Peter Donaldson, MBA CEO, Digestive Health Specialists, PA Winston-Salem, NC

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1 Peter Donaldson, MBA CEO, Digestive Health Specialists, PA Winston-Salem, NC American Gastroenterology Association Partners in Quality Thursday, January 16, 2014

2 Specialty Recognition for GI AGA Digestive Health Recognition Program built in partnership with the Health Care Incentives Institute (HCI3) and the Bridges to Excellence Program Platform for clinicians to demonstrate and be recognized for superior quality of care in the treatment of various digestive diseases. Two recognitions are currently being offered: IBD Recognition HCV Recognition

3 Specialty Practice Recognition NCQA Patient-Centered Specialty Practice Recognition Specialty practice version of the Patient Center Medical Home Recognizes any specialty practices that successfully coordinate care with their primary care colleagues and each other, provide timely access to care, continuous quality improvement, reduce duplication of tests, measure performance and improve communication with patients. PracticeRecognition.aspx

4 What is Value? Value is the worth derived from use of a product or service. Value is not the price you pay but rather the benefit received. Buy and never read the book and the value is zero. Buy and find a great investing idea and the value could be a Million Dollars.

5 GI Practice Value The value or worth of a product or service for a GI practice is generally one that helps the practice maintain or increase revenue. Increased revenue results when a GI practice is perceived to be providing more value than a competitor practice and as a result sees more patients or is able to obtain higher reimbursement GI Practice Value is assessed by Patients (existing and prospective) Payers (health plans and employers) Physicians (referring and colleagues)

6 Patient Perspective Your favorite sister was diagnosed with Crohn's disease 8 years ago just before you retired. Your former partner has been caring for her, but a job transfer takes your sister 500 miles away. You are asked to find her a new doctor that will provide excellent quality care. What resources will you use? Internet, professional connections, social media, specialty recognition directory.

7 Patients Value Experts Patients would prefer to see a gastroenterologist that is a recognized expert. How do patients find recognized GI experts? How do GI Physicians publicize their expertise?

8 Patients Use Internet Only criteria to be listed in the Doctor finder is to be a member. CCFA cannot attest to the credentials of its members, nor do we evaluate the competency of our members.

9 IBD Specialist Search Difficult to find the recognized clinicians listed on any other internet site. Recognition value would be improved if the public could more easily find recognized clinicians on a patient focus site and the importance of the recognition was more widely publicized. AGA page is focused on providing value to the practicing GI physician. Consider partnership with Crohn s and Colitis Foundation.

10 Payer Perspective Payers want to reduce the per capita cost of health care through network providers that deliver economic value added services. Gastroenterologists want patients from the payer and want to be financially rewarded for providing economic value added services.

11 Payer View of Physicians Payers are tracking expected and actual provider costs by treatment group. Payers want more science, evidencedbased medicine, and less art. Specialty recognition can demonstrate to the payers that are following evidenced based medicine guidelines.

12 Payer View of Recognition From the National BCBS website, Blue Physician Recognition (BPR) indicators will be displayed nationally to 100 million Blue patients via the Blue National Doctor & Hospital Finder SM at beginning in July BCBSNC Director of Quality Based Networks stated, We do put the recognitions on our website. We do not offer any incentives for the specialty designations at this time, and to my knowledge do not intend to do so. A quick search for BPR physicians of any specialty on both the national and state sites revealed minimal results for BPR recognition BCBSNC has a Tier program and those in Tier 1 are listed on website as low cost and high quality.

13 Payer/Specialist Interaction Many payers have offered financial incentives to primary care providers but incentives for specialists are not as common. The GI community needs to lobby payers to provide financial incentives to GI providers that achieve specialty recognition to enhance the value of specialty recognition. The GI community needs to lobby payers to better identify GI providers that achieve specialty recognition.

14 Physician Referral Perspectives Many GI physicians have relied on personal, professional, and social relationships for referrals from other physicians for many years. Patients and payers are attempting to disrupt those Country Club relationships by putting pressure on referring providers to send patients to high quality, expert GI physicians. How do referring providers identify high quality, expert GI physicians? How do GI Physicians publicize their expertise to referring physicians? Will achieving specialty recognition classify you as a high quality GI expert in the eyes of the referring physician?

15 Physician Specialty Awareness Specialty recognition can become a value differentiator if the GI community educates referring physicians and colleagues about the GI specialty recognition programs. Advertise GI specialty recognition programs in primary care and payer publications and venues. Issue national and local press releases announcing physicians that achieve recognition. Notify referring physicians, community health care leaders, local newspapers, of recognition achievement. Publicize achievement on practice websites, brochures, newsletters, etc.

16 Physician Recognition Value Additional incidental value in obtaining specialty recognition: Personal satisfaction that you are following best practice evidence based medicine guidelines and in doing so you know you are providing your patients with quality care. Implement standardized best practice guidelines amongst physicians and mid-level providers in a group practice. Competition be the first GI provider in your area to achieve specialty recognition. Demonstrate to corporate health systems, ACO and other organizations that you are committed to being a quality provider. Satisfy PQRS Requirements and Avoid Penalties. Meet ABIM MOC Requirements. Improve Quality Through Peer-to-Peer Networking.

17 Specialty Recognition Value Is a specialty recognition program of value to the GI community? Yes, if the GI specialty recognition programs are more widely publicized to patients, payers and physicians. Is a specialty recognition program of value to an individual physician or group? Yes, if the physician publicizes the recognition and educates patients, payers and physicians as to the worth of the recognition.