Pilot project seeks to

Transcription

1 Summer 2018 The Pulseof Pilot project seeks to IMPROVE DIABETIC CARE Diabetes affects more than 30 million Americans, with 1.5 million new cases every year. Addressing diabetes measures is an important focus area for The Physician Alliance, and a HEDIS quality measure needing improvement. More than 9,000 gaps in care have been identified for TPA diabetic patients so far this year. To address this key focus area, The Physician Alliance recently launched several projects that partner with practices to improve patient outcomes. Along with new prediabetes and high-risk diabetes projects, an outreach and education program is being piloted in several TPA practices. TPA partnered with Merck to offer education to primary care practices that have a high number of diabetic patients. The pilot program began in June, with six practices so far participating in the pilot. These include Academic Internal Medicine, Dudley Roberts, MD, Eastside Internal Medicine, Masonic Medical Center, Schoenherr Family Practice, St. Clair Adult Medicine and St. John Family Medical Center. Over the past year, TPA created multiple diabetes materials for practices to distribute to patients at risk for diabetes and already diagnosed with the disease. These include an action plan, self-management form, managing diabetes poster and preventing diabetes poster. TPA and Merck staff identified additional patient materials that align the messaging on TPA s information to ensure consistent education and information is shared with practice staff and patients. Developed in continued on page 2

2 President s MESSAGE Dear members, We recognize there is much information, sometimes an overload, disseminated to you on a daily basis from multiple sources. Our team works to ensure the information and education that we share with you is done in a concise, helpful manner, meant to improve your workflow, revenue, quality metrics and patient care. We re proud of the results from working with our practices. We have 352 of our primary care physicians designated patient centered medical home, representing 95 percent. Eighty-nine percent, or 805, of our specialists are receiving 5-10 percent additional reimbursement from Blue Cross Blue Shield of Michigan. Over the past three years, more than $46 million in value-based reimbursement has been distributed to our physicians. These achievements are the results of improved quality metrics performance, lower healthcare costs and improved patient care. There is a myriad of resources available to your practice staff and you. I hope you are taking advantage of these education opportunities, marketing materials, coding tips and more available on our website. We are always evaluating and expanding our offerings so please let us know if there are topics of interest. In good health, Michael R. Madden President & CEO Improve Diabetic Care continued from page 1 partnership with the American Diabetes Association, these materials are colorful and easy to read to help ensure understanding and use by all patients and care managers. Merck representatives will meet with medical assistants, and possibly other staff, in the practice for a multi-session education program. Topics will range from general diabetes information (related to HEDIS measures) to goal setting to identifying competency of understanding, as part of a larger focus on self-management goal setting and implementation. TPA will work with practices to determine the pace of the education sessions to ensure smooth integration into workflow and set expectations of program outcomes. Helping our physicians fight this growing disease is important, not only to our current patients, but the population at large, said Carolyn Rada, RN, vice president of operations at The Physician Alliance. We want to ensure our physicians have easy to use and helpful resources to assist their patients in better managing, and hopefully improving, their diabetes. TPA will track practices that receive the education and also work to implement the program with patients. Success will be measured through implementation of related patient centered medical home capabilities. TPA primary care practices interested in participating in the diabetes education pilot can contact Carolyn Rada at Carolyn.rada@thephysicianalliance.org for more information. < The diabetes patient education materials are complimentary to TPA practices. Download or submit an online order form: Visit Click on Learning Center Click on Patient Education Materials 2

3 DID YOU KNOW? Are you staying updated on educational opportunities, insurance provider changes, performance improvement tips, special offers, and news on colleagues? Make certain you re receiving The Physician Alliance s electronic newsletter, The Pulse. Delivered every other Friday morning via , this e-newsletter keeps members updated on relevant programs and services, news from the healthcare industry, tips to improve incentives and more. If you re not receiving the e-newsletter, contact heather.hall@thephysicianalliance.org. Practice staff are also welcome to receive this! If you missed an e-newsletter, you can visit to find archived issues under the Learning Center tab. < Physicians improve important e-prescribing rates As the opioid epidemic in the United States continues to grow, The Physician Alliance is working with our more than 2,200 physicians and health care partners to help combat this crisis. One important way is through improved e-prescribing of controlled substances (EPCS). E-prescribing can improve patient quality care and improve practice workflow and efficiency as it combines traditional e-prescribing with security measures that allow physicians to electronically order these tightly regulated substances. Some benefits include preventing errors related to legibility and clarity of faxed or phone prescriptions, aligns with Meaningful Use criteria, improves monitoring of prescriptions, increases patient satisfaction and compliance, and improves medication management. Blue Cross Blue Shield of Michigan launched an initiative to track e-prescribing of physicians participating in the Physician Group Incentive Program. Through a focused and aggressive plan, TPA and St. John Providence worked with practices to implement e-prescribing of controlled substances. TPA PGIP physicians responded with improved rates. When TPA began tracking rates in 2016, the organization's overall epcs rate was 5.5%. TPA's rate improved to 36.3% by May REMINDER: As of June 1, 2018, Michigan physicians must be registered with the Michigan Automated Prescription System (MAPS) if prescribing any schedule 2 to 5 controlled substance. There are also new rules for any prescription of schedule 2 to 5 controlled substance exceeding a three-day supply. The Michigan Department of Licensing and Regulatory Affairs website contains links with helpful forms and tips. Visit and search MAPS. To learn more about e-prescribing of controlled substances in your practice, contact Fran Burley at francine.burley@ thephysicianalliance.org (private practices) or Tonya Davis-Kennedy at tonya.davis-kennedy@ascension.org (St. John Providence employed practices). < 3

4 Diabetes focus of new system of care model transition plan In the United States, 84 million people are at risk for diabetes, and more than 30 million are already diagnosed with the disease. Last year, diabetes cost the country $327 billion in direct medical costs and reduced productivity, according to reports by the American Diabetes Association. These statistics and more are a stimulus to The Physician Alliance s focus on preventing diabetes and improving care for those already diagnosed. Several pilot projects have recently been implemented, and education offerings and patient education materials are available on these topics. Diabetes is also the backbone of a new plan designed by TPA to meet changes to Blue Cross Blue Shield of Michigan s organized system of care model. Knowing the new OSC model could take years to fully implement, BCBSM invited physician organizations to submit a transitional plan to earn OSC-related funds in the interim. This seed money, funded over time in phases, is meant to help fund additional infrastructure required for physician organizations to develop, implement and maintain the new OSC model goals. However, physician organizations must attain all established goals to receive and retain the funding. TPA s OSC transition plan strives to reduce the overall cost of care for diabetics by standardizing processes in the delivery of care and reduce the growing number of patients diagnosed with the disease. The plan focuses on diabetes prevention, identification of prediabetes through ICD-10 coding, reducing emergency room utilization for diabetic patients, and improving care manager engagement in the high-risk population. High-risk diabetic interventions will be rolled out using a tiered approach. The project will target practices with a high population of diabetic patients including Bay Area Family Physicians, Berkley Primary Care, Deighton Family Practice, Lakefront Internists, Providence Family & Athletic Medicine, and St. John Family Medical Center, and expanded to all TPA OSC primary care practices after a pilot outcome evaluation. Prediabetes interventions will target 123 primary care practices, working to standardize processes to identify and engage these patients and formalize coding of prediabetes. BCBSM approved TPA s plan as part of the new OSC model transition, BCBSM expanded the Physician Group Incentive Program (PGIP) Allocation from 5 percent to 7 percent, effective July 1, The PGIP Allocation is a percentage of the applicable fee schedule on most professional paid claims. Physicians will not see a reduction in their revenue or value-based reimbursement as the monies are taken from employer paid funds. BCBSM shared this change to all PGIPparticipating physicians in several communications. Practices interested in learning more about identification and management of prediabetes should contact Fran Burley at fran.burley@thephysicianalliance.org. < 4

5 Tips for Implementing TELEHEALTH into Your Practice As technology continues to advance, the healthcare industry is looking at opportunities to expand access to care. Telehealth, or virtual care encounters, is one avenue that healthcare providers are using to integrate new technology into patient care. Telehealth, used interchangeably with telemedicine, means the use of an electronic media to link patients with health care professionals in different locations. The Michigan Insurance Code requires telehealth appointments to enable health care professionals to examine the patient via a real-time, interactive audio or video, or both, telecommunications system and the patient must be able to interact with the off-site health care professional at the time the services are provided. Embracing technology innovations to coordinate care and overcome obstacles for patient populations can help to improve access to care. Expanding the market in which a healthcare provider serves can help provide alternative care methods, may reduce costs, and add new revenue sources to a practice. Physicians and patients alike need to be open to adopting virtual alternatives to care options. Incorporating telehealth services allows for delivery of care over a larger target demographic geography and can provide access to care to patients who may have transportation challenges or physical barriers to getting to a healthcare facility. Virtual appointments can also be helpful for follow up care. Telehealth is a new way of practicing medicine, said Karen Swanson, MD, chief medical officer at The Physician Alliance and primary care physician. It can help engage patients who struggle to get to the practice, whether transportation or time constraints, and it can improve practice workflow for routine cases. The Physician Alliance has partnered with several physician practices to implement a telehealth pilot program through Blue Cross Blue Shield of Michigan. TPA continues to engage practices in working through the transition of adopting the new technologies to help with utilization and attain greater volume. Practices will want to check with their payor sources to learn what will be reimbursed back to the practice regarding covered telehealth services. Medicare and Medicaid have stricter reimbursement guidelines regarding telehealth services. If your practice is interested in implementing telehealth, please contact Oleg Savka at oleg.savka@thephysicianalliance.org with technology questions or Karen Swanson, MD at karen.swanson@thephysicianalliance.org for clinical questions. < Tips for incorporating telehealth into physician practices: A licensed provider (physicians, clinical nurse specialists, PAs, clinical social workers and psychologists) must facilitate the telehealth encounter Utilize a HIPAA and COPPA compliant telehealth platform Have patient initiate medical encounter to ensure informed consent Utilize interactive audio and video telecommunications system Train staff and make modifications as needed 5

6 CMO CORNER Social Determinants of Health By Karen Swanson, M.D. The World Health Organization describes social determinants of health (SDH) as the conditions under which people are born, grow, live, work and age. There has been compelling evidence over the past 20 years suggesting social factors shape a population s health (Public Health Rep, Jan-Feb 2014). Multiple studies have shown poor health is closely tied to inadequate housing, food insecurity, and unemployment or underemployment. Unmet social needs are associated with higher rates of emergency room use, hospital admissions, and readmissions. Better-educated adults have longer life expectancies. According to a 2011 national survey by the Robert Wood Foundation, nine out of 10 physicians believe their patients living and work circumstances were as important as their medical problems. A 2018 Modern Health survey found 45% of doctors agree it would greatly or moderately help their patients if they had assistance obtaining affordable housing, but 91% felt it wasn't their responsibility. Physicians frequently stated in the survey that patients "have other resources for their social needs." Most physicians (four out of five) lack confidence in their healthcare network to address patients social needs. Medical schools and residency training programs only recently have integrated social determinants of health into curriculums. Health systems also struggle to address the complexity of a patient s personal, social, economic and environmental circumstances. In the past, the medical provider community focused on surgically excising tumors, performing angioplasties, diagnosing and treating infectious diseases, and delivering Common Social Determinants of Health Safe Housing: an asthmatic child discharged to a home where the electricity has been shut off can t be compliant with a home nebulizer Food Insecurity: a diabetic patient with limited finances receives education on healthy eating but the food options may be unaffordable and inaccessible in an urban environment. Limited Transportation Options: a transitional care appointment post discharge can be difficult for patients that do not have access to a car and Southeast Michigan has limited mass transportation options. Social Support: the elderly living alone may have difficulty with complex medication schedules and lack access to emerging technologies such as a patient portal, smart phone apps, and telemedicine. Exposure to Toxic Substances: people living in Flint were exposed to unhealthy levels of lead in the water which may result in long term damage to a child s nervous system Unsafe Work Conditions: the under-employed may work under the table in construction projects that result in injury. babies. The life situations of patients have been background noise. The patient centered medical home certainly increased the physician s awareness of the importance of connecting patients to appropriate community resources, however, we lack an easily accessible and updated database for referrals to the community. It is also challenging for practices to incorporate appropriate workflows to address their patients social needs, and there is no reimbursement for this important work. continued on page 7 6

7 continued from page 6 The Centers for Medicaid and Medicare, commercial payors, accountable care organizations and employers are realizing that understanding and addressing SDHs can lower costs and improve outcomes for a population. The impact of social factors on a population s health is playing out in new payment models that hold providers accountable for patient health and health care costs. Some models give providers substantial economic incentives to incorporate interventions that target patients social needs into their approach to care. Other payment models do not necessarily require providers to address their patients social needs, however, many organizations are finding that such interventions can improve patient outcomes, reduce patient costs, and trigger more revenue. So how do physicians address the social context of disease? Physicians need support staff like social workers, care coordinators and community health workers to help them address these issues. Despite this significant financial barrier, the first step is to screen the patient, identify the needs and match these patients to resources in the community. TPA and Partners In Care are testing a tool called Now Pow that connects people to high quality community resources to help address their chronic health and social conditions. Now Pow utilizes patients demographics and insurance information (or lack of insurance) when mapping resources applicable for the patient. For example, if a diabetic patient with limited finances needs fresh fruits and vegetables, the tool can match the patient to a qualifying food pantry close to their home. The food pantry will receive an electronic referral from the physician and potentially communicate with the physician about the patient. Connecting a patient to a food bank could improve nutritional status, health status and boost patient satisfaction. The medical community must acknowledge that the life circumstances of patients are powerful determinants of health. A knowledge gap exists in implementing effective interventions but public health initiatives, social service experts, behavioral health specialists, the Centers for Disease Control and Prevention and community-based organizations are partnering to coordinate medical care with interventions that target a multitude of social needs. The U.S spending on medical care far exceeds any other nation, yet consistently ranks near the bottom of affluent nations on key measures of health. Perhaps addressing the social factors in our patient s lives will improve our populations health and reduce the cost of care. < SAVE THE DATE for community resource fairs The Physician Alliance is bringing together local nonprofits and community organizations to share resources for improved patient care. The annual events offer opportunities for practices to gather valuable information on community organizations and resources for patients, including mental health support, nutrition services, domestic violence support and shelter, food pantries, cancer support, home care and more. Attendance by a practice staff also fulfills capabilities for Blue Cross Blue Shield of Michigan s Physician Group Incentive Program. Thursday, October 4, 2018 from 8:30 10:30am Macomb Community College (South Campus-Building K Rm 301) E. 12 Mile Road, Warren, MI Wednesday, October 17, 2018 from 8:30 10:30am Providence - Providence Park Hospital (Novi Campus-conference rooms A, B, C) Grand River Ave. Novi, MI More details will be sent to practices in early September. Check TPA s website for information. 7

8 Mile, Ste. 130 St. Clair Shores, MI PRE SORTED NON PROFIT MAIL US POSTAGE PAID ST. JOHN HEALTH TPA Leadership Team TPA Board of Directors Michael R. Madden President & CEO Robert Asmussen Senior Business Advisor Heather Hall Executive Director, Corporate Communications Jennie Lekich Director, Clinical Applications Katrina Mackrain Executive Director, Project Management & Business Analytics Michele Nichols Vice President, Administrative Services & Business Development Carolyn Rada, RN, MSN Vice President, Operations Sharon Ross, RN, MSN, NP Executive Vice President, Population Health Oleg Savka Director, Systems and Informatics Karen Swanson, MD Chief Medical Officer Dennis Ramus, MD Chairperson Daniel Megler, MD Vice Chairperson Trpko Dimovski, MD Treasurer William Oppat, MD Secretary Eugene Agnone, MD Mazin Alsaqa, MD Bruce Benderoff, DO Paul Benson, MD Dennis Bojrab, MD James Fox, MD Michael Little, MD Sidney Simonian, DO Kevin Thompson, MD Robert Zaid, DO Help us keep connected with you! (586) Follow us on To ensure TPA news and announcements reach you, please make certain any changes in contact information (name, , address, phone) are shared with us. Send to