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Physician Orientation 2016
• Is an ACO (Accountable Care Organization) product of Dell Children’s servicing different payor agreements in our clinically integrated network for value based shared savings
• DCHA was created in 2013 and is comprised of over 300 community providers
DELL CHILDREN’S HEALTH ALLIANCE (DCHA)
DCHA VISION
• To improve the health of the populations we serve by organizing and enabling disparate providers to deliver the highest quality, most efficient care with exceptional patient and provider satisfaction.
Members of DCHA’s network commit to:• Be measured based upon an
agreed-upon set of performance metrics
• Participate in data sharing• Participate in clinical quality
committees and governance• Use other network providers for
referrals within the CIN in order to maximize the coordination of care
• Work to improve the quality, reduce the cost, and enhance patient experience of healthcare in community
DCHA will provide its membership with:• Governance support through
physician-led committees• Regular feedback on performance
measures (scorecards)• Access to value-based
reimbursement such as shared savings incentive payments without disrupting practice independence
• Fully-funded care management programs
• That aim to improve patient outcomes and reduce the cost of healthcare
• New patients through payor contracts with direct patients exclusively to DCHA providers.
DCHA & PROVIDER COMPACTPROVIDER COMMITMENTS ALLIANCE COMMITTMENTS
Dell Children’s Health Alliance is what is known as a “clinically integrated network (CIN).”
A clinically integrated network has the following building blocks:
1. Collaborative, physician-led governance2. Focus on population health3. Health information technology4. Providers receive financial incentives
DCHA CLINICAL INTEGRATION
• Required between DCHA and Providers• Standard one-year term, and automatically
renews and contains mutual termination provisions.
PARTICIPATING PROVIDER AGREEMENT (PPA)
• Must submit a 90 day written notice to terminate agreement
• No membership cost associated DCHA membership.
• Currently, we do not have any risk agreements with our contracted payors.
PPA Highlights
• Providers are only automatically opted-in for upside contracts
• If DCHA accepts a contract with downside risk, providers are informed and have the option of discontinuing participation in DCHA
PPA Highlights
• All DCHA members are required to obtain at least a “membership only” privileges at a Seton facility.
• Based upon PPA, provider can/does have additional credentials at Seton facilities.– If you have any questions, regarding credentials,
please contact Michael Childress [email protected] (512) 324-9999 ext. 15867
PROVIDER MEMBERSHIP REQUIREMENTS
DCHA is a physician-led initiative with a Board of Directors comprised of practicing community physicians and administrative physicians. • Nilda Garcia, MD – Austin Pediatric Surgery• Sarmistha Hauger, MD – ‘Specially for Children’• David Ramsey, MD – Chisholm Trail Pediatrics• Stephen Bekanich, MD – Seton Family of Doctors• Mark Shen, MD – President, Dell Children’s Medical Center• Allison Ziari, MD – Austin Regional Clinic• Vicki Bulter, MD – Lone Star Circle of Care (nonvoting)• Sara Woods, MD – Austin Diagnostic Center (nonvoting)• Sam Mirrop, MD, Pediatric Associates of Austin• Vaishalee Patil, MD, Southwest Pediatric Associates (nonvoting)
DCHA BOARD OF DIRECTORS
2015 DCHA Metrics/Measures
• Measurement period is January 1-December 31, 2015
• Pay-for-Reporting Year• Measures are recommended by the
Clinical Integration Committee to the Board
• Board has final vote on measures
Dell Children’s Health Alliance Clinical Integration Committee (CIC)
Dr. Mark Shen (Chair) – DCMCDr. Sarmistha Hauger – Specially for ChildrenDr. Vickie Butler – LSCCDr. Claire Hebner – ARCDr. Dan Howard – ADCDr. Sujit Iyer – DCMC Emergency DepartmentDr. Stephen Bekanich – Seton Family of DoctorsDr. Lindley Dodson –Pediatric Consultation and Referral Service
Dr. Kelly Thorstad –Lone Star Pediatrics, CTPCADr. Sam Mirrop—Pediatric Associates of Austin, CTPCA
We are actively recruiting members!
DCHA/SHA CIC Administrative Staff
Gemma BorjaClinical Integration Program ManagerEmail: [email protected]: 512-324-9999 x17933
Carlos RodriguezClinical Integration Program LeadEmail: [email protected]: 512-324-9999 x 17973
Measure Cycle:Jan. 2015-Dec. 2015
Performance Measure
CLINICAL MEASURES
Appropriate Testing for Children with PharyngitisChildhood Immunization Status (DTap, PCV, MMR)
DCHA CLINICAL Measures
Measure Cycle:Jan. 2015-Dec. 2015
Performance Measure
CITIZENSHIP MEASURES
Percent of clinicians who have implemented or have plans to implement an EHR
Percent of clinicians who attend Initial/Annual CI Orientation
Percent of clinicians who view provider scorecards
DCHA Citizenship Measures
Citizenship Measures
• Percent of clinicians who attend Initial/Annual CI Orientation– Clinician must attend annual CI meeting OR meet with a
Provider Engagement Representative OR view the online module
– Pediatric Conference: April 24, 2016 @ 1-4 p.m.; DCMC Auditorium– For a schedule or more information, call 512-324-0129 or
email [email protected]• Percent of clinicians who view provider scorecards
– Must view at least once per year ending December 31, 2015.
DCHA Practice IT Assessment
Practice IT Assessment Form • Used to understand your practice’s IT infrastructure• Information gleaned from your PM and EMR system is
used as part of our data sharing initiative• For more information please reference the Data Sharing
Overview handout in your binder• Fax completed form to 512-324-3251 or email to
PRACTICE IT ASSESSMENT FORM
Metrics Report/Scorecard
• All providers need to have a metrics report in-hand by December 31, 2015.
• This will either be a paper copy or through logging in to the Zirmed reporting tool
• The login credentials will be part of your active directory account given to you by Seton/Dell Children’s Medical Staff Services. If you don’t know your password and login please call 512.324.1675 to have it reset
• Look for the Physician Engagement and Clinical Integration teams to partner with your clinics to train you on how to login and view the personal Metrics Reports through the ZirmedPoint of Care (POC) tool.
• The POC is a web-based system for accessing patient information in population studies that support pay-for-performance programs, ACO performance and other quality reporting initiatives with payers.
Metrics Report Login/Training
Sample Metrics Report
Payer Agreements• Aetna• Seton Health Plan
(SmartHealth)• UnitedHealth Care
Employers• AISD• Williamson County• Travis Transit• Austin Recovery
Payor Contracts & Employers
DCHA and SHA Membership
23
CONTRACT MEMBERSHIP EFFECTIVE DATE
United 59,165 8/1/2013
Aetna: TRS-Active Care 2,483 9/1/2014
Aetna: Williamson County 2,603 11/1/2014
Aetna: AISD 10,335 1/1/2015
Aetna: Austin Recovery 28 6/1/2015
Aetna: Travis Transit* In Open Enrollment 9/1/2015
SmartHealth (Seton Employees) 21,391 1/1/2015
TOTAL 96,005*Travis Transit is currently in the midst of open enrollment; 1,500 eligible lives.
• Currently 5 populations signed up for AWH-SHA
• Narrow network product• No Out-of-Network Benefits• ED visits are covered • Your office can use DocFind to identify
in-network providers.
IMPACT ON OFFICE OPERATIONS
• What’s the same through Aetna– Eligibility and benefits – Pre-certifications and authorization requests – Claims submissions – Aetna provider portal
• What’s new– In-network benefits only – Aetna Whole Health-Seton Health Alliance logo
on ID cards– Aetna web portal path: DocFind
• For members effective before 01/01/15
• For members effective on or after 01/01/15
AETNA – SHA ID Cards
• Visit www.aetna.com• Go to HealthCare Professional
at the top of the menu and then to the bottom right “online provider directory”
• Complete provider types and zip codes.
• Choose “Aetna Whole Health” in the “Select a Plan” field
• Choose “(TX) Aetna Whole Health – Seton Health Alliance” from the “Select a Plan” drop-down menu
Doc Find
• Seton Employees only• 22,000 lives• Must use Seton lab services• Utilize the mysmarthealth.org for:
– See the Benefit Schedules.– List of services that require pre-certification– Coverage Policy Bulletins.– Access Provider Manual– Download forms
IMPACT ON OFFICE OPERATIONS
• Seton Health Plan (SHP) is now SmartHealth!
• What’s the same through SmartHealth– Eligibility and benefits – Pre-certifications and authorization requests – Claims submissions
• What’s new– Plan name– New ID cards– New ID numbers for members– New website
ID Cards
• Attribution based contract• No change to existing process for provider
fee for service reimbursement• There is a methodology utilized to attribute
members to providers based on the provider type, the number of times patient visited the provider and which provider the patient saw last.
Impact on Office Operations
• What’s the same through UnitedHealthcare– Everything!
• What’s new– Business as usual
SHA & DCHA LEADERSHIP
Executive Leadership• Jeff Cook – President & CEO Insurance Services• Meredith Duncan – VP of ACO & Physician Engagement• DeWayne Wilson – Sr. Director of Finance• Dr. Stephen Bekanich – Medical Director Seton Health Alliance• Dr. Mark Shen – CEO Dell Children’s Health Alliance
Reach out to your physician engagement account executive with questions.
PHYSICIAN ENGAGEMENT TEAM
Associate Title Phone Extension Email
Meredith Duncan VP Seton ACO & Physician Engagement
512.324.3061 - [email protected]
Laura Mittan Planning Consultant 512.981.8687 - [email protected] HEALTH ALLIANCE
Hayli Baldridge Manager, SHA 512.324.3066 - [email protected] Kennebrew Account Executive 377.853.3796 512.324.1000 x 17946 [email protected]
MARKET DEVELOPMENTMeg Gotcher Manager, Market Development 214.500.8627 - [email protected] Gomez Account Executive - Pediatrics 512.993.9450 [email protected] Account Executive – Pediatrics
SERVICE LINESheila Davis Manager, Service Line 512.906.8698 512.324.1000 x 3045 [email protected]
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The Seton Physician Engagement Team is focused on the needs of Seton’s two clinically integrated networks of Seton Health Alliance and Dell Children’s Health Alliance. The team is also dedicated to the needs of Seton’s hospitals and the employed and community physician groups.
The purpose of the Physician Engagement Team is to strengthen relationships and facilitate interactions among community physicians and providers and the Seton Healthcare Family. The group serves as Seton’s liaison to physician groups within the Austin community, and enables providers across the continuum to maintain a single point of contact within Seton.
Dell Children's Health Alliance Clinical Integration Committee
April 2016
Quality Measures Feasibility Analysis
Feasibility Analysis- URI, NCS, CWP
Timeframe Population Numerator Denominator Result HEDIS 90%ile
Appropriate Children with Upper Respiratory Infection (URI)
7/1/2014-6/30/15 Aetna, UHC 17 306 94.44% 93%
Non-Recommended Cervical Cancer Screening in Adolescent Females
(NCS)
1/1/2015-12/31/2015 Aetna, UHC 253 2672 9.47% NA
Appropriate Testing for Children with Pharyngitis (CWP)
11/1/2014-10/31/2015
All (MSSP, Aetna, UHC,
SHP)183 224 82% 91%
• There is sufficient data to measure all 3 measures for the majority of the pedi pop
• 2015 specifications were used in the analysis, 2016 changes are not material
• CWP is currently a payer contract measure• URI and NCS are not currently payer contract measures
Performance Analysis- CIS
• Measure has shown low performance across the board for all of Measure Year 2015
• Vendor performed a QA check on calculation and found that they were incorrectly processing data, implemented corrections
• Incorrectly flagged PN vax for adult measure only• Manual QA check, with Dr. Hebner, revealed that SHA did not have
sufficient historical immunization data for Measure Year 2015• Need all of 2013 data, but Aetna contract started 2014 and
UHC contract started mid-2013• Measure Year 2016 performance will be available May 2016,
anticipate more accurate results due to having complete history of 3 years
Recommendation to DCHA Board
• 2016 should remain a pay-for-reporting year• 2016 quality measures
• Appropriate Children with Upper Respiratory Infection (URI)• Non-Recommended Cervical Cancer Screening in Adolescent
Females (NCS)
• Appropriate Testing for Children with Pharyngitis (CWP)
