Copyright © 2021 by SullivanCotter
Advanced Primary Care
Compensation Models
October 14, 2021
Copyright © 2021 by SullivanCotter
SullivanCotter Presenters
1
Mike Gizzi
Consulting
Manager, Physician
Workforce
mikegizzi@
sullivancotter.com
765.233.9403 404.915.0277
Kevin Wilson
Managing Principal,
Physician
Workforce
kevinwilson@
sullivancotter.com
734.377.1826
Jason Tackett
Managing Principal,
Physician
Workforce
jasontackett@
sullivancotter.com
Copyright © 2021 by SullivanCotter
Webinar Instructions
2
• Today’s session will include approximately 1 hour and 40
minutes of presentation and additional time for questions
• How to submit questions:
– Use the control panel on the right side of
your screen
– Type your question at any time during the webinar and
click “SEND”
– If you’re on a mobile device, click on the question mark
icon and follow the same steps
– Panelists will answer as many questions as possible
during Q&A time
All attendees can access the slide deck via the Converve platform
Copyright © 2021 by SullivanCotter 3
Agenda
1Value-Based Care:
Driving Today’s Market
Dynamics
Evolution of Primary
Care Compensation
Plans23
Panel Discussion45 Q&A
Advanced Compensation
Approaches
Copyright © 2021 by SullivanCotter
Value-Based Care:
Driving Today’s Market Dynamics
4
Copyright © 2021 by SullivanCotter
Market Dynamics Accelerating Value-Based Care
• Continued support for
alternative payment
models
• Revised physician self
referral and anti-kickback
regulations
• Relaxed telehealth
regulations during public
health emergency
• New tools that can
scale access for
physicians, patients and
affect market share
• Consumer demand for
telehealth and home-
based care
• Commercial payors
adopting site-neutral
payment to mange costs
• Patients looking to reduce
out-of-pocket costs are
likely to avoid inpatient
care locations
• Rise in chronic disease
that requires focused
care management to
ensure quality outcomes
• Vulnerable populations
that benefit from high-
touch programs
Market
Dynamics
Site-Neutral Policies
Aging Population
Federal Government
Initiatives
Digital Health
Adoption
National Physician Shortage
• The U.S. could face a shortage of
37,800 to 124,000 physicians by 20341
5
1Source: Association of American Medical
Colleges (June, 2021). “The Complexities of
Physician Supply and Demand: Projections
From 2019 to 2034”. Accessed at
https://www.aamc.org/media/54681/download
Copyright © 2021 by SullivanCotter
Risk Continuum
6
Small
Financial Risk
Moderate
Financial Risk
Large
Financial Risk
Tiered
Networks Full RiskACOsValue-Based
Incentives
+Pay-for-
Performance
Fee-For-
ServiceBundled
Payments
Copyright © 2021 by SullivanCotterCopyright © 2021 by SullivanCotter 6
CMS and CMMI, the Medicare Innovation Center, have developed value-based care (VBC)
program options across the risk/reward spectrum, allowing providers to enter VBC
arrangements according to their readiness and appetite for risk management
Medicare Value-Based Care Landscape
Medicare Payments Tied to
Alternative Payment Models
Upside Only
(MSSP A/B)
Pay-for-
Performance
(MACRA, MIPS)
Upside /
Downside
(MSSP C/D)
Primary Care
Models
(CPC+, PCF)Bundled
Payments
(CJR, BPCI-A)
Shared Savings
APM
(MSSP Enhanced)
Total Cost of
Care
(NextGen ACO –
Sunset Dec ‘20)TCoC +
Capitation
(Direct Contracting
- Upcoming)
Risk / Reward Spectrum
Advanced Alternative Payment Models
(Eliminate MIPS Reporting)
4.5%
Population Based Payments
51.2%
Pay-for-Performance
33.8%
Shared Savings & Bundles
10.5%
Traditional Fee-For-Service
Copyright © 2021 by SullivanCotter
Population HealthOverview of CMS’ Primary Care First Program
8
‘Primary Care First’
Payments
• Professional
population-based
payments and flat
primary care visit fees
to help practices improve
access to care and
transition from fee-for-
service to population-
based payments
• Performance-based
threshold (Quality
Gateway) for each
measure
(up to 5 measures;
30th percentile)
• Upside/downside
adjustments based on
quality outcomes
Source: https://innovation.cms.gov/files/slides/pcf-info-webinar-series-slides.pdf
Population-Based Payment
• Payment for service inside or
outside of office – adjusted for
practices caring for higher risk
populations
• This base rate is the same for all
patients attributed to this practice
• Payment will be reduced through
calculating a “leakage adjustment” if
beneficiaries seek primary care
services outside the practice
Flat Primary Care Visit Fee*
• Payment for in-person
treatment applied as a fixed
amount to most face-to-face
and home visits
• These payments allow practices
to easily predict payments for
face-to-face care
• Beneficiary cost sharing will
apply and follow traditional
FFS rules
Note: All model payments are also subject to
geographic adjustment, MIPS adjustment, and
2% Medicare sequestration, as required by
federal rulemaking
Practice Risk GroupAverage hierarchical
condition category
PaymentPer beneficiary
per month
Group 1: <1.2 $28
Group 2: 1.2-1.5 $45
Group 3: 1.5-2.0 $100
Group 4: >2.0 $175
Base RatePer face-to-face encounter
$40.82
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Organizations need to change the way they operate and deliver care
in order to move along this continuum
Fee-For-
Service
(FFS)
Varying
percentages
of FFS and
Risk
Risk
(value)
• Population health
management (PHM)
• Triple aim
accountability
• Better care
• Highly reimbursed
services supported
(radiology, lab, etc.)
• Primary care support
and management
• Volume
• Rewards individual
productivity
• Potential provider
burnout
Primary Care continues to serve as a primary focal point to support
population health initiatives
Volume to Value: Striking the Right Balance
9
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Core Competencies to Effectively Manage Risk
10
Business Model
Alignment
Enhanced Care
Delivery
Consumer and Provider
Engagement
Operational
Excellence
• PHM readiness
assessment
• PHM opportunity
analysis
• Value-based contracting
• Value-based benefit
design
• Revenue management
• Care delivery model
development
• Medical care
management program
• Pharmacy care
management program
• Quality improvement
program
• Organization and
governance
development
• Provider incentive
program
• High performance and
network development
• Performance
measurement structure
development
• Consumer engagement
program(s)
• Practice transformation
• Actuarial/underwriting
• Marketing/sales
• Enrollment/attribution
• Infrastructure
• Claims payment/
customer service
• Compliance and audit
• Provider-payer
contracting
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Population Health Management Strategies Potential Barriers to Success
11
Misalignment between
PHM and overall strategy
Operational limitations and
lack of coordination of services
Undefined Key
Performance Indicators
Too few payor partnerships
or arrangements
Constrained resources,
scale and time
Limited or inconsistent
physician engagement
Common setbacks or poor performance may occur when a health system or organization does not invest properly in PHM program design, incentive alignment and governance
Copyright © 2021 by SullivanCotter
Optimizing the Clinical WorkforceGrowth in Physician and APP Staffing | Shift to Team-Based Care
12
Optimize
health between
visits
Check-in to
room time
Patient
scheduling
Pre-visit
planning and
preparation
Total visit
time
Post-visit timing,
test results and
follow-up
scheduling
Care Continuum
Advanced
Practice
Provider
25.1%
Physician/APP Staffing GrowthIncrease in Median FTEs: 2018 to 2020
AMCs and Pediatric Hospitals
Physician
3.4%
Growth in the APP workforce is significantly
outpacing physician growth, driven in part
by supply / demand
Source: AAMC/SullivanCotter Report on Compensation
Methodologies in Top Academic Medical Centers (n=18)
Potential Organizational Benefits
• Supports higher levels of patient access
• Promotes enhanced consumer experience
• Enables an increased focus on higher acuity patients
with their needs throughout the continuum
• Reduces clinician burnout
Support Physicians and APPs
Practicing at Top of License
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Polling Question
13
• Yes, to some degree
• No
Are your physicians and advanced practice
providers prepared for change?
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Polling Question
14
• Yes
• Currently assessing
• Planning to assess in the future
• No
• Not sure
Has your organization assessed performance and internal
competencies for value-based care?
Copyright © 2021 by SullivanCotter
Evolution of Primary Care
Compensation Plans
15
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Current Compensation Plan ComponentsPrimary Care Overview
16
Prevalence of Plan Components
Source: SullivanCotter 2019-2021 Physician Compensation
and Productivity Survey Report, SullivanCotter 2021 Large
ClinicTM Physician Compensation and Productivity Survey
Report
55%
79%
70%
28%
36%
74%
67%
55%
17%
12%
Base Salary
wRVUs
Value/Quality
Discretionary
Panel Size
Large Clinic® Organizations Non-Large Clinic® Organizations90.3%
9.7%
Plan Components Percentage of TCC
Plans without
base salary
component
Plans with
base salary
component
75.7%
20.4%
3.9%
Base Salary
Productivity Incentive
Value/Quality Incentive
Median Quality Incentive PaymentsPercentage of TCC
6.4% 7.4% 6.2%
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Evolution Toward Population HealthPrimary Care Future State
Health system revenues are shifting from fee-for-
service wRVU productivity to risk-based arrangements
90%
80%
50%
0%
10% 10% 20%
50%
0%
10%30%
50%
Volume-Driven Transitional Value-Based Population Health
wRVUs Quality/Outcomes Risk-Adjusted Panel
Quality / Outcomes
• Patient satisfaction
• HEDIS
• Core measures
• Patient cost efficiency
• Care management
• Patient access – growth
• Adherence to protocols
• Service line efficiency
Shift from wRVUs to Population HealthExample
Well-designed physician compensation plans align
compensation rewards with health system risk strategy to
help attain results in patient outcomes and financial performance
17
Copyright © 2021 by SullivanCotter 18
Design TrendsIntegrating Compensation Approaches for Physicians and APPs
Organizations are increasingly redesigning physician and APP compensation
plans simultaneously, with an emphasis on teamwork and collaboration
Aligned plans
may include:
• Similar plan structure
and incentives
• Aligned performance
and quality metrics
• Team incentives in addition
to individual incentives
• Common governance /
oversight
Physician
Compensation
Clinical
Workforce
Compensation
APP
Compensation
Copyright © 2021 by SullivanCotter
Team-Based Care Compensation Design Trends
19
Source: SullivanCotter 2021 Physician Compensation and Productivity Survey Report
Percentage of organizations
utilizing a team-based
component in physician
compensation plans
25%
47%
Percentage of organizations
including APPs as part of the
team-based component in
physician compensation plans
Overall average percentage of
annual physician
compensation tied to team-
based care goals
9.6%
Primary Care: 7.1%
Specialist: 12.0%
Hospital-Based: 12.7%
Copyright © 2021 by SullivanCotter 20
Team-Based Compensation Plan ExampleShared Panel Management and Quality Goals
Base Salary
80% to 90% of
total cash
compensation
Physician
Compensation
Risk-
Adjusted
Patient
Panel
Combined
physician
and APP
wRVU
Productivity
Individual
Quality and
Patient
Experience
Shared metric
and goal
Team-Based
Components
APP
Compensation
Base Salary
90% to 95% of
total cash
compensation
wRVU
Productivity
Individual
Copyright © 2021 by SullivanCotter 21
Patient Panel Management SurveyKey Findings
SullivanCotter conducted a custom survey of health care organizations
in the Large Clinic® Group to understand their perception of panel
management metrics and incentives
Source: SullivanCotter 2020 Large ClinicTM Group Patient Panel Management Survey
Key Findings
• The percentage of revenue tied to value-based contracts and capitated
payments is expected to increase 67% over the coming years
• 77% of participants identified panel management as either
"important" or "extremely important" to organizational operations
and strategic initiatives
• Only 45% of administrators believe their organizations are calculating
panel size with a strong degree of accuracy
• Only 30% of physicians believe their organizations can report panel size
with a strong degree of accuracy
Copyright © 2021 by SullivanCotter 22
93.3%
90.0%
86.7%
66.7%
63.3%
60.0%
60.0%
40.0%
10.0%
Improved Access
Improved Outcomes
Alignment w/ Major Payer Incentives
Favorable Patient Experience
Assist In Optimizing Staffing Decisions
Cost Savings
Increased Efficiency
Reduced Waste
Other
Source: SullivanCotter 2020 Large ClinicTM Group Patient Panel Management Survey
Patient Panel Management Survey
Key Goals for Successful Panel Management
Copyright © 2021 by SullivanCotter 23
Source: SullivanCotter 2020 Large ClinicTM Group Patient Panel Management Survey
Patient Panel Management Survey
17.3%
27.6%
41.4%
10.3%
0.0%
3.5%
6.7%
23.3%
26.7%
33.3%
3.3%
6.7%
Extremely Accurate
Very Accurate
Moderately Accurate
Slightly Accurate
Not at All Accurate
No Answer
Administrators Physicians and APPs
Perception of Accuracy of Panel Size Calculations
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Median Panel Size Primary Care Specialties
24
INSERT
Source: SullivanCotter 2019-2021 Physician Compensation and Productivity Survey Report
SullivanCotter 2019-2021 Advanced Practice Provider Compensation and Pay Practices Survey Report
Three-Year Rolling Average
Primary Care APPs: Three-Year Average Median Panel Size is 1,177
Family Medicine
2019 2020 2021
Internal Medicine
2019 2020 2021
Pediatrics - General
2019 2020 2021
1,8411,825
1,728
1,908 1,904
1,791
1,9301,906
1,863
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Polling Question
25
• Yes
• No, but we are planning to
• No plans to include in the near-term
Have you included a team-based component
in your primary care compensation plan?
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Polling Question
26
• Yes
• No, but we are planning to
• No plans to include in the near-term
Do you use panel management as one
component in your primary care compensation plan?
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Beyond Compensation and Potential Future Plans
Advanced Compensation Approaches
27
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Thinking Beyond CompensationPreferences, Core Performance, Measurement and Reporting
28
Core expectations and value-based performance can be supported
by performance management processes and tools beyond the compensation plan
Supporting
Team/Value-Based
Performance
• Documentation
• Quality/service
• Patient access
• Telehealth utilization
Provider
Preferences
• Work/life balance
• Pay structure
• Resources
• Preferred measures
Performance Management
• Defining core performance
(documentation, professionalism)
• Circuit-breaker feature when core
performance expectations are
not met
• Formal performance reviews
• Professional development goals
• Leadership development
programs/mentoring
• “Best practice” reporting
• Performance improvement plans
Physician and APP input on core performance expectations,
value-based performance categories, targets and metrics
Sample Scorecard:
Patient ExperienceSullivanCotter’s Provider Performance
Management Technology™
Copyright © 2021 by SullivanCotter
Themes from Physician Preferences Survey
29
75% or more of respondents agreed that their current primary care compensation
plan is not appropriately designed for the future of the health care industry
Redefining a high-performing
provider; recognizing
contributions beyond
wRVU productivity
Work-Life Balance
Emerging as a
Top Priority
Majority of physicians prefer a
structure with more
guarantee and less at-risk
incentive; physicians/APPs
desire minimum standards
tied to base salary
Desire to Improve
Salary Stability
Hours worked, wRVUs and
patient encounters were
preferred as top factors; panel
size tends to be mixed and
dependent on measurement
capabilities
Mixed Productivity
Measures Preferred
Low confidence in measuring
panel size (typically 20%) with
attribution a high concern
Opportunities to
Improve Measurement
Systems
Well over 50% indicate
insufficient resources to
attain goals; frequently cite lack
of staff; dissatisfaction with
compensation administration
process is typically cited
(timely data)
Level of Resources
Can Influence
Satisfaction
Majority prefer quality
incentives structured at the
individual level; however,
majority state current
compensation plan does not
support team performance
Value-Based and
Team-Based Measures
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Examples of Recent Value-Based Metrics
Type Measure
Individual
MIPS eCQM 47 Advanced Care Plan (patients 65+)
Percentage panel w/SdOH screening (all domains)
Patient satisfaction: Press Ganey care provider rating /
top box score
Various clinical integration measures from HEDIS (e.g.,
PCMH metrics, controlling high blood pressure)
Completing Medicare annual wellness visits
Building and documenting care plan for all chronic health
conditions (RAF point capture)
Closing gap on HCC and RAF deficiencies
Tied to achieving level for patient panel (> 100) under
specific payer
DivisionTelehealth utilization
Percentage of new patients
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Outcome: Increase in patient access by physicians and APPs working together to
expand a shared panel while maintaining a focus on physician wRVU productivity
Patient AccessCompensation Plan Supported By Performance Management and Reporting
31
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100
wR
VU
s: M
ark
et P
erc
en
tile
Panel Size: Market Percentile
wRVUs v. Panel Size (Percentile Ranks)
OSF Physicians
High wRVU Productivity +
High Panel Size =
Greater Patient Access
to Care
Panel Size Definition:
The number of patients
served by a physician or
physician group
• Defined as a count of the
unique living patients seen
(typically within the last
18 months)
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Future StatePotential Impact of Full Risk Contracts on Primary Care Compensation
32
Evolving from Fee-For-Service to Full Risk
Fee-For-
ServiceGlobal
Payment
Episodic
Bundling
Full Risk/
% of
Premium
Total CostEpisodic Cost
Pay-For-
Performance
Copyright © 2021 by SullivanCotter
Future StatePotential Impact of Full Risk Contracts on Primary Care Compensation
33
Maximizing reimbursement through accurate HCC coding and RAF capture
$6,500Target MLR
$6,000Actual MLR
Difference
between
target and
actual MLR
= $500 PMPY
Scenario 1: RAF = 1.0
$8,000Target MLR
$6,000Actual MLR
Scenario 2: RAF = 1.3
Difference
between
target and
actual MLR
= $2,000 PMPY
Target Medical Loss Ratio
(MLR)Dollar amount organization receives
from payer for total cost of care
Actual MLRDollar amount an organization
actually spends on providing care
Difference Between Target
and Actual MLRBasic to high levels of specificity in
the care plan and RAF capture can
result in millions in PMPY profit
across a patient population
Difference Between Target and
Actual MLR
Copyright © 2021 by SullivanCotter
Expense/InvestmentStepsCritical Success
Factors
Future StatePotential Impact of Full Risk Contracts on Primary Care Compensation
34
Increased profit margin allows for greater shared incentives
after consideration of all expenses
• Educate clinicians
and teams
• Identify patient population
• Outreach and
schedule visits
− Consider reporting /
capture time frame
• Document care plans with
accurate coding
• Audit for accuracy
• Staff
− Coders
− Nurses
− Dieticians
− Social workers
− Pharmacists
− Health coaches
− Case manager
− Palliative
• Practice overhead
• Telemedicine
• Reinsurance
• Administrative fees
• Compensation
• High quality
• Member retention
• Documentation/coding
• Reducing total cost of care
− Readmissions/ED
avoidance
− Disease management
− Preventative care
• Patient engagement
• Patient access
• Health equity
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Polling Question
35
• Yes, we recently redesigned our plan
• No, but planning to address in the near-term
• No, no plans at this time
Would your primary care providers agree that their compensation
plan(s) is appropriately designed for the future of health care?
Copyright © 2021 by SullivanCotter
Polling Question
36
• No, current state and readiness are top priorities
• Yes, basic physician scorecards and monitor performance
• Yes, sophisticated analytics, advanced PC compensation
Is your organization making significant investments
in population health performance management
and operational excellence?
Copyright © 2021 by SullivanCotter
Key Takeaways
37
1Collect data to uncover the
increasing levels of compensation
tied to panel management
2Conduct education on the
advantages of using panel
incentives for physicians and APPs
3 Determine the organization’s
risk-adjustment methodology
4Consider different ways physicians
and APPs can work together for an
effective team-based approach
5
Evaluate incentive metrics to
ensure alignment with
organizational strategy, culture
and contracting objectives
Copyright © 2021 by SullivanCotter
Panelist Discussion
38
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Panelists
39
Dr. Martinson Arnan
Vice President, Chief
Clinical Officer
Bronson Medical
Center
Alex Jackson
President & Chief
Operating Officer,
MultiCare Rockwood
Clinic
MultiCare Health
System
Anne Hunsaker
Vice President –
Physician
Compensation & APP
Alignment
Mercy
BRONSON HEALTHCARE
RISK READINESS
Martinson Arnan, MD, Vice President, Chief Clinical Officer
Copyright © Bronson Healthcare
Copyright © Bronson Healthcare
Bronson Healthcare
• Regional, not-for-profit health system
• Locally owned and governed
• Serving southwest Michigan since 1900
• 8,400 employees
• 1,500 medical staff
• 4 hospitals: Battle Creek, Kalamazoo, Paw Keep age and South
Haven
• 796 licensed beds: 648 acute care, 49 psych/gero-psych, 100
skilled nursing
42
Copyright © Bronson Healthcare
Bronson’s Service Area
43
Copyright © Bronson Healthcare
History & Current Structure
• Providers: 604
➢ 122 PC MD/DOs
➢ 66 PC APPs
➢ 409 Specialists
• Care Team:
➢ Care Management
➢ MSW
➢ Pharmacist
• TINs: 4
• Medicare Beneficiaries: 14,300
• Participation in Affirmant/Federation ACO since 2015
Medical Group
Clinically Integrated Network
• Operations• Performance• Growth • Access
• Legal Structure for Independent Providers
• Practice Support• Population Health Analytics• Value Based Reimbursement
Strategy ⚫ Systemness ⚫ Standardization
44
Copyright © Bronson Healthcare
Bronson’s Strategic Aims
PEOPLE QUALITY SERVICE COST
Strategic Aims ❑ Strive for zero
preventable harm
Develop data infrastructure & systems to support equity
❑ Improve access ❑ Improve operating margin
❑ Reimagine our work, workforce & workplaces
❑ Recruit, develop & retain a workforce that reflects our communities
Reliably provide safe, equitable outcomes that matter most to
our patients
Uncover and address disparities that impact the health and wellbeing of our patients, employees and communities
1
2
3 5 6
4
Cultivate a diverse, equitable, engaging and inclusive
environment where all can thrive and excel
Together We Advance the Health of Our Communities
Mission
Exceptional Experience for Every Person Every Time
Vision
Compassionately provide timely and convenient services
Efficiently provide careat a predictable cost
45
Copyright © Bronson Healthcare
Affirmant/ Federation ACO
(Track B)
Priority/Affirmant Medicare Advantage
(up & down)
Primary Care CPC+ Practices
(upside)
Primary Care First Practice
(up & down)
2016 – Current 2017 – 2021 2017 - Current Jan. 2021 - Current
14,300 beneficiaries
10,200 beneficiaries
11,000beneficiaries
650 beneficiaries
Value-Based Care Arrangements
86.4% 86.4%82.7%
76.5%
85.6%
2017 2018 2019 2020 2021*
Bronson/Priority Health MAMLR History
97%
53%
Primary Care
Received VBR
Speciality Provider
Received VBR
Payer Incentive ProgramsPGIP/PRP/PIP
*Dates of Service 01/01/21 – 03/31/21 with claims run-out May 2021
46
Copyright © Bronson Healthcare
There are many important and
necessary components of a
successful value-based care model
Analytics and reporting
Incentive alignment and compensation design
Physician engagement and training
Care team optimization
Governance structure and leadership
Change management
Financial models/flow of funds
VBC Contract management
Operations and performance
Partnerships and alignment
Value-Based Care StrategiesEvaluating Key Elements of a High-Functioning PHM Model
47
Copyright © Bronson Healthcare
Bronson and VBC Going Forward
Bronson will focus on four primary areas to ensure enhanced success along the VBC journey. These areas
do require near-term action, engagement and investment by administration and providers.
Care Management
Optimize outpatient Care
Management. Reinvest
in and redesign care
management to deliver
seamless, integrated
services to drive
enhanced outcomes for
beneficiaries. Focus on
the patient is our goal.
Provider Network and
Incentive Alignment
Develop a strategy that
advances the entire
Bronson Provider Network,
physicians and APPs as a
high-performing,
comprehensive continuum
of care. Enable providers to
achieve success and optimal
performance.
Technology and
Intelligence Enablement
Establish a VBC technology
and intelligence platform;
improve ability to use
technology and informatics
to support value-based care
and population health
initiatives for the residents
that Bronson serves.
VBC Operational
Governance
Integrate a VBC / PHM
governance process and
team within broader system
governance to ensure
progress, consistency and
performance with VBC
initiatives. Executive,
physician and APP
leadership will drive this
team.
48
Copyright © Bronson Healthcare
Primary Care Incentive Structure
Eligible incentive compensation based on value-based metrics
Value-Based Care Readiness and Performance
49
Quality Access
• Aligns with clinically integrated network metrics with focus on:
‒ Preventative care
‒ Managing chronic conditions
• Performance improvement metrics
• Patient Experience
• Accepting new patients
• Non-traditional office hours
• Participate in virtual access/visits
• Panel size (risk adjusted)
Copyright © Bronson Healthcare
Thank you!bronsonhealth.com
50
Copyright © Bronson Healthcare
MultiCare: Primary Care
Alex Jackson
President & Chief Operating Officer, MultiCare Rockwood Clinic
Copyright © 2021 MultiCare
MultiCare At A Glance
52
Copyright © 2021 MultiCare
Our Mission
Partnering for healing and a healthy future
53
Our Vision
We will be the Pacific Northwest’s highest value system of health
• Leading as a people-centric community asset
• Integrating a full continuum of high-performance, customer-focused health and health
related solutions
• Delivering world class health outcomes and exceptional experience at a competitive price
Copyright © 2021 MultiCare
Our Values
Respect• We affirm the dignity of each person and treat each individual with care and compassion
Integrity
• We speak and act honestly to build trust
Stewardship
• We develop, use and preserve our resources for the benefit of our customers and community
Excellence
• We hold ourselves accountable to excel in quality of care, personal competence, and operational performance
Collaboration
• We work together recognizing that the power of our combined efforts will exceed what we can accomplish individually
Kindness
• We always treat everyone we come into contact with as we would want to be treated
54
Copyright © 2021 MultiCare
MultiCare’s Strategic Priorities
Performance Excellence
• Top decile performance people, quality, service
• Bottom quartile performance on total cost of care
• Top quartile on margin
Expanding Access to Care and Services
• Continuing to grow existing services
• Adding new programs and services
• Expanding into new geographies and sites of care
Population-Based Care
• Innovate access
• Transform care delivery
• Engage patients
• Redesign the business model
55
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• Our heritage dates back to the founding of Tacoma’s first hospital in 1882
• MultiCare is an independently owned, non-profit organization governed by a local board of directors
• Today we care for patients across the Puget Sound (PSR) and the Inland Northwest (INW)
• We believe care is better local – in our patients’ homes and communities
56
MultiCare Overview
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Primary Care Redesign: Objectives
57
MultiCare is creating a next generation physician and advanced practice provider (APP) compensation strategy that aligns with the future of health care
Consistency
Population Health Market Competitive
• Align framework (common approach) across locations and providers (physicians and APPs)
• Support provider behaviors that focus on outcomes
• Improve patient access
• Lower cost of care
• Support recruitment and retention
• Adhere to applicable regulations
Team-Based Care
Financial Sustainability
Adaptability
• Remove barriers to team-based care
• Ensure appropriate and adequate access for patient population
• Align with current and future reimbursement
• Adapts to market changes, e.g., population health, fee for service, other market conditions
Objectives should be aligned with MultiCare’s compensation Guiding Principles
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Physician and APP Compensation Guiding Principles
58
MultiCare seeks to provide equitable, market competitive compensation that:
Rewards multi-dimensional performance (as detailed below), aligned with MultiCare’s strategic objectives
• Supports population health through responsive, patient-centered, collaborative care, increased patient access, and value-based metrics
• Promotes innovation in care delivery and results in improved patient outcomes
• Is flexible with the changing healthcare environment, considering the manner in whichproviders practice today and in the future
• Supports recruitment and retention of top provider talent and provider satisfaction
• Is transparent, adheres to all regulatory requirements and is easy to understand, administer and report
• Promotes financial responsibility, effective resource utilization, and is aligned with current reimbursement practices
MultiCare compensation plans are structured to support a win for patients, a win for providers and a win for the organization
Copyright © 2021 MultiCare
Population Health: Why now and is it here to stay?
• In 2018, Federal Gov’t spent 24% of $4.1 trillion dollar budget on Medicare & Medicaid. National Debt $28T.
• By 2025 CMS committed to capitating 100% of payments to insurers and providers to control spending and incentivize population-based care.
• Medicare Trust Fund projected to be insolvent 2024.
• Washington State Budget Healthcare spending increased from 28% to 38% over past decade.
Value-Based Agreement: 2020 Highlights• VBA contract provide access to lives = 290K+ lives
• FFS Revenues associated with VBA contracts = $1.7B
• Total Cost of Care Full Risk Contracts $1B
• 2020 VBA Revenues est. $22.7M
• 2020 Medicare Shared Savings Program Savings est. 4% associated with 35K lives
Copyright © 2021 MultiCare
MultiCare Current Compensation Plans
MMA, Mary Bridge, Rockwood Clinic
60Copyright © 2021 MultiCare
Current State: Primary CareFour Plan Types Across Multiple Locations
Clinical Cash Compensation
wRVU Productivity
Three tiers determined as a
percentage of median TCC per
wRVU rates
Gateway
Coding Accuracy
Mandatory Education
Meeting Attendance
Chart Closure
Value-Based Incentive
Meets/Exceeds for Quality and Patient Sat
Other work and Wellness based on hours
Gateway Applies
Value-Based Metrics
Quality Up to 4% individual and 2% group
Patient Experience up to 4%
Other MMA Work/Wellness up to 5%
Additional Stipends: APP Supervision, Virtual Visits
MMA/MB: Physicians
Clinical Cash Compensation
Base Salary
100% of Median
Blended Survey Data
Gateway
Coding Accuracy
Mandatory Education
Meeting Attendance
Chart Closure
Value-Based Incentive
Meets/Exceeds for Quality and Patient Sat
Other work and Wellness based on hours
Gateway Applies
Value-Based Metrics
Quality Up to 2% individual/group
Patient Experience up to 1.5%
Other MMA Work/Wellness up to 1.5%
* Eligibility. .5 FTE or greater. Not on guarantee. Employed before Sep 1st and on Dec 31st
wRVU Productivity Bonus
Tiered (14) Bonus Comp.
Based on Annual Survey data
MMA/MB APPs: (ARNP/PA)
Clinical Cash Compensation
wRVU Productivity
Compensation per wRVU
at % of Median
Gateway
Conflict of Interest Form
Mandatory Education
Meeting Attendance
Chart Closure
Panel Compensation
$ per unique patient seen in 18
month lookback period
Age/Gender Adjusted
Value-Based Metrics*
Up to 5% of Productivity Compensation
Quality: 2%, VOI/CMP: 1% FM/IM, 2% Peds
HMV : 1% for FM/IM, Citizenship: 1%
* Eligibility 0.5 FTE or greater. Not on guarantee. Employed before July 1st and on Dec 31st
Additional Stipends: APP Supervision
Clinical Cash Compensation
Base Salary
100% of Median
Blended Survey Data
Gateway
Conflict of Interest Form
Mandatory Education
Meeting Attendance
Chart Closure
wRVU Productivity
Compensation per wRVU
above Survey Median
Value-Based Metrics*
Fixed Dollar Amount
Quality, VOI/CMP, Citizenship
* Eligibility: 0.5 FTE or greater. Not on guarantee. Employed before July 1st and on Dec 31st
Additional Stipends: APP Supervision
RWC: Physicians RWC: APPs (NP/PA)
Copyright © 2021 MultiCare
Primary Care Compensation Redesign
Development of a Common Physician and APP Compensation Framework
62Copyright © 2021 MultiCare
The Journey
63
Objective of the Design Process
Support an inclusive and collaborative process allowing input from Physicians and APPs from all locations in the development of a common framework across MultiCare
Project Phases
Discovery Phase(January – March)
Design Phase(April – May)
Model Refinement(June)
Scope
All Primary Care Providers
Phys ≈ 200 APPs ≈ 100
MMA • Mary Bridge • Rockwood Clinic
• Developed and refined a go-forward
Framework/Model from which
MultiCare will define the final
compensation plan
03
01
This is a sample text.
This is a sample text.
• Developed six compensation
frameworks with varying structures
• Completed iterations with optional
components and weighting
• Preferences Surveys
• Three design meetings with
compensation component and
minimum standards polling
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Provider Preferences
64
Main themes emerged through the Provider Preferences Surveys and Design Advisory Team feedback
Work-Life Balance
Redefining a high-performing provider;
recognizing contributions beyond wRVU productivity
Salary Stability
83% of Primary Care physicians preferred a compensation structure
with more guarantee and less at-risk incentive
Productivity
wRVUs, Panel Size and Patient Encounters were
preferred as top variable pay considerations
Critical Success Factors (abbreviated from Population Health Meeting)
• High Performing Quality
• Member Retention “Keepage”
• Documentation and Coding (Risk Adjustment)
• Reducing Readmission & Avoidable ED Usage
• Disease Management
• Preventative Care
• Patient Engagement
• Health Equity
• Enhancing Accessibility to Care
• Identification of High & Rising Risk
Copyright © 2021 MultiCare
Revised Variable Base Framework/ModelA
cces
s /
Pre
sen
tee
ism
TCC is comprised of four categories
Weighting of each component may be adjusted year-over-year
Patient Visits: ≈ 30%
Visits x rate per visit
wRVUs: ≈ 30%
wRVUs x rate per wRVU ≈ 60% of TCC
Risk- Adjusted Panel
Risk-Adjusted Panel Members x rate per patient ≈ 20% of TCC
Quality Metrics≈ 15% of TCC
≈ 5% of TCC
AWV – HMV - Well Child
# visits x rate per visit
Pro
du
ctiv
ity
Pop
ula
tio
n H
ealt
h
65
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Care Model: Current State and Future PreferencesMovement Toward An Integrated Model
66
Independent Supportive Integrated
• Incentive plans have little in
common; focus on individual
productivity/performance
• Can include integrated value-
based performance metrics
• May create competition and
unintended consequences
• Encourages APP
optimization
• Adds team-based metrics
to incentive plans
• May include productivity
thresholds for physicians
and APPs
• Aligned performance drivers
structured by team, site or region
• Shared incentive plan: individual and
team-based measures
• Collaborative practice allows APPs and
physicians to hit thresholds and
receive payouts
Spectrum of Team-Based Primary Care Compensation Programs
12 3 2
1 5 9
Current
Future
MultiCare Primary Care APPs practice independently (and enjoy this structure) • Productivity compensation plan has driven an individual approach to care • Competition is not an issue given patient
volume • Historically a salary-based plan resulted in very low productivity • Providers can have an independent panel and integrated model
Copyright © 2021 MultiCare
Key Takeaways and Next Steps
67
Key Takeaways:
• Creating a common model takes more time than anticipated, especially considering:
▪ ~ 500 providers with different needs
▪ Medical groups have similar comp philosophies but different models
▪ MultiCare is evolving to create more consistency in provider enterprise
▪ Our preferred inclusive approach involved ~ 30 colleagues (physicians, APPs, leadership, subject matter experts) takes more time
▪ Finding the balance in a model that embraces current (and future) reality
Next Steps:
• We will turn this model on in 2022 and run it in tandem with 2021 comp model
• Working through the important details of this model
• A thorough communication plan that includes:
▪ Sharing the model and the Why
▪ Provider town halls
▪ Model details, definitions, FAQs
▪ Shadowing each provider
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68 |
Mercy Physician Primary Care Compensation Plan
Private and Confidential
69 |
Why Change?
Insert Text Box
Insert Text Box Insert Text Box
Justify Left
Our future requires us to be successful in value-based care
January 2022: All ACO lives convert to downside risk
To be financially sustainable, Mercy must continue to grow
covered lives
Contracting strategy focused on taking on more risk in current
contracts, which will require higher levels of performance
Need alignment between compensation structure and
system value-based strategy
Private and Confidential
Copyright © 2019 by SullivanCotter
71 |
Primary Care Compensation Structure
Clinical Compensation Components
✓Panel Size (Individual
OR Team)
✓Performance Metrics
Institutional
Incentives (Up to 10%)
✓Patient Experience
✓ Institutional Incentives
Performance Tier Categories
Growth • Documentation • Quality • Medical Management
Population Health
Private and Confidential
Copyright © 2019 by SullivanCotter
72 |
Individual OR Team Panel for Determining Compensation
Physician Supervising
1.0 FTE
APP Target
Achieved
Yes
NoPhysician Compensated
on Individual Panel Size
Physician Compensated
on a % of the Team
Panel Size1
Tier 1: 80% of P50 PMPY
Tier 2: 90% of P50 PMPY
Tier 3: P50 PMPY
Tier 4: 110% of P50 PMPY
Tier 5: 120% of P50 PMPY1Physicians in level 3 or above: Receive 85% of the difference between individual and team panel size
Physicians in level 2: Receive 25% of the difference between individual and panel size
Physicians in level 1: Not eligible for team panel credit
Private and Confidential
Copyright © 2019 by SullivanCotter
73 |
Physician Dashboard Example to Support New Model
Private and Confidential
Copyright © 2019 by SullivanCotter
74 |
Physician Dashboard Example to Support New Model
Private and Confidential
Copyright © 2021 by SullivanCotter
Answering Your Questions
All participants have
access to a copy of the
slides via Converve.
Copyright © 2021 by SullivanCotter
Four Plan Types
Appendix: MultiCare
76Private and Confidential
Copyright © 2021 by SullivanCotter
Compensation Plan Transition
77
MultiCare is developing a transition plan, creating safeguards as providers
transition to the new compensation plan
Initial Transition Plan Revised Transition Plan
2022 Implement the new model and
shadow calculate compensation
under the current model; safeguard
= no greater than 5% decrease
from current plan
Pay on current model* and implement
the new compensation plan that would
be paid in addition; safeguard = no
decrease from current plan but no
more than 7.5% increase from current
model
2023 Implement the new model and
shadow calculate compensation
under the current model; safeguard
= no greater than 10% decrease
from current plan
Pay on new compensation
and calculate year end compensation
under the current model; safeguard =
no greater than 5% decrease from
current plan
2024 Full transition – no safeguard Pay on new compensation model with
no safeguard
* 2021 CMS EM RVU updates will be implemented as per standard process
Copyright © 2021 MultiCare
Copyright © 2021 by SullivanCotter
Determined Based On
Conceptual Framework: Example
78
Base Compensation
Minimum Expectations
Patient Contact Hours
Panel Size
Citizenship
Meeting attendance
Variable Compensation
Gateway (Eligibility)
Chart Closure
Coding Accuracy
Mandatory Education
Determined Based On
Other Compensation
Additional Work Effort
Virtual Visits
Committee Chair
For work over and above minimum
expectations
Determined Based On
Work Effort Outside of
Minimum Expectations
Clinical Cash Compensation
Quality
Metrics
Patient
Experience
Target
Market
Position
Combined
wRVU /
Panel
Size Tiers
Copyright © 2021 MultiCare