2018 Annual Report - pcanetwork.comThis enabled us to distribute health plan incentives to...
Transcript of 2018 Annual Report - pcanetwork.comThis enabled us to distribute health plan incentives to...
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2018 Annual Report
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Introduction
Denis McDonald, Executive Director
Mary Anderson MD, Medical Director
2018 Summary
2018 was a very good year for PCA. We performed well on our health plan contracts in
terms of both quality and cost. This enabled us to distribute health plan incentives to
participating groups. We added Physicians of Southwest Washington and two health plan
contracts – United (10/1/18) and Regence (1/1/19). We also expanded the IBM platform to
include more data and increased its capabilities by adding the Watson Care Manager
module. We used our improved data and analytics capabilities to provide supplemental
data and prove that our quality performance was higher than initial health plan reports.
However, the year was not without challenges. We unfortunately lost Edmonds Family
Medicine at the end of 2018 due to their acquisition by Virginia Mason. We also struggled
with delayed contracting and prolonged settlement processes with health plans.
2019 is an important year for PCA. We need to grow in terms of participating groups and
covered lives. We recently completed an analysis of opportunities to expand (new groups,
provider types, regions and services) and we’ll aggressively pursue opportunities
throughout 2019. We must also continue to demonstrate our ability to improve quality,
control costs and take care of patients.
Thank you for your continued participation in and outside PCA committees and we look
forward to building on our success in 2019.
- Denis and Mary
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Quality Performance Summary
Improved in 5 of 10 measures:
Achieved the goal for three measures
Came within 5% of achieving five additional measures
Realized improvements across all practice organizations
Measure Description 2018 Goal
2018Performance
BMI Determination - Adult 95% 96%
Breast Cancer Screening 75% 70%
Cervical Cancer Screening 68% 57%
Colorectal Cancer Screening 65% 70%
Childhood Immunization Status 40% 18%
Blood Pressure Control 69% 67%
DM: Eye Exam 35% 28%
DM: HbA1c Control 65% 62%
DM: Medical Attention for Nephropathy 88% 88%
DM: Statin Therapy 75% 79%
Appropriate Testing for Children w/Pharyngitis 82% Not Available
BMI Determination - Pediatrics 90% Not Available
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Financial Performance Summary
Solid performance across all payers
High performance in Aetna across all programs
Cigna missed market trend as new groups were added
• PCA identified and escalated data discrepancies yielding additional shared savings
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Financial Distributions
Distributed almost $600k to provider organizations to-date
Distributions in 2018 were based on organization size; 2019 distributions will be based on quality
Health Plan DistributionAetna $194kCigna $183kPremera $203kTotal $580k
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Budget Review
Phased-in functionality of IBM resulted in a positive variance
Aggressive plans to hire and continue to implement IBM in 2019 to support substantial revenue growth targets
Final capital contribution completed
On track to achieve profitability in 2020
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The PCA Network
Gained a strong new partner with PSW
Realized significant impacts due to market consolidation
Physicians of Southwest Washington joined PCA at the beginning of 2018, bringing in three family medicine practices
NPN was purchased by DaVita and is no longer participating
Edmonds Family Medicine was purchased by Virginia Mason and is no longer participating
Woodcreek Healthcare was purchased by Mary Bridge Childrens and is no longer participating
The Polyclinic entered into a strategic partnership with OptumCare, who supports the clinic’s continued participation in PCA
With the support of Physicians Insurance, PCA began building out a menu of services to provide to non-participating groups such as rural hospitals
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Health Plan Contracting
Achieved major milestones with the addition of United and Regence value-based contracts
Successfully renegotiated contracts with Aetna and Premera
Signed a revised contract with Premera effective 7/1/2018 which expanded our patient population to include self-insured groups
Signed a revised contract with Aetna effective 1/1/2019 with favorable terms
Signed a new contract with United HealthCare effective 10/1/2018
Signed a new contract with Regence effective 1/1/2019
The addition of the United and Regence contracts and expansion of the Premera covered lives has potential to greatly expand the shared savings pool beginning in 2019
Premera Aetna Cigna United Regence
14,119 14,092 5,106 9,330 6,912
Covered Lives:
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Population Health Platform – IBM Watson Health
IBM Watson Health EPM • Clinical & Claims Data• Utilization Measures• Foundation Measures
Watson Care Manager• Transition of Care • Complex and Chronic
Care Management
Next Steps• 2019 HEDIS Measures• Provider Dashboards• Tableau Dashboards
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Population Health Platform Reporting and Dashboards
New provider dashboards
Network leakage reports and visualizations
Other reports under development
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Practice TransformationCase Study #1:
Patient Focused Campaign:Diabetes Mellitus
August 2018
Why WWMG chose this project: Opportunity to extend recalls to contact a specific patient population to get
recommended follow-up care Improve patient outcomes
Goal of campaign: Improve the care of diabetic patients (population health) Improve performance of practices in closing diabetes related care gaps
Methodology: Email campaign to patients with outstanding care gaps related to
preventative diabetes care as identified in the population health platform
Results: 1,298 emails sent via Phytel Population Health Platform 73% of the sent emails were received by patients 65% of those patients seen or have a future appointment
Next steps: Monitoring response to campaign and diabetic care gap reports
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Practice TransformationCase Study #2:
BMI, diabetic measures, and medication management
Why PSW chose this project: It supports two strategic initiatives: 1) create an opportunity for independent
providers to collaborate on new models of care and 2) leverage current quality reporting efforts across a commercial population
Goal of campaign: Improve preventive care and management of chronic disease
Methodology: Working with Physician Care Alliance to understand required quality measures,
supporting algorithms and evidence-based data, PSW’s team created alignment with its own provider and patient goals
Created a campaign to highlight and improve performance on three main measures: BMI, diabetic measures and medication management to include medication reconciliation
Created materials to support provider education on how to effectively engage patients, such as intensive behavioral therapy for obesity, and to ensure provider visits met the coding and billing requirements
Results: All providers now better understand how to document and engage their patients
in meaningful preventive care Standout example was a provider who improved their BMI quality measure from
9.4% in 2017 to 57.1% in the third quarter
Next steps: Continue to monitor for additional improvement opportunities
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Practice TransformationCase Study #3:
DiabeticRetinopathy Screening
Why SFM chose this project: Team noted the need for a referral or second appointment was a barrier to
patients completing the diabetic retinopathy screening
Goal of campaign: Decrease the barriers to identifying and preventing retinopathy in SFM
patients with DM
Methodology: Implemented retinal image camera in primary care clinics Trained care team staff to capture image prior to patient leaving the clinic Image transmitted to and read by local ophthalmologist Results updated in EMR and provided to provider and patient
Results: 6% increase in percent of SFM DM patients with Retinopathy screening in
calendar year 2018 11% increase for SFM provider champion 12% increase for pilot clinic
Next steps: Spreading engagement to additional SFM providers and clinics
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Practice TransformationCase Study #4:
Diabetic Retinopathy Screening
Q4 2018
Why TPC chose this project: Annual Diabetic Retinopathy screening is a significant performance opportunity
for Polyclinic with current performance of 28% based on clinical data
Goal of campaign: Increase numbers of Polyclinic patients with diabetes with completed annual
retinopathy screening Develop a standard workflow for referrals and documenting annual retinopathy
screenings
Methodology: Capture best practice from high performing clinics and teams Create new workflow using best practice PDSA workflow in primary care and endocrinology clinics
Results: Project in process
Next steps: Assess results related to number of diabetic eye exams captured in the
Polyclinic electronic health record Assess results related to in-house referrals to ophthalmology Identify additional diabetes best practice workflows to implement organization
wide
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Closing
Thank you again for your participation in PCA. Please let us know if you have any questions about this report, PCA’s goals for 2019 or your participation. We value your input and engagement and want to keep the lines of communication open.
Here’s to a great 2019!
Denis McDonald Kim ClementsSenior Vice President for The Polyclinic Manager Population [email protected] [email protected]
Mary Anderson, MD David JohanssonChief Clinical Integration and Quality Officer Manager Analytics and Decision [email protected] [email protected]
Gena Tadych Sarah MiltonDirector of Quality and Practice Transformation Provider and Payer Relations [email protected] [email protected]
Jeff Wright Michelle KarlssonDirector of Care Management Project [email protected] [email protected]