What an IPA does for Sacramento County Beneficiaries

Transcription

1 What an IPA does for Sacramento County Beneficiaries

2 What is an IPA (Reprise) Independent Practice Association consists of a network of physicians in a region or community solo practitioners or groups of physicians, i both primary care and specialists ili who agree to participate in an association to contract with health plans and other managed care organizations, for the benefit of each of the physicians in the IPA. The IPA physicians do not combine their individual practices. Instead, the IPAphysicians retain their practices and work out of their own offices.

3 What is Synermed/EHS? 300 FTEs Over 10,000 CONNECT Users 650,000+ members Serving Sacramento, Fresno, Madera, Kings, San Bernardino, Riverside, Los Angeles and San Diego Counties and Georgia Over $450 Million of healthcare dollars spent under our management All healthcare products: TANF, SPD, SCHIP, Medi Medi, Medicare, and Commercial

4 Sacramento County EHS Serves in Sacramento County as Primary Care Practices of Sacramento Sacramento Health Plan Partners; MHC, ABX, and HN Medi Cal TANF SPD Dual Eligibles Healthy Families Healthy Kids

5 Our Heroes The Independent Traditional Provider Critical member of the healthcare safety net Provides the highest value at the lowest costs in the safety net Endangered Species

6 Independent Physicians A large part of the Safety Net

7 Tools of the Trade 1. Claims Administration 2. Utilization Management 3. Quality Management 4. Credentialing 5. Financial Management 6. Management Reporting 7. Contracting: Physician, Hospital, Health Plan and Ancillary 8. HIPAA Compliance 9. Encounter Data Submission 10. P4P and HEDIS Reporting Measures

8 Tools That Make Us Unique SynerMedCONNECT SHARE MATH CHECKBOOK CONSULT DIRECT CONNECT

9 SHARE Where is the patient In the System? The Patient Must Not Get Lost Key Features and Benefits 1. Trouble Free Viewing and Navigation 2. Document Management 3. Prioritized Workflow 4. Inventory At a Glance 5. Flagged Alerts 6. Rapid Communication 7. Erase of Use for Auditing 8. Business Rules Engine 9. Complete Integration through SynerMedCONNECT

10 MATH How Are We Doing? Data Analysis Program Key Features and Benefits 1. Real Time Physician Financial Performance Compared to Respective Premium 2. MATH Reporting 3. Examine By Providers 4. Effortless Organized dinformation 5. Data Is Organized By Month 6. Define Values for Calculating Net Margin 7. HP Code Mappings

11 CHECKBOOK How do Providers Get Paid? Key Features and Benefits CFO s Best Friend 1. User friendly and intuitive software design 2. Data sorting and reporting capabilities for claims 3. Provides access to associated authorization and image of the original claim 4. Offers case communication tracking history 5. Accessible member information and authorization history 6. Customizable approval rights and financial controls 7. Effortless locates providers information 8. Flags potential issues by comparing data to billing and medical standards of care

12 CONSULT How do I Find Help? How do I refer, or gain information? Key Features and Benefits 1. Secure Communication 2. Improved poedpatient Access 3. Greater Access to Specialty Care 4. Better Treatment Times 5. Continuing Education 6. Increased Patient Satisfaction 7. Advanced Clinical Technology 8. Greater Patient Retention 9. E referrals

13 DIRECT Insuring Quality We Must Provide a High Standard of Care Key Features and Benefits 1. Smart Rules Search Engine 2. Confirms Standard of Care are Followed 3. Convenient and Easy Access 4. Easy Organization and Prioritization 5. Authorization and Review Based on Business Rules 6. Detailed Information and History 7. Instantaneous Management of Authorizations and Hospitalized Patients 8. Secure Communications 9. Reduced Time and Costs 10. Seamless Integration into Internal Workflow Programs

14 CONNECT Online Interface Provider and IPA Information Tools. Key Features and Benefits Interconnected Virtual Platform User Friendly with a 2.0 User Interface Greater Efficiencyy and Elimination of Paper Increased Coding and Reporting Efficiency Smart Rules with Evidenced Based Criteria Improved Workflow

15 Low Cost + High Quality = Value Group Care Management HIT Accountability /Transparency Patient Centered Care Achievement Brown and Toland Medical Group Elite Healthcare Partners Medical Group Elite Heritage Providers Groups Elite Hill Physicians Medical Group Elite Monarch HealthCare Elite Kaiser Permanente Medical Group Elite NAMM Affiliated IPAs Elite Sharp Community Mdi Medical lgroup Elite Sutter Medical Foundation Elite SynerMed Groups Elite UCLA Medical Group Elite For more details go to

16 Matthias E. Mengelkoch Regional Administrator THANK YOU!