CAPG Health Sept/Oct 2014

healthDr. Amy Nguyen Howellon Work-Life Balance, p.6

Community Pharmacistsand ACOs, p.16

CAPG Colloquium on Medicare Advantage, p.22

Volume 8 • No. 5 September/October 2014

• Fast, accurate claims payments• Free eReferrals, ePrescribing and online doctor-patient communications• Experienced RN case management for complex, time-intensive cases• Deep discounts on EPM and EHR solutions to help you meet the federal mandate• Easy preventive care and disease management reminders for patients• Extensive health resources that boost patient engagement• High consumer awareness that builds practice volume

At Hill Physicians, we continue to improve upon coordinated care, with remarkable results. We provide the tools and support that practices need to be financially successful and improve the coordinated care experience for their patients. Our advantages include:

That’s why 3,800 independent primary care physicians, specialists and healthcare professionals have joined Hill. Feel confident in the future of your practice and your patients by affiliating with Hill Physicians Medical Group.

Hill Physicians’ 3,800 healthcare providers accept commercial HMOs from Aetna, Alliance CompleteCare (Alameda County), Anthem Blue Cross, Blue Shield, CIGNA, Easy Choice, Health Administrators (San Joaquin), Health Net, Humana, United Healthcare WEST and Western Health Advantage. Medicare Advantage plans in all regions. Medi-Cal in some regions for physicians who opt in.

Lawrence LT Chao, M.D.Hill Physicians provider since 2001.

Uses Ascender preventive care reminders, RelayHealth online communication tools and Hill inSite to review eClaims and eligibility.

Confidence

For more about the advantages of affiliating, visit HillPhysicians.com/JoinUs.

The feeling you have when you are affiliated with Hill Physicians.

CAPG_Chao_Aug.indd 1 7/30/2014 2:34:58 PM

Knowing when your patient is hospice appropriate is critical

Learn more. Visit VITAS at the CAPG Colloquium event!

1.800.93.VITAS • 1.800.938.4827 • VITAS.com

Studies have shown a 40–50% decrease in hospitalizations for patients who were appropriately referred to hospice. A collaboration with VITAS benefits physicians and their patients:

• You can provide your patients with more care choices, including palliative care when appropriate.

• For physicians, making VITAS a part of the continuum of care can curb the rising costs associated with rehospitalizations and improve quality ratings, which lowers the risk of reduced reimbursement.

• For our partners in care, VITAS brings added resources to the bedside, which helps keep residents at home and out of the hospital.

Knowing when your patient is hospice appropriate is critical

Learn more. Visit VITAS at the CAPG Colloquium event!

1.800.93.VITAS • 1.800.938.4827 • VITAS.com

Studies have shown a 40–50% decrease in hospitalizations for patients who were appropriately referred to hospice. A collaboration with VITAS benefits physicians and their patients:

• You can provide your patients with more care choices, including palliative care when appropriate.

• For physicians, making VITAS a part of the continuum of care can curb the rising costs associated with rehospitalizations and improve quality ratings, which lowers the risk of reduced reimbursement.

• For our partners in care, VITAS brings added resources to the bedside, which helps keep residents at home and out of the hospital.

tab

le o

f c

on

ten

ts ON the COVer 6Dr. amy nguyen Howell: Having it all Without burning out

DepartmeNtS

5Notes from the president

8CapG member Spotlight

10State legislative Update

12Names in the News

14CapG member list

18Federal Update

30Upcoming events

FeatUreS

16Community pharmacists

Fitting into the aCO model

20Supporting patients with

the right tools to Improve

medication adherence

22CapG Colloquium on physician

Groups in medicare advantage

24prop. 46: higher Costs, Fewer

Doctors, No privacy

26how primary Care physicians

Can maximize Safety Net

Coordinated Care models for

patients

28Seven Steps to effective

healthcare Data Sharing

4 l capg health September/October 2014

healthPublisherValerie Okunami

Editor-in-ChiefDon Crane

Managing EditorLura Hawkins, MBA

EditorDaryn Kobata

Editorial AssistantNelson Maldonado

Contributing WritersBill BarcellonaTrudi Carter, MDDon CraneYalda Dorosti, PharmDCarlos Hernandez, MD, MSAmy Nguyen Howell, MD, MBALisa Maas Mara McDermottFrancine MoskowitzTom PetersonDavid Tripi

CAPG Health Magazine is published byValerie Okunami MediaPO Box 674, Sloughhouse, CA 95683Phone 916.761.1853

capghealth.org

Please send press releases and editorial inquiries to [email protected] and/orc/o CAPG Health, 915 Wilshire Blvd., Suite 1620, Los Angeles, CA 90017

For advertising, please send email to [email protected]

Subscription rates: $32 per year; $58 two years; $3.00 single copy.

Advertising rates on request. Bulk third class mail paid in Jefferson City, MOEvery precaution is taken to ensure the accuracy of the articles published inCAPG Health Magazine.

Opinions expressed or facts supplied by its authors are not the responsibility ofCAPG Health Magazine.

© 2014, CAPG Health Magazine.All rights reserved.

Reproduction in whole or in part without written permission is strictly prohibited.

capg health September/October 2014 l 5

CAPG Members and Friends:

Thank you for reading CAPG Health. Our goal for each issue is to bring you the facts, the tools and the expertise needed to succeed in the practice of high-quality accountable care. This month, for example, we’re featuring a wide range of practical, how-to articles on primary care, along with news about our exciting, first-time-ever CAPG Colloquium on Physician Groups in Medicare Advantage, scheduled for October 6–8 in Washington, DC.

Most of our members and readers are deeply involved with Medicare Advantage plans, and more than 50 percent of the nation’s newly eligible seniors are signing up for these plans. With that in mind, I urge you to make every effort to attend this important new CAPG Colloquium. To make it easy, we are offering both onsite and online attendance options. The conference zeroes in exclusively on Medicare Advantage, providing a one-of-a-kind opportunity to learn the basics, dig down into the specifics, and take away a deeper understanding of how to make the system work for your organization.

The roster of nationally acclaimed presenters is exceptional, representing the U.S. Centers for Medicare & Medicaid Services, world-class think tanks, healthcare policymakers, and leaders from the nation’s largest health plans and physician organizations. Nowhere else will you find the breadth and depth of knowledge on this important subject—or a better example of CAPG’s growth in membership and national presence.

Please check our Colloquium article and ad in this publication for more information, or go to www.capgmacolloquium.com to register.

I sincerely hope to see you October 6–8 in the nation’s capital. o

From the presidentA MeSSAGe FrOM DONAlD CrANe, PreSIDeNT AND CeO, CAPG

Donald Crane, CAPG President and CEO

2 0 1 5 E D I T O R I A L c A L E n D A RQ1/WinterHR, finance, and operations: the business of Healthcareeditorial due Friday, December 12, 2014advertising due monday, December 15

Q2/springMeaningful Decision support: no Data left behindeditorial due Friday, march 6advertising due monday, march 9

conference editioneditorial due Friday, april 24advertising due monday, april 27

Q3/summerchanging Healthcare for Good: clinical Practice transformationeditorial due Friday, June 19advertising due monday, June 22

Q4/fallMedicare advantage: a Valuable choice for seniorseditorial due Friday, august 28advertising due monday, august 31

editorial Departments:Notes From the presidentUpcoming eventsNames In the Newsmember SpotlightFederal and California legislative Updates

for editorial guidelines contact [email protected]

Valerie okunamiph: 916.761.1853 | Fx: [email protected]

caPG Health | p.O. Box 674 | Sloughhouse, Ca 95683

health

on the cover


Finding Balance: having it all Without Burning OutBY amY NGUYeN hOWell, mD, mBa, ChIeF meDICal OFFICer, CapG

I’m often asked, “How do you do it all, Amy?” Sometimes, bolder folks have asked me, “Why do you do all that?” My days are filled by working full-time as the Chief Medical Officer at CAPG; seeing patients as a family physician on the weekends; mothering my 15-month-old; and working out at least 30 minutes a day, three times a week.

On the other hand, I haven’t taken a vacation in almost three years and took only one month off for maternity leave. I was working on my Blackberry through my labor, up until two hours before I delivered my son. For six months afterwards, I hauled around a heavy breast pump machine, multiple ice packs and a mid-size Igloo cooler onto planes, trains, and automobiles and into hotels, hospitals, and executive offices.

Having journeyed thus far as a working mom, I often think to myself: Am I trying to have it all? Am I going to win the lean In award? Would I dare to leave the best job I’ve ever had?

Both men and women have written about ways to maintain a work/life balance. Anne-Marie Slaughter wrote “Why Women Still Can’t Have It All”; meanwhile, Sheryl Sandberg directed women to lean into work and leadership positions in her book, Lean In: Women, Work, and the Will to Lead. Most recently, Max Schireson, now the former CeO of a billion-dollar Silicon Valley software company, has detailed how he is leaning out by leaving his high-powered career to spend more time with his family.

There’s a growing body of evidence that making work the focus of your life and overworking yourself into a hot stress mess is simply not healthy. Overwork has been linked to sleep loss, heart disease, anxiety, substance abuse, increased motor vehicle accidents, and work-related depression. For physicians, several studies confirm that work satisfaction is decreased significantly when we perceive that we don’t have work/life balance; this is resulting in more and more primary care physicians either getting burnt out and leaving clinical practice or lessening the hours in their work week. This will cause a national physician shortage—and a noticeable gap in primary care delivery.

“Having journeyed thus far as a working mom, I often think to myself: Am I trying to have it all? Am I going to win the Lean In award? Would I dare to leave the best job I’ve ever had?”


A recent article in the Harvard Business review, titled “Manage Your Work, Manage Your life,” drew on interviews with 4,000 executives, male and female, to find out how they balanced work and home life. “They’ve discovered through hard experience that prospering in the senior ranks is a matter of carefully combining work and home so as not to lose themselves, their loved ones, or their foothold on success,” wrote authors Boris Groysberg and robin Abrahams.

They continued, “Those who do this most effectively involve their families in work decisions and activities. They also vigilantly manage their own human capital, endeavoring to give both work and home their due—over a period of years, not weeks or days.”

In my tenure at CAPG—even as I continue seeking this equilibrium in my own life—I hope to foster such a sense of work/life balance for our members, respecting the need to optimize a successful career in our rapidly changing healthcare environment while also understanding the demands of a personal and family life. I would like to offer alternatives and solutions to help create such a formidable balance, such as consolidation of our clinical committees to reduce the number of meetings and beginning a movement of primary care practice transformation for the fulfillment of physician satisfaction.

Here are some thoughts that have helped me in striving to lead a purposeful, balanced and successful life at work and at home:

• Be kind to yourself and affirm your actions daily.

• Be present to each moment, reduce multitasking and assign a time limit to work and play.

• Try to organize your thoughts and life events in one place (calendar, journal, notepad) so that your work and home lives are not bifurcated.

• Delegate wisely and lose the addictions and compulsions to control every detail.

• Be compassionate and empathetic (with a sense of humor), and learn the art of equanimity.

• Focus on living a healthy lifestyle with adequate nutrition and hydration, along with regular aerobic exercise.

• Give more to your family than you give to work. This “imbalance” creates a disciplined equilibrium.

As we all journey toward reaching this balance—and especially with its implications for the future of primary care—I plan to make this a topic of ongoing conversation. I invite you to share your experience, comments, or suggestions on how CAPG can

support members in this area at [email protected]. o

Wellmed Gains National attention as medical home/Care Coordination model for SeniorsBY CarlOS O. herNaNDez, mD, mS, preSIDeNt, WellmeD meDICal GrOUp pa

The WellMed Medical Group is a physician-led primary care group with a model aligning the incentives of the provider, the patient and the payer, which in our case involves multiple Medicare Advantage plans.

Founded nearly 25 years ago by our CeO, Dr. George rapier, with a single clinic in the San Antonio Medical Center, WellMed today has 90-plus clinics in Texas and Florida with over 300 providers serving more than 120,000 Medicare-eligible patients.

Dr. rapier’s inspiration? “When I founded this company in 1990, I had already been in practice for 10 years and basically had reached a point of frustration,” he said. “There was essentially no focus on prevention, and there was really no focus on helping people live better lives.”

WellMed coordinates patient care through population management of chronic diseases across all settings—a true medical home. We serve the community’s sickest and poorest and still routinely achieve good health outcomes in a financially sustainable practice.

We serve Medicare patients in markets where many providers no longer see these patients due to falling Medicare reimbursement rates. A few years ago in South Austin, Texas, for example, only two or three physicians were taking new Medicare patients before we entered the market. We are now expanding our South Austin clinic to accommodate added providers and demand.

Many of our patients are ethnic and/or racial minorities from lower socioeconomic backgrounds. Many have at least one chronic disease state. Almost all are seniors. I call them my “MVPs”—Most Vulnerable Patients.

The WellMed Care Model is proven to help these patients live a better quality of life. In fact, they tend to live longer than their peers, according to an independent, federally funded study published in the Journal of Ambulatory Care Management (Jan. 2011).

The robert Graham Center found that the adjusted mortality rate for WellMed patients was consistently and considerably lower compared with the Texas senior population as a whole. researchers noted, “WellMed patients are older and more likely to be male (features typically associated with worse outcomes) than the Texas Medicare population.”

Another examination of the WellMed Care Model was included in the California Healthcare Foundation’s November 2011 study, Primary Care, Everywhere: Connecting the Dots Across the Emerging Health Landscape, which stated, “WellMed’s patient outcomes are superior to those of the average Medicare enrollee in Texas, including significantly lower er, hospitalization, re-hospitalization, and mortality rates.”

Also from that study: “WellMed substantially increases the use of preventive services among the same population, including screenings for cholesterol, colon cancer, and mammography. WellMed also sees evidence building that its return on investment is high in other ways, with more funding for primary care leading to lower overall costs.”

Since these studies were released, we have added more evidence-based screenings. These include a voluntary screening for potential elder abuse in Texas and a screening for depression, which is a major factor inhibiting patients from complying with critical medication therapies that help effectively manage chronic disease.


CapG member Spotlight

continued on page 25

ATTEND IN PERSON OR ONLINE

EXHIBITS/SPONSORSHIPS:www.CAPGMAColloquium.com

or Lura Hawkins: 213.239.5046 / [email protected]

MEDIA PARTNERS:Harvard Health Policy Review

Health Affairs

SPEAKERS INCLUDE: BRUCE BROUSSARD, MBA

CEO, Humana, Inc.

SEAN CAVANAUGHDeputy Administrator/Director,

Centers for Medicare & Medicaid Services

PAUL B. GINSBURG, PhDNorman Topping Chair in Medicine and Public Policy,

Schaeffer Center for Health Policy and Economics, USC; Senior Fellow, Engelberg Center for Health Care Reform,

Brookings Institution

STEPHEN J. HEMSLEYCEO, UnitedHealth Group

CHRIS JENNINGSPresident, Jennings Policy Strategies, Inc.; Former Health

Reform Coordinator, White House (Obama); Former Senior Health Advisor, White House (Clinton)

ROBERT MARGOLIS, MDCo-Chairman of the Board, DaVita HealthCare Partners

MARK McCLELLAN, MD, PhDSenior Fellow and Director, Health Care Innovation and

Value Initiative, Brookings Institution

ALICE M. RIVLIN, PhDSchaeffer Chair in Health Policy Studies and

Director, Engelberg Center for Health Care Reform, Brookings Institution

THOMAS A. SCULLY, ESQ.General Partner, Welsh, Carson, Anderson & Stowe;

Senior Counsel, Alston & Bird LLP, Former Administrator, CMS

GAIL WILENSKY, PhDSenior Fellow, Project Hope; Former Senior Advisor,

White House (GHW Bush); Former HCFA Administrator

AGENDA:MONDAY, OCTOBER 6, 2014

1:30 pm Preconference SessionsPrecon I: Everything You Ever Wanted to Know About Risk Adjustment Precon II: How to Move from Fragmented Fee-for- Service to Integrated, Coordinated Care Using CAPG’s Standards of Excellence

5:30 pm CAPG Colloquium Opening Reception

TUESDAY, OCTOBER 7, 20147:30 am Breakfast Buffet8:00 am Welcome8:10 am Keynotes: CMS Policy on Medicare Advantage MA and the Better Care, Lower Cost Act9:00 am Break9:30 am Keynotes: Medicare Advantage: Public Policy The Future of Medicare Advantage Making Policy Work: Clinical Transformation12:00 pm Lunch1:00 pm Breakout Sessions Group I

I: Maximizing Your Medicare Star RatingsII: Reducing Hospital ReadmissionsIII: Drug Reconciliation and Medication AdherenceIV: Medicare Advantage vs. Original MedicareV: Congressional Committee Staff Panel

2:30 pm Break3:00 pm Breakout Sessions Group II

VI: Behavioral Health: Linchpin of Population HealthVII: Medicare Advantage vs. Original MedicareVIII: Ambulatory and Home-Based Palliative CareIX: Primary Care Practice TransformationX: ACOs to MA — A Movement in Evolution

5:30 pm Strolling Dinner and Exhibit Fair

WEDNESDAY, OCTOBER 8, 20147:15 am Breakfast Buffet8:00 am Keynotes: Physician Group Collaboration in MA Humana on Medicare Advantage9:20 am Coffee Break9:40 am Panels: Thoughts on Improving MA The Future of Accountable Care in MA11:45 am Wrap-up and Closing Remarks12:00 pm Adjournment

2014 CAPG COLLOQUIUM ON PHYSICIAN GROUPSIN MEDICARE ADVANTAGE

www.CAPGMAColloquium.comOCTOBER 6-8 • WASHINGTON, DC

proposition 45: the “Other” trial lawyer proposition puts a State politician in Charge of Your patients’ healthcareBY BIll BarCellONa , SeNIOr Vp, GOVerNmeNt aFFaIrS, CapG

There is more than one proposition on the California ballot this November that threatens healthcare providers and patients. The same groups pushing to change the Medical Injury Compensation reform Act (MICrA)—“Consumer Watchdog” and their trial lawyer

allies—are also pushing Proposition 45, which would give the state Insurance Commissioner sweeping new power over healthcare benefits, rates and co-payments for individuals and small groups.

CAPG is part of a broad coalition opposed to Proposition 45, including the California Medical Association, California Hospital Association, county medical societies, specialty societies, hospitals, health plans, labor and small businesses.


State legislative Update

Proposition 45 threatens physicians’ ability to provide the care that patients need by giving a single elected politician—the Insurance Commissioner—vast new power over healthcare benefits and rates. With recent cuts to the Medi-Cal program, we are already seeing the devastating impact it can have on patient access to care when politicians cut reimbursement rates below the cost of providing care. Additional cuts would result in an even more difficult time for patients that need care the most.

even worse, Prop 45 gives a politician new power over benefits too. The last thing doctors and patients need is a politician having more power to interfere with what treatments are or aren’t covered—those decisions are best left to the exam room.

Beyond these flaws, Prop 45 has a hidden agenda—allowing trial lawyers and the sponsors to file costly new healthcare lawsuits. They buried a provision in the fine print that allows them to “intervene” in the regulatory process created under the Initiative and file lawsuits if they don’t like the results. In doing so, they can pocket millions of dollars in so-called “intervenor fees”—as much as $675 per hour. In fact, the proponents have already received more than $11.5 million from a similar provision used in auto and home insurance regulation.

Many business groups and taxpayer organizations also oppose Prop 45 because it sets up a costly, duplicative new bureaucracy, when California already has multiple regulators overseeing healthcare.

lastly, Prop 45 establishes new and conflicting rules that could interfere with California’s implementation of the Affordable Care Act—providing more uncertainty, delays and confusion at a time when California providers and patients are already dealing with massive changes to our healthcare system.

For more information or to sign up to oppose Prop 45, visit www.stophighercosts.org. o

KEYNOTE SPEAKERS:

REGISTRATION NOW OPEN

THE FIFTH NATIONAL

ACCOUNTABLE CARE CONGRESSNOVEMBER 10–12, 2014HYATT REGENCY CENTURY PLAZA, LOS ANGELES

www.acocongress.comIn Person or Via Webcast

• Elliott S. Fisher, MD, MPH, Director, The Dartmouth Institute for Health Policy and Clinical Practice

• Samuel W. Ho, MD, Executive VP and CMO, UnitedHealthcare; President, UnitedHealthcare Clinical Services

• Jonathan S. Bush, MBA, Cofounder, CEO, and President, athenahealth

• Hoangmai H. Pham, MD, MPH, Acting Director, Seamless Care Models Group, Center for Medicare and Medicaid Innovation, CMS

• Farzad Mostashari, MD, Founder and CEO, Aledade, Inc.; Visiting Fellow, Engelberg Center for Health Care Reform, Brookings Institution

• And more

SPONSORSHIP AND EXHIBIT INFORMATION:Lura Hawkins, 213.239.5046 or [email protected]

MEDIA PARTNERS:

PRODUCED BY:

FEATURED SESSIONS:

• CMS Accountable Care Update• Health Plan Perspectives: Commercial ACO

Arrangements• Hospital Perspectives: Role of Hospitals in

Accountable Care• Physician Group Perspectives: Leading

Accountable Care• Mobilizing Team Based Care Towards Patient

Engagement and Population Health• Lessons Learned in Launching a Commercial

ACO• Risky Business: California's Delegated Model in

Critical Condition• Accountable Care and Government Programs

SChUltz NameD preSIDeNt aND CeO OF epFmC

The eisner Pediatric & Family Medical Center (ePFMC) Board of Directors has appointed Herb K. Schultz as President and Chief executive Officer. Mr. Schultz also will serve as President and CeO of the Pediatric & Family Medical Center Foundation, working to ensure that eisner has the resources to serve people in need in los Angeles County. Formerly Director of region IX of the U.S. Department of Health and Human Services, Schultz is recognized for his work on major public policy issues across California and nationally, including the Affordable Care Act, Medicare, Medicaid/Medi-Cal, HIV/AIDS, and public health.

three SCrIppS health–aFFIlIateD meDICal GrOUpS FOrm SCrIppS phYSICIaNS meDICal GrOUp

San Diego Physicians Medical Group, Connect-the-Docs Multi-Specialty Network, and XIMeD Medical Group have united to create Scripps Physicians Medical Group, an integrated physician organization. The new group includes more than 500 primary care and specialty physicians in San Diego County and will partner with Scripps Health in managed care and preferred provider organization (PPO) insurance contracts. Scripps Health has licensed its name and brand identity to the new group to signify the exclusive partnership. Scripps Physicians recently signed its first payer contract with Health Net for Medicare Advantage managed care in collaboration with Scripps Health.

raDNet JOINS UCla-eaStON CeNter StUDY ON alzheImer’S

radNet Inc., a provider of fixed-site outpatient diagnostic imaging services, has joined the Imaging and Genetic Biomarkers for Alzheimer’s Disease (ImaGene) research study. launched by the UClA-easton Center in 2008, the project is a six-year observational biomarker study investigating the potential interaction between genes, proteins, amyloid positron emission tomography (PeT) imaging, and MrI brain imaging in aging and the prodromal stages of Alzheimer’s disease.

Study participants will have a PeT/CT scan at a los Angeles–area radNet radiology facility. Vizamyl (Flutemetamol F18), a radioactive tracer used in PeT brain imaging, will be employed to estimate beta amyloid neuritic plaque density in adult patients with cognitive impairment. Such radiotracers can help physicians and


Names in the Newsresearchers assess patients with cognitive impairment, including AD, said Judith rose, MD, radNet medical director of PeT/CT. “We are excited by the potential for these imaging techniques to help researchers better understand how Alzheimer’s disease develops.”

mOlINa healthCare NameS NeW CmO

Molina Healthcare, Inc. has named Keith Wilson, MD, former VP of clinical services for the Molina Medical Group clinics and American Family Care, as chief medical officer. Dr. Wilson will be responsible for establishing clinical policy and oversight of medical management functions of all health plan subsidiaries. Prior to joining Molina Healthcare in March 2013, Dr. Wilson was a regional medical director with HealthCare Partners, and previously was president and CeO of Talbert Medical Group until he arranged the group’s merger with HealthCare Partners. A member and past chair of the Financial Solvency Standards Board for the State of California’s Department of Managed Care, he is a member of the American Medical Association, National Medical Association, Orange County Medical Association, and CAPG Public Policy committee and a former board chair of CAPG and the Spencer Hospice Foundation.

reGIStratION OpeN FOr CeDarS-SINaI’S rUN FOr her 5K

registration is open for the 10th annual run for Her 5K run and Friendship Walk, an event to raise public awareness and funds to fight ovarian cancer. The flagship los Angeles event takes place Sunday, November 9, in Pan Pacific Park. Sister events will be held in New York on September 6 and the San Francisco Bay Area on September 20. Proceeds support research and public education projects for the Women’s Cancer Program at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute. The event was founded in 2005 by Kelli Sargent in honor of her mother, who succumbed to ovarian cancer six years ago. To learn more, visit runforher.com.

WellpOINt WIll ChaNGe Name tO aNthem, INC.

WellPoint, Inc. has announced plans to change its corporate name to Anthem, Inc. The change will enable the company to create better alignment between its corporate and product brands and better reflect its purpose and strategy to help transform healthcare. Pending shareholder approval, the change is expected


to take place by the end of 2014. “As consumer engagement is heightened, we recognize that brand—an indicator of trust and a predictor of willingness to engage—is going to be of increasing importance,” said WellPoint president and CeO Joseph Swedish. “We believe it is important to call ourselves by the name that people know best—Anthem. Changing the corporate brand to Anthem is an important expression of our commitment to serve as a trusted partner in health.”

GIUNtO IS NeW exeCUtIVe DIreCtOr OF WaShINGtON health allIaNCe

Nancy A. Giunto has been named the new executive director of the Washington Health Alliance by the organization’s Board of Directors. Ms. Giunto brings to the position 20 years of experience as a healthcare leader and purchaser of healthcare, along with a track record of effectively identifying and solving challenges. Since 2000, she has been executive director of Foster Pepper, a law firm with 120 attorneys and 130 staff in Seattle and Spokane. Ms. Giunto will begin her new post on September 2.

healthCare partNerS reCeIVeS GraNt tO StUDY FallS

HealthCare Partners, based in Torrance, California, is one of 10 providers taking part in a national initiative to reduce falls among elderly patients. Organized by the aging division of the National Institute of Health and the Patient-Centered Outcomes research Institute, the project will spend at least $30 million in the next five years in an attempt to reduce the number of falls among older patients. HealthCare Partners was selected in part for its extensive data on patient falls, collected through its electronic medical records system.

CeDarS-SINaI heart INStItUte OpeNS reSearCh Stem Cell ClINIC FOr CarDIaC patIeNtS

regenerative medicine experts at the Cedars-Sinai Heart Institute have opened the Heart Institute regenerative Medicine Clinic to evaluate heart and vascular disease patients for participation in stem cell studies. The Institute is thought to be the first at a major U.S. academic medical center dedicated to matching patients with appropriate stem cell clinical trials. led by eduardo Marbán, MD, PhD, and Timothy Henry, MD, the clinic offers consultations for patients who may qualify for investigative stem cell therapy. As part of each patient’s assessment, physicians will evaluate those interested in joining clinical trials at Cedars-Sinai or other medical institutions nationwide. Preliminary

evaluation appointments can be made by calling 855-STeM-WOrK (855-783-6967) or 310-423-1231.

In 2009, Marbán and his team completed the world’s first procedure in which a heart attack patient’s own heart tissue was used to grow specialized stem cells. The cells were then injected back into the patient’s injured heart in an effort to repair and regrow healthy muscle. Study results published in The lancet in 2012 showed that one year after such treatment, heart attack patients demonstrated a significant reduction in the size of the scar left on heart muscle. “Stem cells offer not only hope but a real chance of a game-changing treatment,” Henry said.

UCSF, JOhN mUIr health JOIN FOrCeS IN reGIONal NetWOrK

renowned healthcare institutions UCSF Medical Center and John Muir Health have signed a letter of intent to create a new company and healthcare network in the San Francisco Bay Area. A final agreement is expected by the end of 2014. Under the proposed agreement, the new company created would be equally owned and operated by both organizations, which will remain independent.

The new company would serve as a funding vehicle for future joint initiatives and a shared services organization to support programs and initiatives focused on better, lower-cost healthcare. The first initiative is a collaboration with other healthcare providers to form a Bay Area-wide accountable care organization (ACO). Both John Muir Health and UCSF Medical Center are widely recognized for quality healthcare and have experience in successful ACOs with demonstrated lower costs and improved care quality.

FrONt pOrCh SOCIal aCCOUNtaBIlItY IN aCtION prOGram GraNtS $15,000 tO reSOUNDING JOY

Front Porch, a nonprofit organization that aims to meet the changing needs of aging individuals, has provided $15,000 through its Social Accountability in Action program to resounding Joy. The funds will support the Joy Giver Program, a recreational quality-of-life-enhancing music program for older adults at the San Diego Senior Community Centers and at-risk seniors served by the Alzheimer’s Association San Diego Chapter. resounding Joy promotes healing through music therapy services and recreational music experiences to San Diego County residents including seniors, hospitalized children, teen parents and their children, active duty military personnel, and veterans. o


CA

PG

M

EM

BE

RS

ORGANIZATIONAL MEMBERS

accountable Health care IPaGeorge M. Jayatilaka, MD, CeODruvi Jayatilaka, Vice President

advanced Medical Management, Inc.Kathy Hegstrom, President

• Access Medical Group/Access Santa Monica • Community Care IPA • Future Care IPA • Me-diChoice IPA • Pacific Healthcare IPA • Premier Care IPA • Seoul Medical Group •

affinity Medical Grouprichard Sankary, MD, PresidentScott Ptacnik, COO

allcare IPa*randy Winter, MD, PresidentMatt Coury, CeO

all care Medical GroupSamuel rotenberg, MD, Medical DirectorCraig Kaner, Administrator

allied Physicians of californiaThomas lam, MD, CeOKenneth Sim, MD, CFO alta bates Medical Group*evan Moore, Vice President, east Bay region altaMed Health services corporation*Martin Serota, MD, Chief Medical OfficerCastulo de la rocha, JD, President/CeO

applecare Medical Group, Inc.*Surendra Jain, MD, Chief Medical OfficerVinod Jivrajka, MD, President/CeO

bakersfield family Medical centerJu Hwan lee, MD, Medical Director

beaver Medical Group*Charles Payton, MD, VP Medical Administration/CMOJohn Goodman, President/CeO brown & toland Physicians*Andrew M. Snyder, MD, Chief Medical Officerrichard Fish, CeO

california Pacific Physicians Medical Group, Inc.Dien V. Pham, MD, Chief executive OfficerCarol Houchins, Administrator

careMore Medical GroupTom Tancredi, Dir. of Practice Operations

catholic Health Initiatives*James Slaggert, VP Physician Practice Manage-ment

cedars-sinai Medical Group*Stephen C. Deutsch, MD, Chief Medical DirectorThomas D. Gordon, CeO

children’s Physicians Medical Groupleonard Kornreich, MD, President and CeO

chinese community Health care associationJohn M. Williams, Pharm.D., CeOPolly Chen, Director of Operations

choice Medical Group IPaManmohan Nayyar, MD, PresidentMarie langley, IPA Administrator

cigna Medical GroupKevin ellis, DO, Chief Medical Officeredward Kim, President and General Manager

conifer Health solutionsMegan North, CeO

• AKM Medical Group Amvi Medical Group • exceptional Care Medical Group • Family Choice Medical Group • Family Health Alliance • Hun-tington Park Mission Medical Group • Medicina Familiar Medical Group • New Horizon Medical Group • Noble Community Medical Associates • OmniCare Medical Group • Premier Physician Network • United Care Medical Group •

DcHs Medical foundationDean M. Didech, MD Chief Medical Officerernest Wallerstein, CeO

Desert oasis Healthcare*Marc Hoffing, MD, Medical DirectorDan Frank, Chief Operating Officer

Dignity HealthBruce Swartz, SVP, Physician Integration

edinger Medical GroupMatthew C. Boone, MD, executive Medical DirectorDenise McCourt, Chief Operating Officer

empire Physicians Medical Group*Steven Dorfman, MD, PresidentYvonne Sonnenberg, executive Director

everett clinic, P.s., theAdrianne Wagner, Quality Improvement Consul-tant ManagerShashank Kalokhe, Associate Administrator of Value-Based Contracting and Coordinated Care

facey Medical foundation*erik Davydov, MD, Medical DirectorBill Gil, President/CeO

Golden empire Managed care, Inc.*C. Vincent Phillips, MD, Presidentrobert Severs, CeO

Good samaritan Medical Practice associationNupar Kumar, MD, Medical Director Cynthia Guzman, CeO

Greater newport Physicians Medical Group, Inc.*Diane laird, CeO

Healthcare Partners*robert Margolis, MD, Co-Chairman of the Board, DaVita Heritage Provider network*richard Merkin, MD, Presidentrichard lipeles, Chief Operations Officer

• Affiliated Doctors of Orange County • Bakersfield Family Medical Group • California Coastal Physician Network California Desert IPA • Desert Oasis Healthcare • Greater Covina Medical Group • Heritage Physician Network • Heritage Victor Valley Medical Group • High Desert Medical Group • regal Medical Group • Sierra Medical Group •

High Desert Medical GroupCharles lim, MD, FACP, Medical DirectorAnthony Dulgeroff, MD, Assistant Medical Director

Hill Physicians Medical Group, Inc.*Tom long, MD, Chief Medical OfficerDarryl Cardoza, CeO

Hoag Medical Group, Inc.ehab Mady, DO, Medical DirectorKris V. Iyer, MD, Sr. VP / Chief Administrative Officer HMTS

Independence Medical GroupArmi lynn Walker, MD, Medical DirectorGary M. Bohamed, executive Director

Inland Healthcare Group, Inc.Carey Paul, MD, Presidentlisa Perko, Controller

John Muir Physician network ravi Hundal, MD, Medical Directorlee Huskins, Interim CeO/Sr. VP/ COO lakeside community HealthcareKerry Weiner, MD, Chief Medical OfficerJonathan Gluck, Counsel

lakeside Medical Group, Inc. lakewood IPaJean Shahdadpuri, MD, MBA, Chief Medical OfficerVarsha Desai, Chief Operating Officer

• Alamitos IPA • St. Mary IPA • Brookshire IPA •

loma linda University Health careJ. Todd Martell, MD, Medical Director Maverick Medical GroupWarren Hosseinion, MD, ChairmanrMark C. Marten, Chief executive Officer MeD3000Gary Proffett, MD, Medical Directorlynn Stratton Haas, CeO

• SeaView IPA • Valley Care IPA •

MedPoint Managementrick Powell, MD, Chief Medical OfficerKimberly Carey, President

• Apollo Healthcare • Bella Vista Medical Group IPA • Centinela Valley IPA • el Proyecto Del Barrio, Inc. • Global Care Medical Group • HealthCare lA IPA • Jewish Home for the Aging IPA • redwood Community Health Network • United Physicians International • Watts Healthcare Corporation •

Memorialcare Medical Group*Mark Schafer, MD, CeOJennifer Jackman, Chief Operating Officer

Meritage Medical networkJ. David Andrew, MD, Medical DirectorJoel Criste, CeO

Molina Medical centers Keith Wilson, MD, Vice President of Clinical Services Gloria Calderon, Vice President of Clinic Operations

Monarch Healthcare*Bart Asner, MD, CeOray Chicoine, President and COO

Mso of Puerto Ricorichard Shinto, MD, CeOraul Montalvo, MD, President

Muir Medical Group, IPa Steve Kaplan, MD, PresidentUte Burness, rN, CeO naMM california*leigh Hutchins, President, COOelizabeth Haughton, Vice President, legal Affairs

* Indicates 2013 - 2014 Board Members

• Coachella Valley Physicians of PrimeCare, Inc., • Mercy Physicians Medical Group • Primary Care Associated Medical Group, Inc. • PrimeCare Medi-cal Group of Chino • PrimeCare of Citrus Valley • PrimeCare of Corona • PrimeCare of Hemet Valley Inc • PrimeCare of Inland Valley • PrimeCare of Moreno Valley • PrimeCare of redlands • PrimeC-are of riverside • PrimeCare of San Bernardino • PrimeCare of Sun City • PrimeCare of Temecula • redlands Family Practice Medical Group, Inc. •

omnicare Medical GroupAshok raheja, MD, Medical Director Toni Chavis, MD, President

Pacific IPaTheresa Tseng, MD, PresidentPen lee, MD, CeO

the Permanente Medical Group, Inc. oakland (north)*Sharon levine, MD, Associate executive DirectorSuketu Sanghvi, MD, Associate executive Director

Physicians DatatrustAnthony Ausband, President lisa Serratore, Chief Operations Officer

• Greater Tri-Cities IPA • Noble AMA IPA • St. Vincent IPA •

Physicians Medical Group of santa cruz county*Nancy Greenstreet, MD, Medical DirectorMarvin labrie, CeO

Physicians Medical Group of santa MariaJohn Okerblom, MD, PresidentBarbara Cheever, executive Director

Physicians of southwest Washington, llcGary r. Goin, MD, PresidentMariella Cummings, CeO

PIH Health PhysiciansDeeling Teng, MD, Sr. Medical Director, Group Opera-tionsramona Pratt, rN, Chief Operating Officer, Group Operations

Pioneer Medical Group, Inc.*Jerry Floro, MD, President John Kirk, CeO

Preferred IPa of californiaMark Amico, MD, Medical DirectorZahra Movaghar, Administrator Prospect Medical GroupPrasad Jeereddi, MD, ChairmanMitchell lew, MD, CeO

• AMVI/Prospect Health Network • Gateway Medical Group • Genesis Healthcare • Nuestra Familia Medical Group • Prospect Corona • Prospect HealthSource • Prospect Huntington Beach • Prospect Northwest Orange County • Prospect Orange County • Prospect Professional Care • Prospect Van Nuys •

Providence Medical Management servicesBart Wald, MD, Physician Chief executivePhil Jackson, Chief Integration and Transformation Officer • Korean American Medical Group • Providence Care Network •

Providence Health & servicesBart Wald, MD, Physician Chief executiveBill Gil, Chief executive Medical Foundations

River city Medical Group, Inc.Jose Abad, MD, President/Medical Directorloren Douglas, CeO

Riverside Medical clinicSteven larson, MD, ChairmanJudy Carpenter, President/COO Riverside Physician network Paul Snowden, COOHoward Saner, CeO

st. Joseph Heritage HealthcareKhaliq Siddiq, MD, Chief Medical OfficerC.r. Burke, Chief executive Officer

san bernardino Medical GroupThomas Hellwig, MD, PresidentJames Malin, CeO

san Diego Physicians Medical GroupJames Cordell, MD, PresidentJoyce Cook, CeO

san luis obispo select IPaBarbara Cheever, executive Director

sansum clinic*Kurt ransohoff, MD, Medical Director/CeOVince Jensen, COO santa clara county IPa (sccIPa)*J. Kersten Kraft, MD, President of the Boardlori Vatcher, Chief executive Officer

santé Health system, Inc Daniel Bluestone, MD, Medical DirectorScott B. Wells, CeO

scripps coastal Medical center*louis Hogrefe, MD, APC, Chief Medical OfficerTracy Chu, Assistant Vice President of Operations

sharp community Medical Group*John Jenrette, MD, Chief executive OfficerChristopher McGlone, Chief Operating Officer

• Graybill Medical Group • Arch Health Partners • sharp Rees-stealy Medical Group*Donald C. Balfour, III, MD, Chief Medical OfficerStacey Hrountas, Senior VP and Chief executive Officer

southeast Permanente Medical Group, Inc., theMichael Doherty, MD, executive Medical Director and Chief of Staff

southern california Permanente Medical Group*Vito Imbasciani, MD, Director of Government relationsJames Malone, Medical Group Administrator

sutter Health foundations & affiliated Groups*Jeffrey Burnich, MD, SVP and executive Officer, Sut-ter Medical Network Brian roach, President, Mills Peninsula Division of PAMF

• Brown & Toland Physicians • Central Valley Medical Group • east Bay Physicians Medical Group • Gould Medical Group • Marin Headlands Medical Group • Mills-Peninsula Medical Group • Palo Alto Foundation Medical Group • Palo Alto Medical Foundation • Peninsula Medi-cal Clinic • Physician Foundation Medical Associates • Sutter east Bay Medical Foundation • Sutter Gould Medical Foundation • Sutter Independent Physicians • Sutter Medical Foundation • Sutter Medical Group • Sutter Medical Group of the redwoods • Sutter North Medical Group • Sutter Pacific Medical Foundation •

synerMed*George Ma, MD, Medical DirectorJames Mason, President and CeO

• Alpha Care Medical Group • Angeles IPA • Crown City Medical Group • eHS Inland Valleys IPA • eHS Medical

Group – Central Valley • eHS Medical Group – los Angeles • eHS Medical Group – Sacramento • employee Health Systems • MultiCultural IPA • Pacific Alliance Medical Center • Southern California Children’s Network • talbert Medical Group*Pratibha A. Patel, MD, Market PresidentDonald rebhun, MD, Corporate Medical Director

torrance Hospital IPaNorman Panitch, MD, PresidentStephen J. linesch, CeO triad Healthcare network, llcThomas C. Wall, MD, executive Medical DirectorSteve Neorr, VP, executive Director

U.c.l.a. Medical Group*Sam Skootsky, MD, Medical DirectorDavid Hartenbower, MD, COO

Usc care Medical Group, Inc.Donald larsen, MD, Chief Medical OfficerKeith Gran, CeO

WellMed Medical Group, P.a.George M. rapier III, MD, Director and VPCarlos O. Hernandez, MD, President

CORPORATE PARTNERS

Anthem Blue Cross of CaliforniaAthenahealthBayer HealthCare PharmaceuticalsBoehringer Ingelheim Pharmaceuticals, Inc.Humana, Inc.Merck & Co.Novartis PharmaceuticalsNovo NordiskSCAN Health Plan

ASSOCIATE PARTNERS

abbvieActavis Pharma, Inc.ArkrayAstellas Pharma US, Inc.AstraZeneca PharmaceuticalsCVS Caremark, Corp.Daiichi Sankyoeisai, Inc.GenPath DiagnosticsGenomic HealthGilead SciencesGroup Practice ForumJohnson & Johnson Family of CompaniesKaufman, Hall & AssociatesKindred Healthcare, Inc.lilly USA, llCPfizer, Inc.ralphs Grocery CompanySanofiSunovion Pharmaceuticals Inc.The Doctors CompanyVitas Healthcare Corporation of California

AFFILIATE PARTNERS

AlturaAscender Software, llCClarity Health ServicesChildrens Hospital los Angeles Medical GroupMills Peninsula Medical GroupMZI HealthCare, llCPartners in Care FoundationPharmacyclics, Inc.redlands Community HospitalSaint Agnes Medical GroupSullivanluallin GroupUnlimited Innovations, Inc. Ventegra, llC

CapG health September/October 2014 l 15

5 l capg health July/august 2014

the expanding role of Community pharmacists in Improving patient Outcomes: Fitting into the aCO modelBY YalDa DOrOStI , pharm.D.

In 2014 and beyond, we are likely to see more public and private accountable care organizations (ACOs) dominating the healthcare arena as a direct result of the Patient Protection and Affordable Care Act. Similar in concept to the traditional

health maintenance organization (HMO), the ACO is defined as an organization of healthcare providers that work together collaboratively and accept collective accountability for the cost and quality of care delivered to a population of patients.1 As of July 2013, there were approximately 488 ACOs around the country and that number is projected to grow rapidly.2

With the increasing number of ACOs and estimates that the Affordable Care Act will provide health insurance to an additional 3.4 million people in California by 2016, there will be an unmatched demand for cost-effective, outcomes-based care.3 This growing demand, along with the increased focus on pay for performance and overall disproportionate lack of primary care physicians, has forced healthcare to look to other providers for help. As many of the quality measures by the Centers for Medicare & Medicaid Services (CMS) focus on pharmaceutical drug therapy management, community pharmacists are uniquely qualified to step in and assist these efforts.

In order to better assess private and public sector Part D prescription plans, the Pharmacy Quality Alliance (PQA) was formed in 2006. Since its inception, the organization has focused on developing and implementing performance measures that are largely used to calculate Medicare Part D star ratings. Pharmacy-related measures make up almost 50% of plan star ratings and

include important areas such as medication adherence, appropriate management of diabetes and hypertension, and high-risk medication management for the elderly.4

To help reach these measures, many community pharmacies now provide a myriad of individual patient-centered care services. One area of particular interest is chronic management of diseases such as diabetes, hypertension, and dyslipidemia. For example, community pharmacies offer patients comprehensive diabetes coaching, which includes medication and dietary education. This is done in conjunction with reviewing patient glucose records and titrating medications per physician-based protocols. Another example is the identification of patients with gaps in therapy who are not currently taking medication per guidelines, such as ACe inhibitors in patients with diabetes or statin therapy in cardiovascular disease patients.

Pharmacists are also focusing on helping reduce hospital readmissions by performing post-discharge medication reconciliation. This occurs in the community pharmacy when the patient receives discharge medications. Pharmacists ensure that patients understand changes made to their medication regimens and the proper use of new medications. last, pharmacists continue to provide patients with comprehensive medication therapy management (MTM), now mandated for at-risk Medicare beneficiaries, to identify drug-drug and drug-disease interactions, drug therapy noncompliance, and alternate therapies to reduce cost.

As ACOs aim to score higher on performance measures in pharmaceutical drug therapy management, community pharmacists can be invaluable resources in tracking and improving their performance. This will likely be accomplished by establishing payment models, which includes risk sharing by pharmacists. This concept is currently being implemented by the Inland empire Health Plan, which recently launched a pay-for-performance


program for its network of pharmacies in Southern California.5 Pharmacies are able to track their performance through a web-based platform known as eQuIPP, the electronic Quality Improvement Platform for Plans and Pharmacies, which calculates performance scores of pharmacies within health plans. With these changes, health plans and patients will soon select pharmacies based not only on convenience, but also on their ability to prove that their drug therapy management services meet quality measures.

As our healthcare system moves towards a patient-centered, outcomes-based model, it is essential to increase the collaboration and communication between healthcare providers. By sharing accountability, members of a patient’s healthcare team are working together and taking responsibility to ensure quality measures are followed. Community pharmacists are proving to be an integral part of this healthcare team and, with their clinical knowledge and accessibility to patients, are uniquely positioned to help improve patient outcomes in the ACO model. o

Yalda Dorosti, PharmD, served her first-year community pharmacy practice residency at Ralphs Pharmacy/USC and currently is a PGY-2 pharmacy administration resident at Kaiser Permanente Downey Medical Center in Southern California.

references:

1. Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 (2010)

2. Petersen M, Muhlestein D, Gardner P. Growth and Dispersion of Accountable Care Organizations : August 2013 Update. Cent Accountable Care Intell. 2013;(August).

3. long P, Gruber J. Projecting the impact of the Affordable Care Act on California. Health Aff (Millwood). 2011;30(1):63–70. doi:10.1377/hlthaff.2010.0961.

4. Pharmacist can Improve Medicare plan star ratings. Pharm Today. 2013. Available at: cms-star-ratings-compounding-bill-passes-senate-heads-obama @ www.pharmacist.com.

5. Pharmacy P4P Program - Inland empire Health Plan. Available at: https://ww3.iehp.org/en/providers/pharmaceutical-services/pharmacy-p4p-program/. Accessed February 24, 2014.


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physician Groups in medicare advantage: time to actBY mara mCDermOtt, DIreCtOr OF FeDeral aFFaIrS, CapG

We have reached an interesting time in federal physician payment policy. All at once, it seems members of Congress across political parties are in agreement about the direction for physician payment. While the labels vary—two-sided risk, population-based

payment, global capitation, value-based payment models—the notion is the same: a physician organization accepting a budgeted payment for providing healthcare to a defined population of patients.

early this year, the Senate Finance Committee Chairman, Senator ron Wyden (D-Or), introduced the Better Care, lower Cost Act. This legislation would provide capitated payments for certain chronically ill patients in Medicare Part A, Part B and, in some cases, Part D.

late last year, the four Committees with jurisdiction developed a bipartisan, bicameral permanent repeal and replacement bill for the flawed Sustainable Growth rate formula (the formula that sets payment in Medicare Part B). The permanent replacement bill would stop the costly annual process of proposed cuts and legislative fixes to physician Medicare Part B payments and create a new payment formula. In the replacement payment formula, Congress includes incentives for physician organizations that take on financial risk for the health of a defined patient population.

Finally, in our work on Medicare accountable care organizations (ACOs), we see the Administration and Congress pushing these organizations to accept more financial risk and reward, with robust requirements for quality—again, beginning to embrace population-based payment.


Federal Update

For many CAPG members, this model is not new. CAPG member organizations have been accepting capitation or population-based payment for quite some time. What is new is the vocal, powerful policy support for advancing and spreading this model.

meDICare aDVaNtaGe: the BeSt exIStING

example OF CapItateD paYmeNtS tO

phYSICIaN GrOUpS

While this new focus on population-based payments is exciting, CAPG continues to urge policymakers to support the one program in which capitated payment to physician organizations is already alive and well—Medicare Advantage.

For many CAPG members in Medicare Advantage, the Centers for Medicare & Medicaid Services (CMS) makes a capitated payment to a health plan. The plan then makes a capitated payment to the physician organization to care for a specific patient population. Physician organizations and their downstream contracted or employed physicians are held to robust quality reporting standards. But, unlike fee-for-service, there is no extra money for additional services provided. Physician groups must manage the patient’s care within a defined budget.

In other words, the very coordinated, population-based payment model that Congress seeks to create in Medicare Part B is already available in the Medicare Advantage program, or Medicare Part C.

meDICare aDVaNtaGe: Death BY a

thOUSaND CUtS

To borrow the phrase from Dr. robert Margolis’s Congressional testimony that so accurately describes the pressures facing the program: Medicare Advantage is at risk of death by a thousand cuts. When the Affordable Care Act (ACA) passed, close observers knew that cuts to Medicare Advantage were on the horizon. The ACA slashed about $200 billion from Medicare Advantage through a combination of direct and indirect cuts. The reductions were largely intended to bring Medicare Advantage payments to parity with fee-for-service Medicare payments.

Since then, though, cutbacks have continued to plague the program. Subsequent legislation and regulation have continued slicing deeply into Medicare Advantage.

CAPG is deeply concerned that continuing this pattern of proposed and implemented cuts will undermine the very coordinated, capitated model that Congress and the Administration seek to create in Medicare Part B.

CapG’S WOrK tO preSerVe aND StreNGtheN

meDICare aDVaNtaGe

CAPG continues working to preserve and strengthen the Medicare Advantage program. Our work has included direct advocacy with members of Congress and their staff, the Administration, and outside stakeholder groups. Our efforts focus on the importance of coordinated care in providing high quality services to seniors. Highlights of our advocacy include:

• caPG leads Physician letter on Medicare advantage. In March, CAPG sent a letter on protecting Medicare Advantage signed by over


140 physician organizations to CMS Administrator Marilyn Tavenner. This letter was a significant factor in significant improvement of MA rates in last year’s Medicare Advantage payment setting process.

• caPG board Members testify on capitol Hill. Over the past 12 months, three CAPG board members have testified before House Committees on the future of Medicare Advantage.

• caPG’s colloquium on Physician Groups in Medicare advantage. For the first time, CAPG will gather hundreds of physicians and healthcare industry stakeholders to discuss the role of Medicare Advantage in high-quality patient care.

As we continue our tireless work to protect and grow the Medicare Advantage program, we urge all of you to join us. There is much more work to be done to ensure a robust future for this important program. We encourage you to visit www.SupportMedicareAdvantage.org to learn more about ways to get involved. We hope that you will add your voice and your support to strengthen Medicare Advantage. o

CAPG member Dr. Chris Rao (left) and U.S. Rep. Patrick Murphy of Florida met with seniors in August about the value of Medicare Advantage for beneficiaries.

Photo: Coalition for Medicare Choices


Supporting patients with the right tools to Improve medication adherenceBY DaVID trIp I , GlOBal heaD OF OperatIONS, JaNSSeN healthCare INNOVatION

We know that patients often face significant challenges adhering to their medication regimen, especially when they are on several medications that need to be taken at different times throughout the day. We also know that failures in medication adherence are extremely common. It is estimated that only about half of patients take medication as prescribed. This not only results in worse health outcomes, but is extremely costly in financial terms. A recent study estimates that about 8 percent of total health expenditures, or about $500 billion in annual global health spending, could be avoided through responsible use of medicines.

Healthcare providers and purchasers have become more aware that failures in medication adherence exact a heavy toll and that many patients need additional support in order to take their medication correctly. So patients are often advised to establish a daily routine for taking medication, keep a written schedule, and use daily dosing containers to stay on track. These are all good ideas, but even patients who take these steps can still find themselves skipping doses. Despite patients’ best efforts, they often simply forget to take their medication on schedule. This is a serious problem that can delay their recovery and increase the risk of relapse and hospitalization.

So what to do about it? How can patients improve their medication adherence, and how can healthcare providers support them in those efforts? Thanks to modern technology, patients and their caregivers, as well as their physicians and other providers, have an important new tool to assist them: mobile phones.

The overwhelming majority of American adults—about 90 percent—carry a mobile phone wherever they go. Many of them already use their phones to keep track of their daily schedules. So why not use their phones as a tool to support their self-care?

Technologies such as the mobile phone create solutions that are modernizing healthcare delivery and transforming the consumer health experience. For example, studies have shown that a text message reminder can significantly help patients maintain their prescribed drug regimens. These types of alerts are a simple yet effective way to nudge patients to take their medication on schedule, wherever they are and whatever they happen to be doing.

recognizing the opportunity presented by mobile phones and text messaging, the Care4Today™ Mobile Health Manager—an easy-to-use, two-way, secure messaging platform—was developed. The program includes a mobile app (iOS



and Android), SMS text messaging, and website that patients can utilize for free to receive reminders to take their medication. With Care4Today™, patients have a valuable and customizable tool to help them manage complex treatment regimens.

This online platform also promotes collaboration between patients and their family members, caregivers and healthcare providers, enabling all of them to work together on the patient’s behalf. Patients can choose to share their adherence reports with their healthcare providers, giving doctors and caregivers a convenient way to effectively manage patients’ medications and improve adherence.

Family members and loved ones are also vital participants, especially those among the four in ten US adults who are caring for an adult or child with significant health issues. So we developed the Care4Family™ function, which allows family members to monitor their loved one’s medication adherence. Family members are alerted if medication is not taken on time. Once alerted, they can call or text their loved ones as an additional reminder.

Best of all, patients and their family members and caregivers can download the app at no cost from the App Store, Google Play or Care4Today website, mhm.care4today.com.

We believe this kind of tool can significantly improve patients’ health and well-being while also helping to bend the cost curve in healthcare spending. Anecdotally, doctors tell us they believe the Care4Today™ Mobile Health Manager could really improve their patients’ medication adherence. We are also getting a very positive response from patients and their families.

It’s a reminder that in healthcare, as in other areas of life, small things—like a simple text message that it’s time to take your pill—can sometimes make a big difference.

For more information about Care4Today™, please reach out to your local Johnson & Johnson Health Care Systems contact or Michele Cappel at [email protected]. Additionally, our full-service Customer Care team is available by calling 1-800-503-1049. o

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Saturday, November 1, 2014 • 6:00 pm – 10:00 pmHeavy Hors d’oeuvres and Hosted BarLive and Silent AuctionsEntertainment

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CapG Colloquium on physician Groups in medicare advantageBY FraNCINe mOSKOWItz, V ICe preSIDeNt, OperatIONS, CapG

In addition to the CAPG Annual Healthcare Conference in June and the Accountable Care Congress in November, CAPG is now adding a new and exciting conference to its annual event roster—the CAPG Colloquium on Physician Groups in

Medicare Advantage. The inaugural Colloquium will be held October 6-8, 2014 at the new Marriott Marquis in Washington, DC.

We have assembled a strong agenda and an outstanding faculty to very specifically address physician groups’ role in Medicare Advantage (MA), and we expect to attract a national audience of leaders in all sectors of healthcare policy and practice.

We have a stellar lineup of speakers. A selected list:

• Sean Cavanaugh, Deputy Administrator and Director, CMS

• Senator ron Wyden (D, Or) (Invited)• Paul Ginsburg, PhD, Chair in Medicine/Public

Policy, USC’s Schaeffer Center for Health Policy and economics

• Chris Jennings, former White House Senior Health Advisor

• Tom Scully, former Administrator, CMS• Gail Wilensky, former Administrator, HCFA • Stephen Hemsley, CeO of UnitedHealth Group• Bruce Broussard, CeO of Humana• Douglas Holtz-eakin, PhD, former Director, CBO• Kavita Patel, MD, Brookings• Mark McClellan, MD, PhD, Brookings; former

Administrator, CMS• Alice rivlin, PhD, Brookings; founding Director,

CBO; former Director, OMB; and former Vice Chair, Federal reserve

In addition to these outstanding keynote speakers, we are offering two preconferences—one on risk adjustment and one on Standards of excellence as a platform for movement to coordinated care—along with ten “how-to” best practice breakouts on practical, applicable topics, including:

• Star ratings• readmissions reduction• Medication reconciliation/Adherence• MA vs. Original Medicare—A Comparison• Behavioral Health—linchpin of Population Health• Ambulatory and Home-Based Palliative Care• Primary Care Practice Transformation• evolution from ACO to MA

registration is open, and as of this writing, rooms are still available at the beautiful conference hotel, at a very enticing rate. We do hope you and your team will be able to join us in DC in October—a beautiful time of year to visit our nation’s capital.

Among the objectives of the Colloquium are:

• To substantially enhance CAPG’s national advocacy platform—our visibility, relevance and credibility—with DC policymakers, think tanks and groups that support MA and the coordinated, accountable, capitated care model

• To attract members throughout the US among physician organizations that practice, or aspire to practice, in the coordinated, accountable, capitated care model, recognized as the value-based, vital framework for the ACA

Visit the Colloquium website at www.capgmacolloquium.com. Check out the complete agenda and speaker lineup of experts from the nation’s leading providers, policymakers and healthcare industry leaders—and make your plans to attend!

The Colloquium will provide continuing education credits for physicians (AMA Category 1), healthcare executives (ACHe Category 2), attorneys (MCle) and accountants (NASBA). o


1-888-HEALING (432-5464)california.providence.org

Providence Affi liated Medical GroupsAffi liates in Medical SpecialtiesAxminster Medical GroupFacey Medical GroupProvidence Medical Group

Providence Holy Cross Medical Center

Providence Little Company of Mary Medical Center San Pedro

Providence Little Company of Mary Medical Center Torrance

Providence Saint John’s Health Center

Providence Saint Joseph Medical Center

Providence Tarzana Medical Center

Providence TrinityCare Hospice

*Based on risk adjusted, in-hospital data. Providence Little Company of Mary Medical Center San Pedro was not eligible for consideration for this award.

If you believe in practicing medicine that changes lives and creates healthier communities, we invite you to consider partnering with Providence Health & Services, Southern California.

Our goal is to provide fl exibility for physicians to practice in a model that suits each physician’s needs. Available today or in active development are practice models including:

Multi-Specialty Group modelsSpecialty Group and Institute modelsIndependent Physician Association models

Medical groups like Affi liates in Medical Specialties, Axminster, Facey and Providence Medical Group have all made Providence their home for the support they need and the compassionate, quality care for their patients. With Providence, you’re aligning yourself with California’s fi rst and only health system to have our eligible hospitals recognized with the Healthgrades’ Distinguished Hospital Award for Clinical Excellence.

At Providence, you can practice medicine the way that’s best for you and your patients.

For more information about Providence Health & Services, visit us online at california.providence.org or call 1-888-HEALING (432-5464).

When you practice medicine at Providence, you’re in good company

Providence Health & Services, Southern California

phsca_capg-8.125x10.875_physician recruiting_May-June2014.indd 1 4/23/2014 8:36:25 AM


prop. 46: higher Costs, Fewer Doctors, No privacyBY l ISa maaS, exeCUtIVe D IreCtOr, Cal IFOrNIaNS all IeD FOr pat IeNt prOteCtION

CAPG is part of a large and diverse coalition—including healthcare providers, community clinics and health centers, labor unions, business and taxpayer groups, local government, public safety, and community groups—working to defeat Proposition 46

on the November ballot.

We strongly urge you to vote no on Prop. 46 on november 4. If passed, Prop. 46 will:

• increase healthcare costs;

• jeopardize people’s ability to see their trusted healthcare providers; and

• threaten the privacy of personal prescription drug information.

Get the FaCtS

What does Prop. 46 do?

1. Quadruples the MICrA limit on medical malpractice awards in California. This increase will cost consumers and taxpayers hundreds of millions of dollars every year in higher healthcare costs, and cause many doctors and other medical care professionals to quit their practice or move to places with lower medical malpractice insurance premiums—reducing access to care.

2. Threatens people’s privacy by requiring a massive expansion of the use of a personal prescription drug database.

3. requires alcohol and drug testing of doctors, which was only added to this initiative to distract from the main purpose of changing MICrA.

Proposition 46 uses alcohol and drug testing of doctors to disguise the real intent—to increase a limit on the amount of medical malpractice lawsuit awards.

Who opposes Prop. 46?

Thousands of organizations and individuals oppose Prop. 46 because it will lead to more lawsuits, higher healthcare costs, threaten people’s access to their trusted healthcare providers, and jeopardize people’s personal prescription drug information.

Who supports Prop. 46?

One hundred percent of the reported contributions to pay for signature gathering to place this on the ballot in November 2014 came from trial lawyers and their allies.

How will Prop. 46 increase healthcare costs?

There is no question that more lawsuits against healthcare providers will increase costs, and someone has to pay. And that someone is consumers and taxpayers.

California’s former legislative Analyst found Prop. 46 would increase health costs for consumers and the state by about $9.9 billion annually.

This translates to more than $1,000 each year in higher healthcare costs for a family of four.

California’s current independent, nonpartisan legislative Analyst Office (lAO) said impacts to state and local governments (i.e.—taxpayers) would be “several hundred million dollars annually.”

In its evaluation, the lAO warned “even a small percentage change in healthcare costs could have a significant effect on government healthcare spending.”


What about access to healthcare? How will that be affected by Prop. 46?

If California’s medical liability cap goes up, people could lose the ability to see their trusted doctors. Many community clinics operate on slim margins. Any significant increase in their costs will force them to reduce or eliminate services for patients. Many doctors will be forced to leave California to practice in states where medical liability insurance is more affordable.

respected community clinics including Planned Parenthood warn that specialists like OB-GYNs will have no choice but to reduce or eliminate vital services, especially for women and families in underserved areas.

How will Prop. 46 threaten people’s personal privacy?

Prop. 46 forces doctors and pharmacists to use an archaic, outdated statewide database filled with Californians’ personal medical prescription information. Government will find this mandate impossible to implement, and the mandate comes with no additional funding and no increased security standards to protect people’s personal prescription information from hacking and theft—none. And who controls the database? The


government—in an age when government already has too many tools for violating your privacy.

here’S hOW YOU CaN Get INVOlVeD

Please join with CAPG and become an official member of the No on Prop. 46 campaign. Visit the campaign website, www.NoOn46.com, to:

• Sign up to add your name to the growing list of individuals and groups opposed to Prop. 46

• Get important facts, downloads and information that will help you spread the word about this costly measure

• Check out the list of groups opposed to Prop. 46

• Contribute to No on Prop. 46 to help fight the trial lawyers

• Get pamphlets, buttons and posters from our campaign store to help educate your patients about the negative impacts of Prop. 46. These materials are perfect for your office lobbies or exam rooms.

• Follow us on social media:o Twitter: @NoOn46o Facebook: No on 46 o

WellMed’s philosophy is to help the patient become as well as possible and maintain health at the highest level while avoiding costly consequences of uncoordinated care. We utilize the full risk capitation payment to fund programs and services that physicians could not normally afford and that directly contribute to better health outcomes. WellMed also supplements transportation benefits to ensure patients get to medical appointments and provide health coaches to ensure patients actively participate in their own care and have self-management skills.

Overall, we have been successful, but we see challenges on the horizon.

Seniors make up the nation’s fastest-growing population. We are facing a shortage of primary care physicians as Medicare cuts impact residency training programs. Our MVPs, those with multiple chronic conditions, will be faced with finding primary care doctors to take care of them.

Volume creates access problems. Access problems create emergency room overcrowding. er overcrowding results in fragmented, uncoordinated care leading to poor patient outcomes. Poor patient outcomes result in higher costs to the system.

The solution? Create a payment strategy that allows healthcare providers to be paid on positive outcomes, coordinated care and providing a medical home, rather than a fee-for-service strategy that encourages waste and increased healthcare costs.

Models like ours, not unique to WellMed but found in many states, have been proving that coordinated care is a sustainable solution to these looming challenges. o

Dr. Carlos Hernandez, President of the WellMed Medical Group, is certified by the American Board of Internal Medicine and American Board of Hospice and Palliative Care Medicine. He also is a Fellow with the American College of Physicians. He holds an MS in Healthcare Management from the University of Texas, Dallas. Dr. Hernandez currently serves on the State Medicaid Managed Care Advisory Committee for the state of Texas.

Member Spotlight, continued from page 8


how primary Care physicians Can maximize Safety Net Coordinated Care models for patientsBY trUDI Carter, mD, ChIeF meDICal OFF ICer, l .a . Care health plaN

A need for improved care and greater support for physicians and patients are among the factors driving the move toward coordinated care in Medicaid programs across the country. These systems improvements aim to change the way healthcare is delivered to some of the country’s most vulnerable citizens: elderly, low-income and disabled individuals.

California’s Coordinated Care Initiative (CCI) seeks to bring about two key improvements in the way California is delivering healthcare to its Medicare and Medi-Cal (Medicaid) beneficiaries. The first is the transition of Managed long-Term Supports and Services (MlTSS) from a fee-for-service Medi-Cal benefit to a Medi-Cal health plan benefit. All Medi-Cal beneficiaries must enroll in a health plan in order to continue to receive MlTSS benefits, which includes Multi-Purpose Senior Services Programs (MSSP), In-Home Supportive Services (IHSS), Community-Based Adult Services (CBAS) and Skilled Nursing Facilities (SNF).

The second change is that patients who are eligible for both Medicare and Medi-Cal (often referred to as “Medi-Medis” or “Dual eligibles”) now have the option to enroll in Cal MediConnect to receive their Medicare and Medi-Cal benefits through a single, complete and coordinated system of care under one health plan. Many other states have initiated similar programs in order to streamline and improve care.

UNIqUe ChalleNGeS OF DUal elIGIBle patIeNtS

For many primary care physicians, participating in coordinated care programs like Cal MediConnect will likely mean an influx of dual eligible beneficiaries. It is important to remember that ultimately, these individuals are no different than commercial patients: they care about their health and want to make the best choices for themselves and their families. However, they may face obstacles that are not readily apparent, requiring increased sensitivity and communication from their primary care physicians.

For example, they may not tell you that transportation issues are preventing them from attending appointments or that they cannot afford a particular service. They may not be able to utilize the convenience of mail-order prescription delivery because they lack a permanent home address or credit card.

Such circumstances make it especially important that primary care physicians learn about the services that are available to dual eligible patients who choose to join coordinated care programs like Cal MediConnect—and why the care coordination assistance offered by the plans can be of great benefit to physicians seeking the best outcomes for their patients.


“ For patients who self-manage multiple chronic conditions through several providers and physicians, a care manager can be a great relief...”

BeNeFItS FOr patIeNtS

By blending Medicare and Medi-Cal benefits into one complete, integrated plan under Cal MediConnect, the desired result will be better coordination of services and better communication between providers, which in turn will give patients a broader, better informed care team and a care manager focused on meeting their individual medical needs.

For patients who self-manage multiple chronic conditions through several providers and physicians, a care manager can be a great relief, serving as the patient’s guide through the healthcare system. Cal MediConnect also provides additional benefits at no extra cost, including dental, vision and transportation to and from medical appointments.

mOre SUppOrt FOr prImarY Care phYSICIaNS

Primary care physicians will also benefit from the added support offered by Cal MediConnect. For example, it will be significantly easier to ensure that your patients are receiving the support services they need to maintain or improve their current health status.

In addition, a health plan care manager is available to conduct health risk assessments for patients identified as potentially high-risk and to facilitate the response to episodic needs. For example, a care manager can be relied upon to coordinate physical therapy or a wheelchair for a patient with an injury. Care managers can also ensure that patients are seeing the right specialists to manage various conditions.

For dual eligible patients who enroll in Cal MediConnect, the plan will also coordinate behavioral health. The integration of behavioral health services along with medical care can greatly improve care outcomes when the primary care physician and behavioral health provider work together for the patient.

In fact, working together for the benefit of the patient is exactly what care coordination models are designed to facilitate. The center of Cal MediConnect—and other similar safety net models now being implemented around the country—is providing maximum support so that physicians can do what they do best: help their patients thrive.

To learn more, please visit www.calmediconnectla.org or call l.A. Care Health Plan at 1-888-522-1298. o


Seven Steps to effective healthcare Data SharingBY tOm peterSON, preSIDeNt aND CeO, Clear V IS ION INFOrmatION SYStemS

How data is gathered, analyzed, shared and maximized is one of the most important topics gripping healthcare today. Physicians, insurers and patients themselves all have a vested interest in using data properly to make sure that the system works as efficiently and effectively as it can. Collected and shared appropriately, data

impacts quality of care, patient health, physician income, STAr ratings and patient retention.

While this has always been true, it has never been more so than today with the emergence of accountable care organizations (ACOs). Under this model, in which healthcare systems assume the financial risk of caring for entire populations, having actionable data at the ready can be the game changer between success and financial chaos. What’s more, ACOs participating in the Medicare Shared Savings Program (MSSP) must not only demonstrate cost savings, they are also expected to collect and report data demonstrating that they have met quality standards established by the Centers for Medicare and Medicaid Services (CMS).

The hiccup in all of this is that healthcare, as a whole, has never been particularly good at collecting and sharing data in a meaningful way. The industry’s failure to embrace one universally accepted method of collecting and communicating data leaves us in a world where medical groups, individual physicians, hospitals and health plans each have their own practices in place—some homegrown, some bought, and some more digitized than others. And with California once again leading the nation with the emergence of so many new partnerships, affiliations and “virtual” arrangements, the task of finding ways to securely and efficiently share data across the continuum—starting with the fundamental question of what clinical and financial data to share—is especially daunting in this state.

Despite these barriers, physicians in California and around the rest of the country need to find a way to ensure that everyone involved in patient care has timely access to the same information, in the same secure and understandable format. Here’s a good seven-step roadmap to help get started:


1. Focus on sharing information that is relevant, meaningful, timely and actionable. Avoid simply doing a data dump, as too much information becomes a burden and in the end is counterproductive.

2. Share the right data for the right purpose (financial or clinical).

3. Worry less about “Who owns the data?” and more about “How can this data do the most good?” That focus requires thinking collaboratively and presenting data in a format that is understandable to all recipients. Consider spreadsheets versus populated forms.

4. Consider leveraging a reliable and experienced outside partner who can aggregate the jumble of data into one presentation that is easily understandable by all who can benefit from it.

5. Make sure the data is secure. Security trumps everything else.

6. Use data to guide action planning and to measure progress. That means including benchmarking and data goals and agreeing up front on which metrics to measure.

7. Train and communicate with everyone involved in data collection, sharing and analyzing. Make sure there is ongoing alignment and understanding.

The sad truth is that the healthcare industry has yet to fully capitalize on the full potential of the mountains of data that most medical groups have at their fingertips. It’s time to wake up that sleeping giant—both for the good of physicians themselves as well as for the patients they serve.

As fee-for-service gradually gives way to value-based and outcomes-based payments, effective clinical coordination across all points of care will become more critical than ever. The key to success in that new world is the sharing of data among everyone who can benefit from its power: independent physicians; medical groups; hospitals; skilled-nursing facilities; payers; regulators; and increasingly, when it comes to clinical data, patients themselves. Only by working together to generate actionable data will healthcare system stakeholders attain the Triple Aim of lower costs, better outcomes, and a heightened patient experience. oTom Peterson is president and CEO of Clear Vision Information Systems, which specializes in helping physicians and Medicare Advantage plans improve both the health and quality of life of their patients and their own profitability. www.cvinfosys.com

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Accountable care is a relatively simple idea: developing and implementing programs to most effectively manage the total cost of care for a given population, and to base reimbursements on the quality, not quantity, of care provided.

One such group where value-based care has proven effective is with Medicare patients.

Brown & Toland Physicians participated in the CMS Innovation Centers’ Pioneer Medicare Accountable Care project, and the first-year results were positive.

With our team approach, care managers worked closely with physicians to develop programs for the 18,000 patients in our Medicare Pioneer ACO program. These programs helped identify patient needs and comprehensive care and support programs. The results included improved preventive screening rates, reduced hospital stays, and fewer hospital readmissions.

Using predictive health analytics, Brown & Toland has advanced care for these 18,000 Medicare patients, and for more than 67,000 additional patients in our other HMO and PPO accountable care programs.

We will continue to provide proprietary solutions that help our physicians deliver value-based care for Medicare populations as well as all others.

To learn more about Brown & Toland Physicians, please visit our website at www.brownandtoland.com.

Leading the Way Forward in Medicare Value-Based Care

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CAPG Health Sept/Oct 2014

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