HEALTH Volume 9 • No. 2
Dr. Sharon Levine: The Permanente Medical Group’s Visionary Use of IT In Care Delivery, p.10 Big Data: Without Actionable Analytics, It’s Just Noise, p.18 Using Smartphones to Engage Underserved Populations, p.24
Spring 2015
Confidence The feeling you have when you are affiliated with Hill Physicians. Marina Rasnow-Hill, M.D.
Hill Physicians provider since 2012. Uses Ascender preventive care reminders and Hill inSite to review eClaims and eligibility.
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: • 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 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.
For more about the advantages of affiliating, visit HillPhysicians.com/JoinUs.
Hill Physicians’ 3,800 healthcare providers accept HMOs and many PPOs from Aetna, Anthem Blue Cross, Blue Shield, CIGNA, Easy Choice, Health Net, Humana, SCAN, San Francisco Health Plan, United Healthcare WEST and Western Health Advantage. Medicare Advantage plans in all regions. Medi-Cal in some regions for physicians who opt-in.
VITAS MAKES IT EASY to care for some of your most challenging patients. Your most fragile patients may be appropriate for hospice care. VITAS® Healthcare, the nation’s leading hospice provider, now leads the field in convenience, too. Check hospice eligibility, contact a VITAS admissions coordinator, or make a hospice referral with one touch. Download Our App on Your Smartphone
• Provides immediate access to hospice clinical criteria • Offers one-touch referral capability • No referral paperwork • Puts you in immediate contact with a VITAS hospice admissions professional if you prefer • Scan the QR code below or, from your smartphone, go to VITASapp.com
800.93.VITAS VITAS.com
The Impact of
The numbers may surprise you, but the most important number of all is one. It’s our commitment to caring for our community one patient at a time. From our top ranked hospitals to our vibrant and growing primary care network, UCLA is world-renowned but focused right here at home. It’s a commitment we can all count on.
1-800-UCLA-MD1 (1-800-825-2631)
uclahealth.org
uclahealth.org/getsocial
Over
30
years of
managed care experience
1,200 150 40
physicians
Over
community offices
Over
primary care offices
Patients enter our community offices
2.5 million times each year Santa Clarita
N
Simi Valley 118
map not to scale
Porter Ranch
23
210
Northridge
Thousand Oaks
Panorama City
5
170
Burbank
2
Pasadena
134
101
Westlake Village
Arcadia
405
101
Brentwood Malibu
Pacific Palisades
Alhambra
Westwood Santa Monica
10
Century City West Los Angeles Marina del Rey
10
90
60
605
5
110 405
710 105
Manhattan Beach Redondo Beach
91
Torrance
Palos Verdes
Fountain Valley Irvine
TABLE OF CONTENTS
ON THE COVER
10
The Permanente Medical Group: Using Information Technology to Transform Care Delivery for 55 Years HEALTH Publisher
Valerie Okunami Editor-in-Chief
Don Crane
DEPARTMENTS
FEATURES
7
18
Notes from the President
Big Data is Just Noise Without Actionable Analytics
Editorial Advisory Board
Lura Hawkins, MBA Amy Nguyen Howell, MD, MBA Mary Kay Payne, Arch Health Partners Managing Editor
8 Names in the News
Daryn Kobata
Standards of Excellence™: A National
Editorial Assistant
Nelson Maldonado Contributing Writers
Bill Barcellona Don Crane John Gorman Valerie Green-Amos, MD Sharon Levine, MD Mara McDermott Kevin McDonald Amy Nguyen Howell, MD, MBA CAPG Health Magazine is published by
Valerie Okunami Media PO Box 674, Sloughhouse, CA 95683 Phone 916.761.1853
capghealth.com Please send press releases and editorial inquiries to capghealth@capg.org or c/o CAPG Health, 915 Wilshire Blvd., Suite 1620, Los Angeles, CA 90017 For advertising, please send email to vokunami@netscape.com Subscription rates: $32 per year; $58 two years; $3.00 single copy. Advertising rates on request. Bulk third class mail paid in Jefferson City, MO Every precaution is taken to ensure the accuracy of the articles published in CAPG Health Magazine. Opinions expressed or facts supplied by its authors are not the responsibility of CAPG Health Magazine. © 2015, CAPG Health Magazine. All rights reserved. Reproduction in whole or in part without written permission is strictly prohibited.
6 l CAPG HEALTH
22
Spring 2015
12 Upcoming Events
14
Measure of Clinical Excellence
26 Smartphones Encourage High
Federal Legislative Update:
Participation Among Low-income
Accelerating Delivery System
Patients
Transformation
16 CAPG Member List
20 State Legislative Update: CAPG’s Proposal to Pilot an “Accountable Community for Health”
28 Protecting Patient Health Information: A Necessary Challenge
From the President A M ES S AG E F R O M D O N A L D C R A N E , P R ES I D E N T A N D C EO , C A P G
CAPG Members and Friends: Welcome to the spring 2015 issue of CAPG Health. I encourage you to read our article on the CAPG Standards of Excellence™ (SOE™) program, one of our most valuable membership benefits. The voluntary annual survey gives physician groups an effective way to assess and improve their performance in six critical measures— up from four measures when it was established in 2006. We are very proud of the expanded program and the enthusiastic member participation. It is a one-of-a-kind assessment opportunity available exclusively to CAPG members.
Donald Crane, CAPG President and CEO
Services such as SOE™ have always been a priority for CAPG, as has advocacy for the kind of coordinated care our members deliver so successfully. In February of this year, we sent a letter to Congress urging strengthened support and appropriate funding for Medicare Advantage. These prepaid, clinically integrated healthcare plans are used by over 16 million seniors, or approximately 30 percent of all Medicare enrollees. More than 300 member and non-member medical groups and independent practice associations across the country signed the letter, calling on Congress to retain stability and prevent additional cuts to this critical program. In turn, the United States Senate wrote to the Centers for Medicare & Medicaid Services seeking support for our position. We believe that our continuing advocacy has been a major factor in helping policy-makers understand the value of coordinated care. To get the most current information about the healthcare issues that matter most to you, please join us at the 2015 CAPG Healthcare Conference, scheduled for June 11–14 in San Diego. Registration is now open for the Conference, our most popular education and networking event of the year. We hope to see you there. o
Spring 2015
CAPG HEALTH l 7
Names in the News IHA APPOINTS NEW PRESIDENT AND CEO The Integrated Healthcare Association (IHA) has appointed Jeffrey Rideout, MD, as president and CEO effective May 11, 2015. He succeeds Tom Williams, DrPH, who transitioned to Stanford Health Care after ten years at IHA. Dr. Rideout is currently senior medical advisor for Covered California, the nation’s largest state health insurance exchange, supporting clinical quality, network management, and delivery system reform related to 1.1 million enrollees. Formerly president and CEO of Blue Shield of California Foundation and chief medical officer at Blue Shield of California, he is currently a healthcare advisor to GE Ventures. Dr. Rideout holds academic appointments with Stanford University and the University of California, Berkeley Haas School of Business, and has significant experience advising and consulting in venture capital, private equity, and early stage companies in the healthcare IT and healthcare services sector.
REGIONAL LEADERSHIP CHANGES AT PROVIDENCE Bill Gil has been named Chief Executive, Providence Health Network, Southern California. Providence Health Network (PHN) will work with Providence hospitals, medical groups, and physicians to provide comprehensive, coordinated population healthcare. Gil will develop the vision and strategy for the health plan and other population health initiatives that will help achieve the goals of the Accountable Care Act’s triple aim: improved patient access and quality and cost-effective care. He most recently served as Chief Executive, Southern California Medical Foundations. Jim Slaggert joined Providence March 1 as Chief Executive, Medical Group Foundations, filling Gil’s previous position. He brings more than 20 years of healthcare leadership and management experience, primarily with physician organizations and
8 l CAPG HEALTH
Spring 2015
integrated delivery systems. Most recently, Slaggert served as Vice President, Integrated Health Networks, at Catholic Health Initiatives (CHI) and previously as CHI’s Vice President of Operations, Physician Practice Management. CHI is the third largest faith-based nonprofit health system in the U.S. with 89 hospitals in 18 states. For 12 years prior, he was CEO of Alta Bates Medical Group, an independent practice association based in Berkeley, California.
HERITAGE PROVIDER NETWORK, FRESENIUS MEDICAL CARE ANNOUNCE NEW COLLABORATION Heritage Development Organization, an affiliate of CAPG member Heritage Provider Network, has signed an agreement with Fresenius Medical Care to develop physician networks and care coordination and population health management services in select markets across the U.S. The collaboration expands the companies’ successful partnership with shared savings models and furthers their commitment to making coordinated, value-based care more accessible to all Americans. With this agreement, Heritage Provider Network will acquire or build coordinated care networks in markets nationwide that will partner with Fresenius Medical Care, continued on page 30
12th Annual CAPG Healthcare Conference
Accountable Care ACCELERATING THE EVOLUTION
June 11–14, 2015 • Grand Hyatt, San Diego, CA
Featured sessions include: Primary Care Innovation and the Patient-Centered Medical Home
Patient-Centered
Preconference co-hosted with the Patient-Centered Primary Care Collaborative COLLABORATIVE
Leonard D. Schaeffer
Alan Weil
Founding Chairman and CEO, WellPoint
Managing Editor, Health Affairs
Brent James, MD
Daniel Kraft, MD
Executive Director, Institute for Health Care Delivery Research and Chief Quality Officer, Intermountain Healthcare
Faculty Chair for Medicine, Singularity University; Founder and Executive Director, Exponential Medicine
Panel Discussion: Healthcare Reform Moderated by Donald H. Crane, President and CEO, CAPG
Barry S. Arbuckle, PhD President and CEO, MemorialCare Health System Bill Gil Chief Executive, Providence Health Network, Southern California Leeba Lessin President and CEO, CareMore
REGISTER NOW! capg.org/conference2015
ON THE COVER
The Permanente Medical Group: Using Information Technology to Transform Care Delivery for 55 Years BY SHARON L E V I NE , MD , AS S O CI ATE E XECU TI V E D I R ECTO R , T H E P E R M A N E N T E M E DI C A L G R O UP
When The Permanente Medical Group celebrated its 65th anniversary in 2013, the occasion presented an opportunity for us to celebrate our visionary physician founder, Dr. Sidney Garfield, who in partnership with the industrialist Henry Kaiser built the organization we know today as Kaiser Permanente (KP). Garfield’s story is as compelling as Mr. Kaiser’s, whose name is memorialized in the not-for-profit Kaiser Foundation Health Plan and Hospitals. In fact, it was Dr. Garfield’s extraordinary vision and daring innovations in the mid–20th century that enabled Kaiser Permanente to rise to prominence as a nationally recognized leader in healthcare. Garfield and Kaiser were true partners, marrying Mr. Kaiser’s access to capital and organizational genius with Dr. Garfield’s relentless drive for innovation and quality improvement. They shared a commitment to human dignity, and a passion to make healthcare accessible to all.
“
And true to [KP founder Dr. Sidney] Garfield’s prediction, the electronic health record KPHC has become the ‘central nervous system’ of our care system, with multiple nodes of connectivity for members and patients…”
10 l CAPG HEALTH
Spring 2015
Garfield understood that success would be dependent on developing physician leaders capable of designing and implementing a reengineered system of care. The transformative model of care he introduced rested on four big ideas: prospective payment to the medical group; integrated, multispecialty group practice in organized, co-located facilities; an emphasis on prevention and what he termed “the new economy of medicine,” i.e., rewards for keeping people healthy; and—most presciently—a firm belief in the centrality of information technology in the future of healthcare. As early as 1960, Dr. Garfield advocated that computers—at that time, giant roomsized machines processing IBM punch cards—would eventually revolutionize care delivery. He dispatched a brilliant young internist with an electrical engineering degree, Dr. Morris Collen, to investigate the possibilities. Attending an international meeting on computers, Collen reported back that “Medical electronics was beginning a period of great innovation…and…we should begin to take advantage of the potential of electronic digital computers.” In 1968 Garfield wrote, “The computer cannot replace the physician, but it will be able to keep essential data moving smoothly from laboratory to nurse’s station, from x-ray department to the patient’s chart and from all areas of the medical center to the physician himself.” And in 1970 Garfield published a seminal paper in Scientific American describing his vision of the future of medical practice, which included a series of diagrams representing the evolution of American healthcare through the decades, beginning in 1900. In the center of each diagram up to 1970 was the hospital; in the center of the diagram of the “system of the future,” a computer—the “central nervous system” of an entirely novel healthcare organization designed to meet patient needs, whether sick or well—or as Garfield described it, a “total healthcare organization.”
While Dr. Garfield’s vision in 1970 was almost frighteningly prescient about what would ultimately develop, it took four decades for the technology to evolve to support that vision. Along the way there were “fits and starts”—pilot programs, fully operational independent lab and pharmacy information systems, a homegrown eRx application, and a variety of clinical IT systems developed and abandoned. Ultimately, Kaiser Permanente deployed a fully integrated clinical and administrative information system, KPHealthConnect (KPHC), with a web-based personal health record accessible through the members’ portal at kp.org. Development in partnership with Epic Systems began in 2003, and implementation was fully completed in all hospitals and ambulatory care sites in 2010. And true to Dr. Garfield’s prediction, the electronic health record KPHC has become the “central nervous system” of our care system, with multiple nodes of connectivity for members and patients. Through the MyDoctorOnline patient portal, patients can access their physician’s personal web page to send secure messages; book in-person, telephone, or video appointments; view test results; order prescription refills; and explore interactive educational materials. Patients can also connect to KPHC via the 24/7 Appointment and Advice Call Center (AACC). KPHealthConnect also facilitates immediate physicianto-physician connection through eConsult, a collaborative two-way electronic education and information system designed by primary care and specialist physicians. The application connects primary care physicians and their patients with the right consultant specialist 90,000 times a week. The system also facilitates real time three-way conversations between the specialist, the referring primary care physician and the patient—all of whom can access the medical record while the patient is still in the exam room. And as Dr. Garfield predicted, by keeping lines of communication open our information systems have not replaced the physician-patient relationship, but provided a powerful tool to build trust, cement long term relationships, and improve quality. In 2012, 10 million secure e-mails were received and answered, 5 million prescriptions refilled online, and 15 million test results viewed.
mobile apps. These apps are fully integrated with KPHealthConnect, and designed to meet patient needs for care delivered in ways that provide convenience, feel personal and offer meaningful choices. The Preventive Care mobile app, available since 2012 on iOS and Android devices, both reminds patients when they are due for screening and, using the “click to call” button, connects them directly with the AACC to schedule screening appointments. The MyKPMeds app displays active medications, and enables patients to set reminders to take their meds. The system delivers “push” notifications to the mobile device—even when the app is not running—with options to click “take,” “postpone” or “skip,” especially valuable for patients transitioning home from the hospital with a new medication regimen. And integration with the EMR means that when a medication is deleted in the system, it is automatically deleted from the app, and the patient is notified when a medication is added. Video visits, which have been available since 2013 and used in multiple specialties as well as in the AACC after hours, will now be available through a secure connection on iPhones or Android devices—increasing the opportunities for connection and care delivery any place, any time. After four decades of effort, The Permanente Medical Group is realizing the dream, and the vision, of its founder, Dr. Sidney Garfield—to use information technology to improve quality, personalize care, transform care delivery, and deliver a total health experience to members and patients. o Dr. Sharon Levine has practiced with TPMG since 1977, and has been an Associate Executive Director since 1991. She is a member of CAPG’s Board of Directors and Executive Committee.
What Dr. Garfield never envisioned was the next wave of care transformation, mobile health applications. Building on the KPHealthConnect foundation, dozens of physician technology leaders—part of the TPMG Technology Group (TTG)—have continued to innovate and develop
Spring 2015
CAPG HEALTH l 11
E V E N T S
CAPG 12TH ANNUAL HEALTHCARE CONFERENCE June 11–14, 2015 Grand Hyatt, San Diego, CA The CAPG Healthcare Conference is renowned for outstanding speakers, content, and networking. Register now at www.capg. org/conference2015
CONTRACTS COMMITTEE Thursday, April 16 Los Angeles, CAPG Office*
HUMAN RESOURCES COMMITTEE Tuesday, April 21 WebEx*
INLAND EMPIRE REGIONAL MEETINGS
U P C O M I N G
Wednesday, April 22 Riverside, Mission Inn*
SAN DIEGO REGIONAL MEETINGS Tuesday, April 27 Sharp Spectrum Auditorium*
GENERAL MEMBERSHIP (NOR CAL) Thursday, May 14 Oakland, Hilton Oakland Airport Hotel*
PHILADELPHIA REGIONAL MEETING Tuesday, May 19 Philadelphia, Renaissance Airport Hotel*
STATE GOVERNMENT PROGRAMS COMMITTEE Tuesday, May 19 Los Angeles, CAPG Office*
PRIMARY CARE PRACTICE TRANSFORMATION COLLABORATIVE Wednesday, May 20 Los Angeles, CAPG Office*
NATIONAL CAPG COMMITTEE Thursday, June 11 CAPG Annual Healthcare Conference*
PUBLIC POLICY COMMITTEE Thursday, June 18 Conference Call*
PHARMACEUTICAL CARE COMMITTEE
PUBLIC RELATIONS/MARKETING COMMITTEE
Tuesday, April 28 Los Angeles, CAPG Office*
Tuesday, July 7 Los Angeles, CAPG Office*
DENVER REGIONAL MEETING
PUBLIC POLICY COMMITTEE
Thursday, April 30 TBD*
Thursday, July 9 Conference Call*
ACO COMMITTEE
INFORMATION TECHNOLOGY COMMITTEE
Tuesday, May 5 Los Angeles, CAPG Office*
Tuesday, July 14 WebEx*
PUBLIC POLICY COMMITTEE
SAN DIEGO REGIONAL MEETING
Thursday, May 7 Conference Call*
Tuesday, July 14 San Diego, Sharp Spectrum Auditorium*
Tuesday, May 12 Los Angeles, CAPG Office*
Wednesday, July 15 Riverside Mission Inn*
GENERAL MEMBERSHIP (SO CAL)
INLAND EMPIRE REGIONAL MEETINGS
*For more information contact CAPG at (213) 642-CAPG.
If you have an event to list in this column, please submit it at capghealth@capg.org. Include the name of the event, date, location, and where to get additional information.
12 l CAPG HEALTH
Spring 2015
2015 CAPG COLLOQUIUM
Achieving Success in Risk-based Coordinated Care October 5-7 • Washington Marriott Wardman Park, Washington, DC
Government and commercial payers are demanding that physicians and hospitals move from volume to value—specifically, to move into risk-bearing arrangements. Many providers would like to, but are unsure as to just how to do so safely. If this describes you or your organization, this conference is designed for you.
Featured speakers include: Joseph R. Swedish
Bernard J. Tyson
President and CEO, Anthem, Inc.
Chairman and CEO, Kaiser Permanente
Sheila Burke
Kavita Patel, MD
Faculty Research Fellow and Faculty, John F. Kennedy School of Government, Harvard University; Chair, Government Relations & Public Policy, Baker, Donelson
Managing Director for Clinical Transformation and Delivery, Engelberg Center for Healthcare Reform, The Brookings Institution
Edmund F. Haislmaier
Mark E. Miller, PhD
Senior Research Fellow, Health Policy Studies, The Heritage Foundation
Executive Director, Medicare Payment Advisory Commission
T. Clifford Deveny, MD
John Rother
Senior VP, Physician Services, Catholic Health Initiatives
President and CEO, National Coalition on Health Care
Keith Fernandez, MD
Kenneth Cohen, MD, CMO, FACP
President and Physician in Chief, Memorial Hermann Physician Network, Chief Medical Officer, Memorial Hermann ACO
Chief Medical Officer, New West Physicians; Clinical Assistant Professor of Medicine, University of Colorado School of Medicine
Learn more and register at
capgcolloquium.com or call 800.503.3650 Don’t forgetWinter to 2015 tell your November/December 2014 25 CAPGcolleagues! HEALTH l 13
Federal Legislative Update Building on the Success of Medicare Advantage: Accelerating Delivery System Transformation BY MARA MCDERMOTT, VP OF FEDERAL AFFAIRS, CAPG
In January, Health and Human Services (HHS) Secretary Sylvia Burwell announced the Better Care, Smarter Spending, Healthier People initiative. The Secretary’s announcement for the first time sets concrete goals for the adoption of risk-based payment models in Medicare. Specifically, the Secretary set targets of moving 30 percent of the fee-for-service system to risk-based payments by the end of 2016 and 50 percent to these types of payments by the end of 2018. HHS estimates that currently, 20 percent of fee-for-service Medicare reimbursements are in either alternative payment models built on fee-for-service infrastructure (for example, accountable care organizations) or in population-based payments. CAPG applauds this announcement. We believe that the Secretary’s plan represents a critical acceleration of the movement of the delivery system into new payment models. As CAPG members have demonstrated for decades, getting the right payment model in place, combined with a focus on quality and outcomes, can lead to superior health and quality of life for patients. In the months to come, CAPG will continue to work with the Administration and Congress to highlight the important role of Medicare Advantage in advancing a value-based delivery system. In Medicare Advantage, most CAPG members
Mara (second from left) moderated a recent Medicare Advantage briefing on Capitol Hill with (from left) Dan Perry, Alliance for Aging Research; Dr. Erik Steele, Summa Health System; and Dr. Elena Rios, National Hispanic Medical Association. Photo: AHIP
14 l CAPG HEALTH
Spring 2015
“
The very value-driven payment model that the Secretary seeks to build in fee-forservice is alive and well in Medicare Advantage. We want to work with the Secretary to proliferate the model both inside and outside of Medicare Advantage.”
are capitated by health plans. The very value-driven payment model that the Secretary seeks to build in feefor-service is alive and well in Medicare Advantage. We want to work with the Secretary to proliferate the model both inside and outside of Medicare Advantage. CAPG members believe this is the right movement for doctors and—more importantly—the right thing for seniors. Outside of Medicare Advantage, the Centers for Medicare & Medicaid Services continue to work with industry to pursue new and exciting payment and delivery models. Recently, CMS requested information on developing new capitated, patient-centered medical home models. Shortly after that, the agency issued a request for applications for a Next Generation ACO, including new opportunities to test and advance the accountable care organization model. CAPG will continue to work with its members to evaluate and shape these opportunities to meet the needs of an evolving and transforming delivery system. To facilitate the transformation toward risk-based payment models, the Secretary also announced the creation of the Health Care Payment Learning and Action Network. The Learning and Action Network will serve to
convene healthcare stakeholders and work to identify areas of agreement to advance alternative payment models. It is intended to unite stakeholders and to support the transformation of the Medicare delivery system. CAPG CEO Don Crane and several of our members had the opportunity to join President Obama, Secretary Burwell, and other stakeholders at the White House for the Network kickoff on March 25. In the months to come, CAPG members will have opportunities to lead the way in transforming the delivery system from a flawed fee-for-service reimbursement model to one that rewards for better quality, prevention of disease, and a focus on primary care. We know from experience that the transition will not be an easy one. But we welcome the Secretary’s bold new direction and look forward to working with policymakers and thought leaders to accelerate the transformation. CAPG members that want to join the Health Care Payment Learning and Action Network can register at http://innovationgov.force.com/hcplan. Registered organizations will be made public. o
Spring 2015
CAPG HEALTH l 15
ORGANIZATIONAL MEMBERS Accountable Health Care IPA George M. Jayatilaka, MD, CEO Druvi Jayatilaka, Vice President
M E M B E R S
Advanced Medical Management, Inc. Kathy Hegstrom, President • Access Medical Group/Access Santa Monica • Community Care IPA • MediChoice IPA • Premier Care IPA • Seoul Medical Group • Adventist Health Physicians Network IPA Arby Nahapetian, MD, CMO Jim Agronick, VP – IPA Operations Affinity Medical Group Richard Sankary, MD, President Scott Ptacnik, COO Alameda Health Partners William Peruzzi, MD, Chairman David Cox, Treasurer/CFO AllCare IPA* Randy Winter, MD, President Matt Coury, CEO All Care Medical Group Samuel Rotenberg, MD, Medical Director Craig Kaner, Administrator Allied Physicians of California Thomas Lam, MD, CEO Kenneth Sim, MD, CFO Alta Bates Medical Group Richard L. Oken, MD, President and Chairman of the Board Evan Moore, Vice President, East Bay Region AltaMed Health Services Corporation* Martin Serota, MD, Chief Medical Officer Castulo de la Rocha, JD, President/CEO AppleCare Medical Group, Inc.* Surendra Jain, MD, Chief Medical Officer Vinod Jivrajka, MD, President/CEO
C A P G
Bakersfield Family Medical Center Ju Hwan Lee, MD, Medical Director Bayhealth Physician Alliance, LLC Joseph M. Parise, DO, Medical Director Evan W. Polansky, JD, Executive Director Beaver Medical Group* Charles Payton, MD, VP Medical Administration/CMO John Goodman, President/CEO Brown & Toland Physicians* Andrew M. Snyder, MD, Chief Medical Officer Richard Fish, CEO
Chinese Community Health Care Association John M. Williams, PharmD., CEO Polly Chen, Director of Operations Choice Medical Group IPA Manmohan Nayyar, MD, President Marie Langley, IPA Administrator Cigna Medical Group Kevin Ellis, DO, Chief Medical Officer Edward Kim, President and General Manager Citrus Valley Independent Physicians Jorge Reyno, MD, Executive Medical Director Martin Kleinbart, DPM, Chief Strategy Officer Colorado Permanente Medical Group, P.C. William G. Wright, MD, Executive Medical Director Dan A. Oberg, CFO & VP Corporate Development Community Health Innovations Anthony Chavis, MD, VP Enterprise & CMO Liz Lorenzi, VP/COO Conifer Health Solutions Megan North, CEO • AKM Medical Group • Amvi Medical Group • Exceptional Care Medical Group • Family Choice Medical Group • Family Health Alliance • Huntington 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 • Continucare Corporation Alfredo Ginory, MD, Chief Medical Officer Gemma Rosello, Vice President DCHS Medical Foundation Dean M. Didech, MD Chief Medical Officer Ernest Wallerstein, CEO Desert Oasis Healthcare Marc Hoffing, MD, Medical Director Dan Frank, Chief Operating Officer Dignity Health Bruce Swartz, SVP, Physician Integration Edinger Medical Group Matthew C. Boone, MD, Executive Medical Director Denise McCourt, Chief Operating Officer Empire Physicians Medical Group* Steven Dorfman, MD, President Yvonne Sonnenberg, Executive Director Everett Clinic, P.S., The* Adrianne Wagner, Quality Improvement Consultant Manager Shashank Kalokhe, Associate Administrator of Value-Based Contracting and Coordinated Care
California Pacific Physicians Medical Group, Inc. Dien V. Pham, MD, Chief Executive Officer Carol Houchins, Administrator
Facey Medical Foundation* Erik Davydov, MD, Medical Director James Slaggert, CEO
CareMore Medical Group Tom Tancredi, Dir. of Practice Operations
Golden Empire Managed Care, Inc.* Michael Myers, President and CEO
Catholic Health Initiatives* Chris Stanley, MD, VP of Care Management Don Lovasz, President, Clinically Integrated Network
Good Samaritan Medical Practice Association Nupar Kumar, MD, Medical Director
Cedars-Sinai Medical Group* Stephen C. Deutsch, MD, Chief Medical Director Thomas D. Gordon, CEO Central Ohio Primary Care Physicians, Inc. J. William Wulf, MD, CEO Michael Ashanin, COO Children’s Physicians Medical Group Leonard Kornreich, MD, President and CEO * Indicates 2015 - 2016 Board Members
16 l CAPG HEALTH
Spring 2015
Greater Newport Physicians Medical Group, Inc.* Adam Solomon, MD, CMO Diane Laird, CEO HealthCare Partners* Don Rebhun, MD, Corporate Medical Director Kent Thiry, Chairman and CEO, DaVita Heritage Provider Network* Richard Merkin, MD, President Richard 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 • HealthCare Partners, IPA, AZ & NY • Heritage Physician Network • Heritage Victor Valley Medical Group • High Desert Medical Group • Priority Care Plus, AZ • Regal Medical Group • Sierra Medical Group • High Desert Medical Group Charles Lim, MD, FACP, Medical Director Anthony Dulgeroff, MD, Assistant Medical Director Hill Physicians Medical Group, Inc.* Tom Long, MD, Chief Medical Officer Darryl Cardoza, CEO Independence Medical Group Armi Lynn Walker, MD, Medical Director Gary M. Bohamed, Executive Director John Muir Physician Network Ravi Hundal, MD, Medical Director Lee Huskins, Interim CEO/SVP/COO Lakeside Community Healthcare Kerry Weiner, MD, Chief Medical Officer Jonathan Gluck, Counsel Lakeside Medical Group, Inc. Lakewood IPA Jean Shahdadpuri, MD, MBA, Chief Medical Officer Varsha Desai, Chief Operating Officer • Alamitos IPA • St. Mary IPA • Brookshire IPA • Loma Linda University Health Care J. Todd Martell, MD, Medical Director Maverick Medical Group Warren Hosseinion, MD, Chairman Mark C. Marten, CEO MED3000 Gary Proffett, MD, Medical Director Lynn Stratton Haas, CEO • SeaView IPA • Valley Care IPA • MedPoint Management Rick Powell, MD, Chief Medical Officer Kimberly Carey, President • Accountable Healthcare IPA • 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 • Pioneer Provider Network, A Medical Group, Inc. • Premier Physicians Network • Prospect Medical Group, Inc. • Redwood Community Health Network • Watts Healthcare Corporation • MemorialCare Medical Group* Mark Schafer, MD, CEO Jennifer Jackman, Chief Operating Officer Meritage Medical Network J. David Andrew, MD, Medical Director Joel Criste, CEO Mid-Atlantic Permanente Medical Group, PC Bernadette Loftus, MD, Associate Executive Director for MAS Jessica Locke, Special Assistant Molina Medical Centers* Keith Wilson, MD, Vice President of Clinical Services Gloria Calderon, Vice President of Clinic Operations Monarch HealthCare* Bart Asner, MD, CEO Ray Chicoine, President and COO MSO of Puerto Rico Richard Shinto, MD, CEO Raul Montalvo, MD, President
Muir Medical Group, IPA Steve Kaplan, MD, President Ute Burness, RN, CEO
River City Medical Group, Inc. Jose Abad, MD, President/Medical Director Loren Douglas, CEO
Angeles • EHS Medical Group – Sacramento • Employee Health Systems • MultiCultural IPA • Pacific Alliance Medical Center • Southern California Children’s Network •
NAMM California* Leigh Hutchins, President, COO Elizabeth Haughton, Vice President, Legal Affairs
Riverside Medical Clinic Steven Larson, MD, Chairman Judy Carpenter, President/COO Riverside Physician Network Paul Snowden, COO Howard Saner, CEO
Tenet Healthcare Ronald Kaufman, CMO Jacob Furgatch, CEO, Coast Health Plan Services
• Coachella Valley Physicians of PrimeCare, Inc., • Mercy Physicians Medical Group • Primary Care Associated Medical Group, Inc. • PrimeCare Medical 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 • PrimeCare of Riverside • PrimeCare of San Bernardino • PrimeCare of Sun City • PrimeCare of Temecula • Redlands Family Practice Medical Group, Inc. • New West Physicians, PC Thomas M. Jeffers, MD, President and Chair Ruth Benton, CEO Northwest Permanente, P.C. Jeffrey Weisz, MD, Executive Medical Director Harry Stathos, VP and CFO Omnicare Medical Group Ashok Raheja, MD, Medical Director Toni Chavis, MD, President The Permanente Medical Group, Inc. Oakland (North)* Sharon Levine, MD, Associate Executive Director Suketu Sanghvi, MD, Associate Executive Director Physicians DataTrust Anthony Ausband, President Lisa Serratore, Chief Operations Officer • Greater Tri-Cities IPA • Noble AMA IPA • St. Vincent IPA • Physicians Choice Medical Group of San Luis Obispo John Okerblom, MD, President Barbara Cheever, Executive Director Physicians Medical Group of Santa Cruz County* Nancy Greenstreet, MD, Medical Director Marvin Labrie, CEO Physicians Choice Medical Group of Santa Maria John Okerblom, MD, President Barbara Cheever, Executive Director
St. Joseph Heritage Healthcare* Khaliq Siddiq, MD, Chief Medical Officer C.R. Burke, CEO • Hoag Medical Group • Mission Heritage Medical Group • St. Mary High Desert Medical Group • San Bernardino Medical Group Thomas Hellwig, MD, President James Malin, CEO San Diego Physicians Medical Group James Cordell, MD, President Joyce Cook, CEO San Luis Obispo Select IPA Barbara Cheever, Executive Director Sansum Clinic* Kurt Ransohoff, MD, Medical Director/CEO Vince Jensen, COO Santa Clara County IPA (SCCIPA)* J. Kersten Kraft, MD, President of the Board Lori Vatcher, CEO Santé Health System, Inc Daniel Bluestone, MD, Medical Director Scott B. Wells, CEO Scripps Coastal Medical Center Louis Hogrefe, MD, APC, Chief Medical Officer Tracy Chu, Assistant Vice President of Operations Sharp Community Medical Group* John Jenrette, MD, CEO Christopher McGlone, Chief Operating Officer
Physicians of Southwest Washington, LLC Gary R. Goin, MD, President Mariella Cummings, CEO
• Graybill Medical Group • Arch Health Partners • Sharp Rees-Stealy Medical Group* Alan Bier, MD, President Stacey Hrountas, SVP and CEO
PIH Health Physicians Deeling Teng, MD, Sr. Medical Director, Group Operations Ramona Pratt, RN, COO, Group Operations
Southeast Permanente Medical Group, Inc., The Michael Doherty, MD, Executive Medical Director and Chief of Staff
Pioneer Medical Group, Inc.* Jerry Floro, MD, President John Kirk, CEO
Southern California Permanente Medical Group* Vito Imbasciani, MD, Director of Government Relations James Malone, Medical Group Administrator
Preferred IPA of California Mark Amico, MD, Medical Director Zahra Movaghar, Administrator Prospect Medical Group* Jeffrey Hay, MD, CMO Mitchell Lew, MD, CEO
Sutter Health Foundations & Affiliated Groups* Jeffrey Burnich, MD, SVP and Executive Officer, Sutter Medical Network Brian Roach, President, Mills Peninsula Division of PAMF
• AMVI/Prospect Health Network • Gateway Medical Group • Genesis Healthcare • Nuestra Familia Medical Group • Pacific Healthcare IPA • Prospect Corona • Prospect HealthSource • Prospect Huntington Beach • Prospect Northwest Orange County • Prospect Orange County • Prospect Professional Care • Prospect Van Nuys • Providence Medical Management Services Bart Wald, MD, Physician Chief Executive Phil Jackson, Chief Integration and Transformation Officer • Korean American Medical Group • Providence Care Network • Providence Health & Services Bart Wald, MD, Physician Chief Executive Bill Gil, Chief Executive Medical Foundations
• 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 Medical 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 Director James 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
Torrance Hospital IPA Norman Panitch, MD, President Triad HealthCare Network, LLC Thomas C. Wall, MD, Executive Medical Director Steve Neorr, VP, Executive Director U.C.L.A. Medical Group* Sam Skootsky, MD, Medical Director David Hartenbower, MD, COO USC Care Medical Group, Inc. Donald Larsen, MD, Chief Medical Officer Keith Gran, CEO WellMed Medical Group, P.A. George M. Rapier III, MD, Director and VP Carlos O. Hernandez, MD, President CORPORATE PARTNERS Anthem Blue Cross of California Athenahealth Bayer HealthCare Pharmaceuticals Boehringer Ingelheim Pharmaceuticals, Inc. Humana, Inc. Merck & Co. Novartis Pharmaceuticals Novo Nordisk Patient-Centered Primary Care Collaborative SCAN Health Plan ASSOCIATE PARTNERS abbvie Actavis Pharma, Inc. Arkray Astellas Pharma US, Inc. AstraZeneca Pharmaceuticals Bio-Reference Laboratories, Inc. CVS Caremark, Corp. Daiichi Sankyo Easy Choice Health Plan, Inc. Eisai, Inc. Genomic Health Gilead Sciences Incyte Corporation Johnson & Johnson Family of Companies Kaufman, Hall & Associates Kindred Healthcare, Inc. Pfizer, Inc. Ralphs Grocery Company Sanofi Sunovion Pharmaceuticals Inc. Takeda Oncology The Doctors Company Vitas Healthcare Corporation of California AFFILIATE PARTNERS Alignment Healthcare Altura Ascender Software, LLC Childrens Hospital Los Angeles Medical Group Mills Peninsula Medical Group MZI HealthCare, LLC Nifty After Fifty Monarch LLC Partners in Care Foundation Pharmacyclics, Inc. Redlands Community Hospital Saint Agnes Medical Group SullivanLuallin Group Ventegra, LLC
Spring 2015
CAPG HEALTH l 17
Big Data is Just Noise Without Actionable Analytics BY J O H N G O R M A N , E X EC U T I V E C H A I R M A N , G O R M A N H E A LT H G R O U P
This past year, it seems everybody has been talking about Big Data and what its potential is for healthcare, particularly in government health programs where the spending and the stakes are highest. Health plans and providers alike are investing billions in data collection and fancy reports this year—but without actionable analytics, it’s all just expensive noise. Big Data is not the way for an accountable provider organization to make its medical management staff look busy, or to defer decision-making to a black box. Lots of parents ask their kids, “What did you learn today?” Mine asked me, “What questions did you ask today?” Big Data is only useful when we ask the right questions, and then get the answers in the hands of those who can make a difference. Without the right questions and queries, Big Data is toxic in large quantities—and paralyzing to clinical and quality professionals. In government health programs we live by the mantra that 5 percent of patients account for 60 percent of spending. Big Data can be helpful in finding those 5 percent, but its utility ends there because Big Data has never managed or cured a chronic disease or prevented a readmission. Doctors and nurses and social workers and home health aides do that. And that’s what’s lost in the Big Data conversation in healthcare—what works are the low-tech interventions resulting from information communicated in clear, understandable ways: clogs on the street, a social worker in the patient’s home, a well-timed risk assessment, remote monitoring of drug adherence. By now we know the noise from Big Data—and its proper use—comes from the “3 Vs”: Volume, Velocity, and Variability. Volume of healthcare data is growing exponentially, with little of it actionable and much 18 l CAPG HEALTH
Spring 2015
the right “Without questions and queries, Big Data is toxic in large quantities— and paralyzing to clinical and quality professionals.”
expense and effort incurred in merely trying to organize it all. The essence of velocity is that data has a limited shelf life and must be acted upon quickly. This can’t happen without proper organization of the volume, and in healthcare it means medical claims data can be least useful because of the weeks-long cycle in generating it.
Finally, variability speaks to the huge variety of possible data sources, integrating them into systems, and producing actionable insights that feed interventions. Very often this is led by pharmacy and lab data, which is close to real time and a more accurate predictor of diagnoses and outcomes than medical claims. An avalanche of information is not necessarily a good thing. More often than not, it’s a path to obfuscation rather than enlightenment, where speculation can do harm. In order for Big Data to be meaningful to accountable provider organizations: •• Its reports must ask the right questions and be turned around quickly, •• Reports must be designed to be actionable with the end user in mind, •• Information must be provided to those end users at the right time in the right venue, and •• It must articulate clear interventions that are evidence-based and designed to reduce variability.
Anything less will create an expensive noise machine for busy clinicians, and a drag on performance, morale, and the member experience. o
YOU PROBABLY BECAME A DOCTOR BECAUSE... you care deeply about people, their happiness and their health. WellMed shares your healthcare vision. If you’re interested in working with the Medicare population, working in an environment that empowers you and rewards you for your dedication and effort, join WellMed. Call our recruitment partner Provenir today (210) 479-3444. We can help you strengthen your medical practice future. From our WellMed doctors, nurses and physician assistants to our medical assistants and technicians, we have the same focus; to provide the best, most attentive healthcare for our senior patients. WellMed wants to create partnerships that offer physicians who share our vision with the freedom, support, and opportunity for professional growth. We’d like to welcome you to our family.
WellMedHealthcare.com DR_AD TJ101413
State Legislative Update CAPG’s Proposal to Pilot an Accountable Community for Health BY BILL BARCELLONA, SENIOR VP, GOVERNMENT AFFAIRS, CAPG
In the Winter 2015 CAPG Health issue, I wrote about the process of California’s renewal application to the Centers for Medicare & Medicaid Services (CMS) for a five-year Section 1115 Medicaid Waiver, or demonstration program. This article will take a closer look at the state’s goals for the Waiver, and how CAPG members are well positioned to help California succeed in this program. The next California Section 1115 Waiver proposal to CMS will be strongly oriented toward delivery and payment system transformation initiatives. It will also concentrate on expanding access, improving quality and outcomes, and controlling the cost of care. California’s goals for its new waiver are to:
“
1. Strengthen primary care delivery and access;
…CAPG members can provide three decades of experience in clinically integrated care and significant [financial and care coordination infrastructure] to broaden the types of providers within an accountable care entity to form a true ‘accountable community of care.’”
2. Avoid unnecessary institutionalization and services by building the foundation for an integrated healthcare delivery system that incentivizes quality and efficiency; 3. Address social determinants of health; and 4. Use California’s sophisticated Medicaid program, Medi-Cal, as an incubator to test innovative approaches to whole-person care.
California’s backbone for organized delivery systems in Medi-Cal Managed Care (MMC) is the “Delegated Model” of clinically integrated care. Pursuant to the Delegated Model, physician groups: •• Assume responsibility for clinically integrated, comprehensive, and coordinated healthcare; and •• Form the largest component of the MMC delivery system, serving over six million Medi-Cal beneficiaries and almost one million dually eligible Medi-Cal/Medicare beneficiaries across this state.
Many states have followed California’s 2010 Delivery System Reform Incentive Payment (DSRIP) Program with broader delivery system model demonstrations to integrate safety net providers to build a more comprehensive delivery system, while transitioning these critical providers into accountable, risk-based payment systems. CAPG is one of the country’s leading organizations providing support and advocacy for accountable physician organizations to improve the quality and value of healthcare provided to patients. CAPG physician groups can help California meet all its goals for integrated care by providing the chassis for such demonstration delivery systems in DSRIP. Specifically, CAPG members can provide three decades of experience in clinically integrated care and significant infrastructure at the financial and care coordination level to broaden the types of providers within an accountable care entity to form a true “accountable community of care.”
20 l CAPG HEALTH
Spring 2015
in provider-underserved regions across California. These projects would utilize the proven experience, success, and organizational capacity of CAPG member groups to create a broader Accountable Community for Health demonstration that incorporates local safety net providers, including physicians, clinics, hospitals, and skilled nursing facilities. Many of these other entities do not know how to function in a risk-bearing payment environment.
The following are demonstrable ways in which CAPG physician groups can support California’s goals: •• CAPG physician groups can accept full-risk capitation for both professional and institutional risk, creating an entity that can provide maximum accountability and cost containment. Further, many such groups already have limited and restricted Knox-Keene licenses. These entities can provide an infrastructure of proven cost accountability.
By creating a fully capitated entity that functions like an ACO, CAPG physician groups could provide the claims and care coordination management infrastructure to organize a community of safety net providers and, over time, teach the providers to function under a risk-bearing, accountable payment model.
•• CAPG physician groups have subcontracted with HMOs for several decades and have existing contracts within the MMC plans throughout California. •• CAPG physician groups have been monitored for financial solvency compliance by the DMHC for over a decade.
For example, a demonstration project could include the creation of an Accountable Community for Health that sets milestones and includes the formation of the entity across a broad spectrum of medical and social services safety net providers; this entity could be contracted to an existing MCO in a county or across counties. In the first year, the Accountable Community for Health could be paid full-risk capitation, but downstream participants in the entity could be paid under a variety of other payment models and then transitioned during the life of the DSRIP demonstration to risk-based payment.
•• CAPG physician groups participating in the Integrated Healthcare Association Pay-forPerformance and the Medicare Advantage star ratings program have the administrative capacity to collect and report performance data to provide accountability for quality. •• The “Delegated Model” has for decades incorporated the capacity to pay downstream provider claims, which is unique among delivery systems in the 50 states. Delegated model entities can organize and pay downstream providers in several methodologies—from fee-for-service to bundled payment to shared-risk arrangements like sub-capitation—and also have experience in federal shared-savings ACO payment models.
The goal would be to start with a fragmented, siloed delivery system and then build an Accountable Community for Health operating under a risk-based payment model, collecting and reporting performance data in an organized and efficient manner, and meeting milestones for increased care coordination across the entire spectrum of medical and social services care delivery—all while delivering this care under a set budget and meeting predetermined quality and performance standards. o
Many “provider” silos interfere with a more efficient and cost-accountable delivery system for Medi-Cal beneficiaries. CAPG proposes to use its members’ infrastructure to organize multiple demonstration projects
PROPOSED
CURRENT SYSTEM • • •
DHCS contracts with MMC Plan DHCS sets criteria for subcontracting MMC Plan contracts with providers
• •
•
DHCS contracts with MMC Plan DHCS sets expectations for accountable payment model and range of payment models for the accountable payment model MMC plan contracts with Accountable Community for Health using variety payment models
Spring 2015
CAPG HEALTH l 21
Standards of Excellence™: A National Measure of Clinical Excellence BY A M Y N G U Y E N H O W E L L , M D , M B A , C H I E F M E D I C A L O F F I C E R , C A P G
In our busy lives as practicing physicians, how often do we stop to think about the concept of “clinical excellence”? What is the definition of a clinically excellent physician? How do we capture the attributes of a clinically excellent health system? Why is it important to deliver a “team-based care” approach? As the Chief Medical Officer of CAPG, I am in charge of running our national Standards of Excellence™ (SOE™) program. Thus, the mission of clinical excellence is first and foremost on my mind as we enter into our ninth year of SOE. CAPG’s Standards of Excellence is an annual, comprehensive survey of capitated, coordinated care infrastructure for our accountable physician organizations throughout the U.S. SOE is designed to show how well-equipped and structured our physician organizations are in achieving better patient experience, better population health management, and better overall affordability. In alignment with our national expansion, SOE has become an industry standard in measuring the tools required for sophisticated healthcare systems to deliver accountable and value-based care
22 l CAPG HEALTH
Spring 2015
in the physician practice setting. SOE is a voluntary, critical self-assessment for CAPG’s 180-plus physician organizations in 31 states and Puerto Rico. We work diligently with the National Committee for Quality Assurance (NCQA) on the application, analysis, scoring, and auditing of the survey. Our partnership with NCQA further illustrates the credibility and real-world benefits of the survey. Last year, 86 medical groups and IPAs participated in the assessment, covering 11.1 million people in the HMO model of care with an additional estimated five million individuals with PPO coverage and governmental programs. As you read this, the 2015 survey is well underway, with dozens of groups busy gathering data for submission. We look forward to announcing the results and recognizing our members’ achievements at CAPG’s Annual Healthcare Conference in June. Currently, there is no other
“
SOE has become an industry standard in measuring the tools required for sophisticated healthcare systems to deliver accountable and value-based care in the physician practice setting.”
measurement for clinical excellence in the country, and the industry validation continues to solidify the value that CAPG’s Standards of Excellence brings to physician practices nationwide to help improve the coordination and quality of patient care at the local delivery system.
Clinical excellence can be defined as the mastery of communication and interpersonal competencies; professional and personal connections; and collaboration and partnership of the healthcare community. While physicians and clinicians may display diagnostic acumen, knowledge, and an academic approach to clinical practice, they must exude and demonstrate a clear passion for patient care and exceptional customer service. CAPG is seeing phenomenal commitment among physician organizations to stay
ahead of the curve and drive change in how patients receive care. To reflect that engagement, our Board of Directors voted unanimously this past year to recommend the following: 1. Public reporting of SOE Domain 5–Advanced Primary Care. Domain 5 has not been publicly reported in the past; however, the data results of this domain have consistently reflected the good progress our CAPG organizational members are making towards advanced primary care. Given this trend, our Board of Directors found no objection in recommending public reporting for this domain. Additionally, this step aligns with CAPG’s Practice Transformation program, promoting national practice redesign for our primary care offices. 2. Standards of Excellence Awards will be given only to the medical groups for which the survey is completed (i.e., parent organization will get acknowledged for each “satellite” or subsidiary group that completes a survey, not for all affiliated groups). In the last eight years, some of our physician organizations have been awarded overall recognition for SOE, based on the performance of a subset of their affiliated satellite groups, not for each individual group. In this case, surveys were not completed for every individual satellite or subsidiary. On the other hand, there are other physician groups who filled out individual SOE surveys for each affiliated group. continued on page 24
Spring 2015
CAPG HEALTH l 23
Standards of Excellence...continued from page 23
Given CAPG’s mission to improve the transparency and accountability of the Standards of Excellence, the Board of Directors voted that SOE awards be given only to the medical groups for which a survey is completed. The pros and cons were considered thoughtfully, and in alignment with CAPG’s efforts towards national expansion, it was agreed that the program needs to accurately depict the attributes of accountable, coordinated care for every individual CAPG physician group across the country. The following rigorous categories represent the 2015 Standards of Excellence, with Domains 1-5 to be publicly reported: a. Domain 1—Care Management Practices: Clinical system supports for quality and efficiency on a population scale. b. Domain 2—Information Technology: Funnel for accurate, actionable information to support clinical decisions and coordinate team care. c. Domain 3—Accountability and Transparency: Response to the public demand for objective information regarding performance, patient service, and regulatory compliance. d. Domain 4—Patient-Centered Care: Critical components of access, convenience, cultural responsiveness, and customized individual care.
24 l CAPG HEALTH
Spring 2015
e. Domain 5—Group Support of Advanced Primary Care: Patient-centered Medical Home model and how it’s used to revitalize the discipline of primary care. f. Domain 6—Administrative and Financial Capability: Management of complex relationships, diverse revenue streams, innovative payment alignment, and risk-based payments.
We strive to make this survey better every year— more specific, more scalable, and more responsive to our ever-changing national landscape. These improvements come largely as a result of paying attention to our members’ comments and criticisms, as well as actively listening to the voices of our external partners, observers, and regulators. Feedback and correspondence are welcome in our evolution with SOE. “The products, not the profits, were the motivation,” Steve Jobs said about Apple. Taking a tip from one of the brilliant innovators of our time, let’s make the commitment to focus foremost on clinical excellence in our local healthcare communities nationwide. The rest will follow. For more information on CAPG’s Standards of Excellence, please contact Dr. Amy Nguyen Howell at anguyen@capg.org. o
Winter 2015
CAPG HEALTH l 25
Smartphones Encourage High Participation Among Low-income Patients BY VA L E R I E G R E E N - A M O S , M D , P R ES I D E N T, J . M A R I O M O L I N A M E D I C A L P R O F ES S I O N A L C O R P O R AT I O N
In the spring of 2014, Molina Medical Group planned a nationwide rollout of Epic, an electronic health records system. Epic is considered to be one of the premier EHRs available, used by the University of California, Cedars-Sinai, and Kaiser Permanente, among other top institutions. While bringing 25 clinics live on Epic, we rolled out the accompanying patient portal, MyChart. We were pleased to be offering such an advanced tool that allows patients to message providers, refill prescriptions, and receive their lab results. There were just two potential barriers to a successful launch. One: We treat a vastly underserved population, and many of our patients don’t have access to computers at their homes. Smartphones are very prevalent among our patients, but we were unsure how often patients would use their phone to access their information. Two: Though we were confident our patients would appreciate the advantages of MyChart, change can be difficult for many. We needed a strategy to encourage our patients to try it. Then a medical assistant in our Citrus Heights clinic came up with the perfect approach!
PATIENTS DON’T SAY “NO” TO A NEW HEALTH POLICY The idea was simple: Instead of asking if they would like to sign up, we would inform patients that clinic policy was to enroll everyone in MyChart. They would be free to decline—we would never imply that MyChart was mandatory. The invitation would just not be in the form of a question. As each clinic went live with Epic, when the patients came to appointments, our medical assistants told them of our MyChart policy. We enrolled patients on the spot, helped download the mobile app, and showed them how to use it. Similarly, when walk-in patients came to refill prescriptions, they were invited to request refills online by enrolling in MyChart. Many were ecstatic at the convenience of ordering right from their mobile device. Molina Healthcare member Frankie Buckley learns how to access information through the MyChart portal with guidance from medical assistant Elena Perez. 26 l CAPG HEALTH
Spring 2015
Photos: Leon Ly
Access via smartphone has proven to be no issue at all. Not only have many patients gotten the app, a large percentage actually use it. In September, 58 percent of patients who visited the clinic were active users. By the end of October, the number rose to 72 percent. In December alone, clinics received 672 requests for medical advice and 346 refill orders.
WHAT ABOUT THE PATIENTS WHO DON’T WANT MYCHART? Not everyone is inclined to sign up for MyChart solely because it’s clinic policy. In these cases, our medical assistants encourage them to enroll by pointing out all the information the tool will give them, and how easily and conveniently they can tap into it. Patients comment that they appreciate our enthusiasm for trying to help them live healthier lives—and many times this technique entices them into enrolling.
EFFICIENCIES ON ALL FRONTS One enrollee is Marcelo Bustos, a patient at our Wilmington clinic who signed his daughter up after using MyChart himself for a few months. He says, “I like MyChart because I can have the information right away or when I send an email. I don’t need to call and wait on the call. It’s very useful.”
Frankie tries out the MyChart app on his smartphone.
For clinic physician assistant Rosalind Williams, the advantages of the patient portal are clear. “MyChart helps the patients find out what’s going on with them,” she says. “They can get their lab results. They can leave us messages, and [it] also frees up time for providers, and makes for better continuity of care.” MyChart helps providers in other ways as well.
SIMPLE OPERATION, COST SAVINGS, AND PATIENT-CENTERED CARE Many of our administrative tasks take less time with the app, including appointment scheduling. Others are
eliminated altogether. This amounts to less stress and more time focused on direct patient care. MyChart also saves on paper, and other administrative costs. We can use our office space more efficiently because we no longer have to maintain an ever-growing system of paper files and medical records. Perhaps the greatest advantage of MyChart is that it puts a great deal of knowledge regarding our patients’ health right at their own fingertips, along with a direct connection to the providers who can help them manage it. All these factors make it easier than ever for patients to participate in their own treatment and advocate for what they need. We believe this is truly an example of patientcentered health care. o Spring 2015
CAPG HEALTH l 27
Protecting Patient Health Information: A Necessary Challenge BY K E V I N B . M C D O N A L D , H C I S P P, C H P S E , P R ES I D E N T, N O LO K I H E A LT H C A R E I T A N D C O M P L I A N C E
When you think of Anthem, Inc.; Premera Blue Cross; Community Health Systems, Inc.; and Advocate Medical, what comes to mind? Is it how they are doing amazingly innovative things to improve their patients’ lives? Unfortunately, it’s more likely privacy breaches that are top of mind. I don’t enjoy using these companies as examples, but that is precisely what they are: perfect examples of the healthcare data breach reality and associated brand damage. The potential for brand damage in itself is immeasurable, but federal and state compliance regulations that require the guarding of protected health information (PHI) are no joke either. Articles and other materials on “compliance” have likely found their way to your desk ad nauseam. Let’s not focus on brand issues or even legal reasons why PHI must be protected. Let’s focus on:
Electronic data breach usually impacts many more patients and (hopefully) is not the result of intentional action of a doctor, other practitioners, or the organization’s staff. Data breach and the related violation of trust are, however, often the result of inaction on the part of the same. Protecting patient privacy and trust requires commitment from everyone within a healthcare ecosystem. According to an April 2014 Medscape article, the FBI has warned that criminals are increasingly targeting electronic health records (EHRs) for patient information, which can fetch $50 per chart on the black market.2 With credit card records going for $1 to $2 in comparison, that makes medical records exponentially more valuable. Violating patients’ trust can cause them embarrassment— or worse, to not seek treatment, or to speak less openly when they do. This silence can have devastating impacts on overall population health management. Breach of PHI is more damaging than other personally identifiable information (PII) such as financial records. While in most cases one can recover from typical financial identity theft, this is often not true for the release of medical information and the related ID theft.
THE ETHICAL AND MEDICAL REASONS FOR PROTECTING PRIVACY
Once out, facts about a medical condition cannot be cloaked from future disclosure. The breach of PHI can prevent an individual from getting a job, insurance, or housing, and even destroy friendships and families due to ignorance and fear about mental health, addiction, and disease. Moreover, data breaches can lead to medical identity theft with significant adverse medical outcomes from improperly comingled records. I believe we can agree that the need to keep health records private and away from identity thieves rises well above a legal obligation.
Most agree that privacy is a basic covenant between doctors and their patients. A modern-day Hippocratic Oath states, “I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.”1 With or without the Oath, the majority of doctors would not publicly talk about a particular patient without their consent. However, allowing a data breach to occur is in many ways the same as—if not more damaging than—standing at a podium and revealing patient information.
I fully recognize the challenges of protecting patient data. But with that said, according to the Ponemon Institute Fourth Annual Benchmark Study on Patient Privacy & Data Security (2014), “The economic impact of one or more data breaches for healthcare organizations in this study ranges from less than $10,000 to more than $1 million over a two-year period.” The study continues, “Ninety percent of healthcare organizations in this study have had at least one data breach in the past two years. And the average economic impact of data breaches over
1. The ethical and medical reasons we must protect privacy 2. Fifteen actions that help defend patients’ protected health information (PHI)
28 l CAPG HEALTH
Spring 2015
“
Breach of PHI is more damaging than other personally identifiable information...While one can recover from financial identity theft, this is often not true for medical information.”
the past two years for the healthcare organizations represented in this study is $2.0 million.”
In Ponemon’s 2014 Cost of Data Breach Study Global Analysis, the individual per record cost of medical data breach is $359 per record, versus $201 per record across all industries. If the privacy issues are not enough motivation, those statistics should serve as a basis for ROI on significant investment in prevention. Compliance and security can also considerably improve workflows and identify organizational redundancies and inefficiency. With incredible growth in digital technology making data far more accessible, understanding and managing the risks are critical. With governments and ecosystem partners requiring that doctors and healthcare organizations go digital, isolating the system or going back to paper are not viable options. So, how can we be good stewards of our patients’ protected health information? Following are some actions we can take to begin better securing our sensitive data:
FIFTEEN STEPS TO HELP SAFEGUARD PHI 1. Identify and classify what data are possessed, where they are, and how they are accessed and shared. You cannot protect data without doing this first 2. Fully assess entity-wide risks to confidentiality, integrity, and availability of data. This must include technical, physical, and administrative review 3. Develop a risk remediation and management plan based on the assessment results 4. Develop accurate and complete policies and procedures that cover all aspects of the organization’s handling of PHI and work to protect the confidentiality, integrity and availability of the data
5. Verify that employee and partner actions actually match the policies and procedures prescribed 6. Identify and classify employee roles and institute controls to limit and monitor access 7. Create a security incident response team (SIRT) to plan for and activate upon a potential breach 8. Institute systems monitoring, logging, and auditing for illicit or anomalous behavior 9. Schedule regular penetration and vulnerability testing 10. Institute a comprehensive and consistent software patch and upgrade program 11. Remove administrative rights from all accounts where possible 12. Install and maintain best-of-breed antivirus and malware protection 13. Encrypt data at all points in the system where possible. Failure to encrypt is a leading cause of breach notification 14. Require and adhere to best practices as they relate to password complexity, changes, and sharing 15. Train, train, train and then test staff knowledge on a regular basis I know the list seems a bit daunting. It’s true that compliance takes commitment, consistency, and investment. It is also true that compliance distracts from other priorities, but it’s the law—and ultimately, compliance is about protecting the privacy of patient data. And after all, let’s not forget that perfect example of the alternative: even after recovering as an organization, Anthem will undoubtedly be associated with the words “data breach” for the foreseeable future. The good they do for many years to come will be muffled by this one horribly unfortunate event. We all must work to ensure that we do not join them in that distinction. o Kevin B. McDonald is a certified healthcare information security and privacy practitioner (HCISPP); Chairman of the Orange County Sheriff Coroners’ Technology Advisory Council; and a member of the High Tech Crime Consortium (HTCC), the U.S. Secret Service LA Electronic Crimes Task Force (LAECTF), and InfraGard. 1 Peter Tyson, “The Hippocratic Oath Today,” Nova, March 27, 2001. http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html 2 http://www.medscape.com/viewarticle/824192http://public.dhe.ibm. com/common/ssi/ecm/se/en/sel03027usen/SEL03027USEN.PDF Spring 2015
CAPG HEALTH l 29
network physicians, and provide physicians and patients new tools to improve coordination of care. The two organizations will also apply for a restricted Knox-Keene license effective in the Greater Bay Area. Issued by the California Department of Managed Health Care, the license would enable the network to contract directly with health plans to develop an insurance product that provides access to high-quality care at an affordable price.
BAACKES TAKES HELM AT L.A. CARE HEALTH PLAN
Names in the News...continued from page 8
which will provide renal, vascular, and related services to covered members. Through these coordinated networks, the organizations will seek to expand value-based contracting models with payors and jointly sponsor research initiatives to drive clinical innovation forward.
UCSF MEDICAL CENTER, JOHN MUIR HEALTH AFFILIATE TO DEVELOP REGIONAL HEALTHCARE NETWORK UCSF Medical Center and John Muir Health have finalized an agreement that will serve as the foundation for a healthcare network intended to provide high-quality care and enhanced patient experience at lower cost throughout the Bay Area. Under the agreements, both organizations remain independent while investing in the Bay Area Accountable Care Network, a collaborative effort to form a regional healthcare network. The health systems will also co-own and operate a new development company, enabling them to collaborate on building new medical facilities, increase the number of
30 l CAPG HEALTH
Spring 2015
John Baackes became chief executive officer at L.A. Care Health Plan on March 23. He succeeds Howard A. Kahn, who had announced his departure as CEO a year ago. Baackes brings more than 30 years of healthcare experience to L.A. Care, the nation’s largest publicly operated health plan serving more than 1.6 million members. He formerly oversaw the Medicare Advantage business unit at AmeriHealth Caritas, based in Philadelphia, PA. Previously, he served as CEO of Senior Whole Health in Cambridge, MA, a voluntary health care plan for more than 10,000 low-income seniors in Massachusetts and New York. Baackes also was senior vice president for Group Health Incorporated in Albany, NY; president of Kaiser Permanente’s Northeast division in Latham, NY; and CEO of Community Health Plan, also in Latham.
ALAMEDA HEALTH SYSTEM RECEIVES $400,000 KAISER PERMANENTE GRANT TO REDUCE HEART ATTACKS AND STROKES Kaiser Permanente will continue its support of Alameda Health System’s (AHS) Preventing Heart Attacks and Strokes Everyday (PHASE) program with a two-year, $400,000 grant. The funds, administered by Alameda Health System Foundation, will enable AHS to expand the number of participants in PHASE, which targets adults ages 45 to 74 with uncontrolled diabetes or hypertension. Kaiser Permanente is awarding a total of $5.25 million in 17 PHASE grants across Northern California. Grants will support technology and work process changes necessary for implementing PHASE, as well as assistance in program evaluation. Organizations receiving PHASE grants join a learning community that engages in training, problem solving, and advancing best practices. o
More than 1 million prescriptions to date1*
Covered
for more than 80% of commercially insured patients
without prior 1 authorization
®
Savings Card
Learn more and register for updates at INVOKANAhcp.com
*Data on file. Based on TRx data sourced from IMS NPA Database, weekly data through 6/6/14. † The Savings Card is not available to patients enrolled in federally subsidized healthcare programs that cover prescription drugs, including Medicare, Medicaid, TRICARE, or other federal or state programs.
>> Subject to a $3,900 maximum annual benefit, 12 months after activation or 12 uses, whichever comes first >> Continuing support may also be available for eligible patients who have exhausted their 12 months in the program >> For eligibility requirements and restrictions, visit INVOKANACarePath.com or call 1-877-INVOKANA (1-877-468-6526) Reference: 1. Data on file. Janssen Pharmaceuticals Inc., Titusville, NJ.
Janssen Pharmaceuticals, Inc. Canagliflozin is licensed from Mitsubishi Tanabe Pharma Corporation. © Janssen Pharmaceuticals, Inc. 2014
September 2014
019651-140807
Winter 2015
CAPG HEALTH l 31
Putting Data to Good Use With the shift away from fee-for-service care to value-based care, the ability to share data across a network of providers has become more important than ever. It helps large medical groups reduce costs, improve care delivered to patients, and sharing data creates more opportunities to participate in innovative products. Access to data, plus advanced analytics, do even more. Transforming raw clinical data into useful information has allowed Brown & Toland Physicians to become one of the nation’s leading clinically integrated medical groups with positive population health management outcomes, including reducing the total cost of care. Using data and analytics for the Innovation Centers’ Pioneer Medicare Accountable Care project, Brown & Toland Physicians reduced hospital bed days, hospital readmissions, and increased preventative screening rates for close to 18,000 Medicare patients in the Bay Area, saving the Medicare program more than $15.1 million over two years. Data can be a “game changer.” With the right tools, medical groups can keep patients healthy, help physicians deliver patient-centered care, and reduce overall healthcare costs. Patients, doctors, and payers all benefit from use of data and analytics through population health management programs. To learn more about Brown & Toland Physicians, please visit our website at www.brownandtoland.com.
Keeping the San Francisco Bay Area healthy for more than 20 years
brownandtoland.com