient referrals? A: TXCIN Specialists are charged a Performance Informatics fee per accepted patient referral ($9.50 per accepted referral). Q: What role do specialists play in TXCIN s clinical integration? A: TXCIN s unique strategy is connecting PCPs and Specialists thru the use of technology, mpactmd, facilitating daily patient referral mgmt. between physicians. Specialists utilizing the technology build closer alignment while creating deeper clinical integration. 10

11 Frequently Asked Questions Q: What happens if TXCIN is successful in improving quality while eliminating waste and reducing costs? Will there be Shared Savings? A: TXCIN is distributing Quarterly CCFs to network physicians to increase the likelihood of producing Shared Savings! Shared Savings will be distributed to TXCIN physicians based upon both the number of patients they serve and the quality & efficiency of care. 11