1 WELCOME TO THE 2Q2017 R4P MEETING May 23, 2017Annual Meeting 2013 WELCOME TO THE 2Q2017 R4P MEETING May 23, 2017 AGENDA MCPIPA BUSINESS 6-6:45pm Updates RMHP Foundation Physician Leadership 6:45 – 8pm Panel Discussion: The changing healthcare environment in Mesa County… MCPIPA’s role
2 HOUSEKEEPING Did you sign in?Annual Meeting 2013 HOUSEKEEPING Did you sign in? Remember to complete the survey. We appreciate your responses and will share the detail with various committees and MCPIPA Leadership
3 WELCOME NEW MCPIPA MEMBERSRandall Coffey, MD Internal Medicine Associates of the Grand Valley Katherine Phillips, MD The Pathology Group
4 Rocky Mountain Health Plans FoundationUpdate Dr. Chuck Breaux
5 RMHP Foundation (RMHPF) BackgroundRMHPF has existed since 1998 Previous monetary balance ~$250,000 With sale of not-for-profit RMHP to for-profit UHC, proceeds have to go to community benefit (i.e., RMHPF) Sale closed 3/1/2017 Purchase price = $38,875,000 $31,375,000 directly to RMHPF $7,500,000 to escrow account
6 RMHP Foundation Board of DirectorsNicole Bernal-Ruiz, MA (Loma) Program Director, Hispanic Affairs Project Chuck Breaux, MD (GJ) – Treasurer Pediatric Surgeon, St. Mary’s Hospital Terry Chase, MA, ND, RN (GJ) Assistant Professor, Nursing & Mental Health, CMU Focus on disabled community John Feeney-Coyle, JD (Denver) Assistant Attorney General Non-voting member appointed by Attorney General Coffman
7 RMHP Foundation Board of Directors (cont.)Russ George, JD (Rifle) Former State Representative & House Speaker Many other state, college, & civic leadership positions Dan Gibbs (Breckenridge) Summit County Commissioner Former State Senator & Representative Waqqar Khan-Farooqi, MD (Snowmass) Orthopedic Surgeon, OrthoAspen Founding Director, Center for Health Policy Innovation, CMU
8 RMHP Foundation Board of Directors (cont.)Jeff Kuhr, PhD (GJ) – Chair Public Health Director, Mesa County Health Department Coordinator, Mesa County Health Leadership Consortium Marillac Clinic & QHN Board member Pat Riddell, MPH (Montrose) – Secretary Executive Director, Western Colorado Physicians IPA Ellen Roberts, JD (Durango) Former State Senator & Representative Former Mercy Medical Center Board member & Chair Founding Member & Chair, Health Care Committee, Club 20
9 RMHP Foundation Board of Directors (cont.)Jennifer Roller, MD (GJ) Family Medicine Physician, Primary Care Partners COPIC and COPIC Foundation Board member Sal Schaefer, RN (GJ) – Vice Chair Former CEO, Hilltop Community Services Founding Member, HopeWest Board Former Board member & Chair, RMHP Former Board member & Chair, Colorado Health Foundation Errol Snider, HRM (GJ) EVP/COO, Family Health West Former Fruita City Manager, Cañon City City Manager, and Mesa County Commissioner
10 RMHP Foundation Staff Lisa Fenton-Free – Executive DirectorPlans to retire in 9/2018 Stephanie Smith – Executive Assistant Bernie Buescher, JD – Legal Counsel Contracted thru Ireland, Stapleton, Pryor, & Pascoe, PA Helped facilitate closing of UHC-RMHP transaction Helping RMHPF set up and begin operating
11 RMHP Foundation Going ForwardRMHPF essentially starting anew, fully separate from RMHP/UHC Must benefit “Western and rural Colorado” Board is working through details of how RMHPF will be structured & work Sale accounting reassessments at 3 & 14 months post-sale Medicare audit outcome may result in another $10,000,000-$12,000,000 to RMHPF
12 RMHP Foundation Going Forward6-18 months before ready to make grants Projected annual grant money available ≈ $1,500,000-$2,500,000
13 Physician Leadership ProgramDr. Steven M. Norman, Ph.D. – CMU Business Department Head May 23, 2017
14 Program Overview The result of a collaborative effort between Western Colorado Healthcare Entities and CMU Physician Cohort of 30-35 Hybrid delivery model (online + in-seat) Credit toward Certificate Program/MBA CME Cohort 1 set to begin Fall 2017
15 Program Overview – Cont’dInitial course offerings include: Finance 301 Managerial Finance adapted for physicians - August 21 – December 14, 2017 Managerial Economics for Healthcare (MBA- Level)– Spring or Summer 2018 Leading Organizations in Health Care (MBA- Level) – Fall 2018 or Spring 2019 Then measure ongoing demand to potentially start another cohort Fall 2019
16 Registration/Cost Registration Information: www.coloradomesa.edu/applyProgram Cost: ~ $1,000 for the FINA 301 course ~ $1,300 for each MBA course
17 Questions? Thank you!
18 The Direction MCPIPA Takes Moving ForwardThe changing healthcare environment in Mesa County… MCPIPA’s role
19 BOARD UPDATES Decisions Expand NetworkMarket Internally and Externally Explore contracts with other payers Aggressively communicate our needs and wants to RMHP / United Healthcare
20 Current Contracts MCPIPA contract with RMHPInclusive of all MCPIPA physicians Includes Medicare, Medicaid and Commercial, large and small group plans Physicians do not have an Opt-Out provision (some exceptions) Physicians finance the MCPIPA Incentive Program through an 8% withhold and the administration of the IPA with 0.8% Patients have equal access to all hospitals
21 MCPIPA MEMBERSHIP
22 Narrow Provider NetworksInsurance company or employer limits enrollees to specific pool of healthcare providers (physicians, hospitals, labs, pharmacies) “Tier 1” Typically the network discounts rates and agrees to quality standards to employer or insurance company in exchange for access to patients Can result in lower costs, premiums ?better quality Can result in patients losing long- established relationships with providers “If you like your Dr……………” Going to other providers increases patient cost sharing (Tier 2 or OON)
23 Narrow Networks in Mesa County Community HospitalCommunity Health Partnership Includes some physician members of MCPIPA, Uses the CHPO Network MCPIPA physicians are either Tier 1 or Tier 2 Community Hospital is the Tier 1 facility for services they provide – Univ. of Utah is Tier 1 for other services Self Funded Employer Groups: Mesa County, SD#51, Strive, Community Hospital Wellness Programs Grand Valley Preferred Network (April1, 2017) U of U Health Plans (TPA) – partially self funded Physicians/practices offered direct agreements Tier 1 physicians have direct agreement with UU-HP Tier 2 physicians are through Multi-Plan Tier 3 physicians are all others or out of network Community Hospital is the Tier 1 facility for services they provide
24 Narrow Networks in Mesa County St. Mary’sMonument Health Includes all physician members of MCPIPA MCPIPA physicians are either Tier 1 or Tier 2 St. Mary’s is the Tier 1 facility Partnership between SMH, Primary Care Partners Inc. and RMHP Employer groups: St Mary’s, Hilltop
25 Other Parties Interested in MCPIPA’s CINUniversity of Utah Health Plans Large and small self-insured employers MCPIPA would become the network – negotiations ongoing University of Colorado Health Plan Administrators Building the provider network before marketing begins Anthem, Cigna, Humana, RMHP/UHC Are we willing to take on some risk?
26 The Future of MCPIPA POSSIBILITIESOption 1: Stay The Same No alignment with any facility Maintain current network including equal access to all hospitals Cons Payers and employers may not want full network – no tiering Difficult to define the network for payers if facility and employed physicians are allowed to opt out. Pros Unified contracting to meet goals of CIN Greater opportunities for collaboration across specialties and facilities Physicians are not allowed to hold separate agreements OR Physicians are allowed to hold separate agreements Separated/Silo/Fragmented
27 The Future of MCPIPA POSSIBILITIESOption 2: Align with a Hospital Pros Greater opportunity for collaboration, innovation for inpatient care? Cons Lose employed physicians from other facilities Silos of care Loss of Patients
28 The Future of MCPIPA POSSIBILITIESOption 3: Only Independent, Non-aligned Physicians Allowed As Members Pros Contracting for equal access to all hospitals (more patient and physician choice) A single clinically integrated network program All provider contracts through MCPIPA (nonmandatory/nonexclusive) Cons Much smaller provider network without certain specialties represented (60% fewer, less comprehensive) Less opportunity to influence positive change
29 The Future of MCPIPA PANEL DISCUSSION
30 The Future of MCPIPA PANEL DISCUSSION ParticipantsLaura Campbell, MD Juniper Family Medicine Kirk Clifford, MD Rocky Mountain Orthopaedic Associates Eugene Crafton, MD Grand Junction Gastroenterology Todd Hegstrom, MD Diagnostic Radiology Michael Neste, MD Family Health West Radiology Michael Pramenko, MD PCP Inc./Family Physicians of Western Colorado David Scott, MD Allergy and Asthma Clinic of Western Colorado Christopher Taggart, MD St. Mary’s Hospital Family Medicine
31 The Future of MCPIPA PANEL DISCUSSIONHow should MCPIPA respond as hospitals endorse and market their own individual networks?
32 The Future of MCPIPA PANEL DISCUSSIONMoving forward, how should MCPIPA best represent its diverse membership in this changing health care market?
33 The Future of MCPIPA PANEL DISCUSSIONWhat should MCPIPA’s position be on requests from its physicians to hold separate agreements for the same covered lives in a MCPIPA agreement?
34 The Future of MCPIPA PANEL DISCUSSIONHow can MCPIPA best support its membership?
35 The Future of MCPIPA PANEL DISCUSSIONQUESTIONS OR COMMENTS FROM THE AUDIENCE WE VALUE YOUR INPUT AND ASK THAT YOU TO TAKE A FEW MINUTES TO COMPLETE THE SURVEY
36 R4P MEETING CALENDAR Tuesday August 15, 2017 Tuesday November 14, 2017Annual Meeting 2013 R4P MEETING CALENDAR Tuesday August 15, 2017 Tuesday November 14, 2017
37 SAVE THE DATE- August 15, 2017 3Q2017 R4P MEETINGAnnual Meeting 2013 SAVE THE DATE- August 15, Q2017 R4P MEETING R4P MCPIPA
38 Annual Meeting 2013 Thank you Physicians Cooperating to Deliver High Quality Health Care to Our Community