We all know healthcare delivery is rapidly changing. Perhaps the most sweeping paradigm shift for our individual practices is the move to integrated care. In integrated care, a group of providers and their associated hospitals, labs, imaging centers, therapy, etc., are held accountable for the patient population attributed or assigned to the group.

To start, we must have a patient population. This is why UP has been working for the past 4 years in developing patient-centered homes where patients have a clear understanding that they are working in a cooperation with their PCP. With this base solidly in position, the next step is working with specialists and hospitals to coordinate efficient care which results in better care outcomes for patients at the lowest cost. An Organized System of Care (BCBSM) and Accountable Care Organization (CMS) are simply groups of providers working together in an integrated fashion.BCBSM, as part of its PGIP program, has developed an initiative whereby our physician organization is challenged with developing an integrated network of providers. This network is comprised of the patients attributed to our PCMH practices and the specialists to who these PCPs refer. For the most part, this group will be studied and measured for outcomes and overall costs.

Likewise, CMS will roll out full-risk ACOs in 2014. If the integrated network is able to provide care for the population of patients at less than expected costs, the network stands to benefit financially. Alternatively, if the network is more costly, the entire network could bear the downside financial risk.

Recently, United Physicians’ Board voted in favor of participating in an ACO demonstration project with Physicians Organization of Michigan and the University of Michigan

Health System. This ACO is not a full risk model, but rather an opportunity to work with an expanded group of providers to see if care could be delivered at expected costs for a population of medicare patients attributed to the PCPs. If the cost is favorable, some of the shared savings could be passed along to the providers. The decision to participate in this program was made because it is not likely that UP and its affiliates would be able to participate in a full risk ACO within the next couple of years. Thus, the Board felt this would be an excellent learning experience for our PO and physicians.

So, what should your practice do? In general, we would recommend all practices who intend to participate with third party payers in the future get involved. If your practice is gearing up for high quality, cost-effective care, we want you in the integrated care network. Participation in the BCBSM OSC will be open to the best performing PGIP-specialty

practices and all PCMH designated practices. Participation in the POM-ACO is open to all practices committed to quality through improvement and cost-effectiveness.

Should you have any questions on these programs, please call your Practice Development Consultant or an Associate Medical Director.

The Three PsAt a recent meeting, United Physicians’ President and CEO, Michael Williams, M.D., was asked to outline the direction of our organization. He stated our future was predicated on strategy which could be outlined by three Ps.

Population Health Management ─ Integrated high quality care for all patients attributed to our network physicians is key. We are developing and utilizing nurse care management teams, registry tools and IT to manage all care, from chronic diseases to preventive services.

Performance ─ No longer can we tell people how great we are. We must show it. What purchasers want and payers demand is quality and cost-effective care. At UP, we use medical informatics to improve our performance and demonstrate value.

Partnerships ─ UP seeks to develop and nurture high value partnerships between providers, hospitals, payers, purchasers, and ancillary services build on trust and respect. These relationships will allow us to succeed in the competitive healthcare future.

We may not know all the answers to the healthcare future, but we do know the principles. Let’s work together to be the best PO. We control our destiny.

ACO and OSCs - should I participate?

NewsletterNovember 2012

United Physicians’ First Annual Golf Outing benefits American Diabetes Association

Bingham Farms, Mich., September 17, 2012 — It was a perfect day for United Physicians to host its First Annual Golf Outing, presented by Beaumont Health System and Custom Home Health. Under sunny skies, UP welcomed more than 80 golfers and guests for an 18-hole scramble followed by dinner Sept. 11 at the R&S Sharf Golf Course at Oakland University. The American Diabetes Association will receive a portion of the proceeds raised through the outing.

A good time was had by all, with two teams – CMI Diagnostics and Health Plus – shooting a remarkable 59 for their respective rounds. The tie was broken by using scores on the No. 1 handicap hole. The winning flight was a foursome from CMI Diagnostics – Jack Eastham; Evan Moustakas; Joe Masternick, DO; and Hector Villereal – who each took home a shiny, new iPad 2. Nanette Benman, Dan LaPonsie, Scott Pistono and Pat Crane from Health Plus finished second, each earning a box of Titleist ProV1s that were donated by CMI Diagnostics.

Benman also won the longest drive competition on the women’s end while David Claeys from Beaumont Health System won the men’s longest drive. Both took home $100 gift certificates to Andiamo Ristorante.

UP thanks all the participants and volunteers for their support. Special thanks goes to all of the sponsors for their donations:

Title sponsors:Beaumont Health SystemCustom Home Health Bag Tag sponsors:Kotz-SangsterTotal Health Care

Par sponsors:DSS Consulting LLCPlante MoranHAPPrism MedicalMeridian Health PlanSt. Joseph Mercy OaklandMichigan Institute of Urology

Hole sponsors:Blue Care NetworkClavenna Vision InstituteHealthPlus Health PlansHoover and AssociatesMolina HealthcareLakeshore Ear, Nose and Throat Center PCMVP Vaccine PurchasingOakland University Golf and Learning CenterOakland University School of NursingPediatric Consultants of Troy PCStaples

The Incentive Time of YearNow is the time to begin to review your data for HAP, BCN and Medicare Advantage. Contact your patients to schedule vaccinations, preventive care and chronic disease care gaps before the end of the year. Enter the completed patient data in the plan’s proprietary registry. Thousands of incentive dollars are available to you for assuring the care you have already provided is captured in their system. If you are unaware of how to log on, review and enter data, talk to your office manager or call your PDC. We’d love to help you get rewarded for the hard work you do!

Incentives have put everything on the front burner for physicians. These days providers can earn hefty reimbursements under a federal incentive plan that encourages the use of electronic health records (EHR). To date, United Physicians has helped providers earn a combined $1.63 million for Stage 1 of the Centers for Medicare and Medicaid Services’ (CMS) Meaningful Use incentive program.

Successful attestation for Year 1 Meaningful Use gives an eligible provider the opportunity to earn up to $18,000 under Medicare and $21,250 under Medicaid. So far, United Physicians has helped 104 providers attest and earn a combined $1.63 million in incentive bonuses with the potential of helping 210 providers reach attestation and collect up to a combined $3.8 million dollars by the end of 2012 reporting year.

“For these practices to achieve Meaningful Use, it means improved individualized care between each individual provider and his patients, and improved care coordination between our network providers,” said Shannon Kleczka, United Physicians’ Meaningful Use liaison.

The program rewards physicians for their use of EHRs as long as that use meets certain objectives and measures as set by CMS. Meaningful Use applies a three-stage approach with goals for each stage. During Stage 1 (2011 and 2012), providers must meet certain objectives/measures and 80 percent of patients must have records in the certified EHR technology. The reporting period for the first year is 90 days and one year subsequently. Stage 2 regulations begin in 2014 followed by Stage 3 in 2016.

To attest for Meaningful Use as a Medicaid or Medicare eligible provider, providers must use “Meaningful Use

certified technology,” which must meet minimum government requirements and allow the purchaser to attain all of Stage 1 Meaningful Use measures.

EHR implementation has been associated with challenges, including workflow disruption and tedium. Add on the requirements to prove to the federal government a meaningful use of this technology and participants may be less than enthusiastic.

Diana Kirschner, the office manager for Charles E. Heth, D.O. P.C., said there was a lot of resistance to Meaningful Use at her practice. “It was an overwhelming endeavor,” Kirschner said. “It was hard to understand and we didn’t know how to do it.”

Those reservations did not come to pass. It turned out that by using Wellcentive and Dr. First, an EHR-M, Dr. Charles E. Heth D.O. P.C. was able to attest to Meaningful Use in July. “Our office has long been doing all the things that Meaningful Use requires,” Kirschner said. “That convinced me to participate in the program. What we were already doing we just needed to report it to get financial gains from it.”

Kirschner couldn’t stress enough the value of the assistance from the United Physicians staff. “The only challenge we had was when we tried to do something on our own,” she said. “Shannon [Kleczka] assisted us every step of the way and that’s the only reason why we [attested].”

In order to receive and continue to receive incentive payments, providers must achieve and maintain a set of Meaningful Use measures as defined by CMS. If eligible physicians meet all requirements for all three stages of Meaningful Use, the payout is $44,000 over five years for Medicare. Under Medicaid, the reward is $63,750 over six years.

Kleczka said that if a provider is not participating in Meaningful Use by summer 2014, then beginning January 2015 that provider’s Medicare reimbursements will be reduced. For practices that have a high Medicare patient population, it is a huge drop in revenue. To date, Medicaid is not participating in this payment adjustment.

For more information on Meaningful Use, including criteria and requirements, visit www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/MeaningfulUse.html. For information about eligibility, contact Shannon Kleczka at (248) 593-0145.

United Physicians assists 104 providers earn a combined $1.63 million in incentive bonuses through Meaningful Use

The goal of United Physicians is to continually bring value to our physician shareholders. Through Michigan Medical Management Services (MMMS), a subsidiary of UP, physicians have saved $5.5 million over the past four years as participants in the MVP Vaccine Purchasing Program.

MVP provides physician members access to a variety of discounts and rebates on vaccine purchases with our participating vendors, Merck and Sanofi Pasteur. Susie Birge, UP’s MVP Representative, meets with providers one on one to explain this money-saving program and provides service to existing offices with monthly visits. To her credit, Susie has helped contracted practices earn over $2.3 million in savings this year between Merck vaccines, Sanofi Pasteur vaccines and Fluzone.

Those savings have translated to hefty rebates for participating providers. This year Susie helped contracted practices earn a cumulative total of nearly $200,000 in rebates. Susie said that with added value to the Merck contract, savings are projected to increase in the program’s future.

In order to participate in the MVP program, participants are

MMMS’s Vaccine Purchasing Program, MVP, saves members $5.5 mil. since 2008

required to purchase Sanofi Pasteur and Merck products. Please note that the pharmaceutical representative that serves a practice does not change and there is not a set number of vaccination purchases required to receive the discount or rebate. For more information on MVP, or to inquire about joining the program, contact Susie Birge at sbirge@updoctors.com or at (248) 593-0132.

Managed care plans attempt to control health care costs by contracting for laboratory services at a discounted rate. Both HAP and BCN have contracted with the Joint Venture Hospital Laboratories (JVHL) for the vast majority of laboratory services. Primary Care Physicians have an assessment of $2.50 or more for laboratory services. Every patient that is sent to another lab from one of the HMOs will cost the PCP double or more – the assessment plus the cost of the laboratory tests. These increased costs can add up, and make the PCP look like an expensive doctor. Some HMOs will stop paying for these “out-of-network” tests, leading to patients receiving a bill. UP recommends that our physicians take action to prevent this billing.

As a general rule, all HMO patients should have their laboratory work done by the JVHL. Any exceptions should be rare and only for tests (like genetic screening) that cannot be performed in a JVHL lab. For all other non-HMO patients, physicians are free to send to which ever laboratory they prefer. If UP doctors instruct their office staff to follow these simple guidelines, it should forestall any billing of patients and still obtain the needed laboratory services.

JVHL Laboratory Services LeakageOn October 28, 2012, AT&T migrated AMAGINE Users to the new United Physicians portal within the AT&T Healthcare Community Online. Though the initial version is similar in content to the old AMAGINE physician portal, it contains many new features that will be rolled out to UP physicians over the next several months. The core structural changes and enhancements brought to United Physicians through AT&T Healthcare Community Online will optimize your ability to provide outstanding care to your entire patient population by facilitating clinical information sharing between physicians and other healthcare providers. This is integral to UP’s ongoing transformation to a patient-centered, physician lead healthcare delivery system.

All current customer contracts will be honored by AT&T and you will have the opportunity to consider a broader portfolio of products and options. We will continue to work with AT&T to ensure that the availability and accessibility of health information technology for physicians continues to expand. United Physicians remains committed to assisting you and your practice prepare for future of healthcare by utilizing health information technology to provide high quality patient care. If you have any questions or need additional information, please contact customer care at (248) 593-0233.

AT&T Healthcare Community Online Migration