Catholic Medical Partners

Annual
Report

2018 - 2019

1A Message from Leadership

Message from Chairman
of the Board

"As Board Chair, I want to thank you for the important work that you do to improve the delivery of healthcare in our community. Every day you make a difference in your patients' lives and in transforming healthcare throughout Western New York. Together, we all play a part in making Catholic Medical Partners (CMP) a successful organization, and a leader in population health management.

 

As a physician member of CMP, I appreciate the value an association of this caliber brings to my practice. CMP provides us with the necessary framework for provider collaboration, as well as the tools, resources, and support needed for many of our practices to remain independent, and for all of our practitioners to excel.

 

This is an exciting time for our organization as we welcome our new President & CEO, Thomas P. Lawrence, MD, MBA. Dr. Lawrence is passionate about private practice and supports the unified efforts of independent and employed physicians. His energy, experience, and expertise will propel us through our next chapter and build on the strong foundation laid by our previous leaders.

 

Thank you for your engagement and commitment to our mission. Your talent, drive, and dedication are what make us the quality providers that we are called to be."

President Kristen Robillard, MD
President Thomas Lawrence, MD

Message from President & CEO

"I am happy to join Catholic Medical Partners as we begin an exciting new chapter for our association and its members. From my vantage point, CMP is a network of phenomenal physicians, all working towards one common goal: transforming the delivery of healthcare in Western New York.

 

I am pleased to lead the efforts of such an accomplished organization and look forward to strengthening the partnerships you have built. It is evident to me that you truly care about your patients and the mission of CMP. It's illustrated through your commitment to deliver high quality, clinically integrated care, while building strong relationships with your patients and colleagues. CMP's pledge, to provide you with the support you need to successfully manage your practice, sets us apart from other organizations. I am eager to continue this collaborative work to help you grow your practices, while preparing for an ever-changing healthcare landscape."

2Summary of Benefits

Catholic Medical Partners is comprised of an experienced and committed group of over 900 physicians, unified by a passion for transforming the way healthcare is delivered in Western New York. Each of our members are committed to being good citizens of the organization. Below lists out what some of those commitments are:

 
  • CMP providers must maintain participation in two Tier 1 Payers and, one tier 2 Payer, or three tier 1 payors, at a minimum to maintain membership in CMP.

  • CMP providers are required to have, and utilize, a certified electronic health record (EHR) system, at all locations, for all patient visits.

  • Providers must comply with CMP's annual Clinical Integration program including at a minimum EMR Quarterly Reporting, or bi-annual CMP quality audits, and adopt its best practice clinical guidelines as approved by Clinical Integration and Standardization Committee.

  • CMP providers must ensure their practices have a designated leads in the following areas: Physician lead, Administrative lead, PCMH lead (as applicable), and Clinical/Quality Improvement lead. The administrative lead may be the same as the PCMH and Quality Improvement lead, but the physician may not be all 4. Each lead is required to have a unique, functioning email address, and meet with their Clinical Transformation and/or Care Management Advisors on a regular basis throughout the year.

  • CMP Providers ensure that they, or the Administrative lead on their staff reviews the weekly email communication sent to CMP members, and communicates important information across the practice as necessary.

  • CMP provider agrees to participate in quality improvement initiatives aimed at improving metrics under the Clinical Integration program.

  • CMP providers agree to update, and maintain referral agreements with other CMP in-network providers. CMP providers must also exchange data at all care transitions with referring provider, including all applicable ICD-10 codes, updated medication lists – including meds started and stopped, medication allergies, and plan of care.

  • CMP providers should participate in at least one large group physician meeting, and CMP physician surveys.

CMP has been providing support to our physician practices for over ten years, on the path towards Population Health Management and Value Based Care. Our team provides a spectrum of services to help our practices meet the ever-changing demands of the healthcare system, and achieve success. We hope that you take some time to review all the different services that our highly-experienced team can provide.

 

CMP Providers must maintain participation in (1) three Tier 1 Payers, or (2) two Tier 1 Payers and, one Tier 2 Payer, at a minimum to maintain membership in CMP. We encourage participation in all CMP contracts. Tiers are based on the number of attributed lives covered under the contract

 

Tier 1

BlueCross BlueShield of Western New York Independent Health Univera

Tier 2

Fidelis Care Martin's Point HealthCare MVP Health Care UPMC Health Plan WellCare
infographic 1

3Raising the Bar

"The triple aim has always served as a compass for our organization. Improving population health, reducing the medical cost trend, and improving the patient experience are clear priorities that are easily visible through the many initiatives we have launched over the past several years. Our model has since expanded to the quadruple aim and incorporates another important piece—physician satisfaction.

 

CMP's clinical integration programs are designed with these important objectives in mind. Your diligence and hard work has allowed us to be successful with the local health plans' at-risk contracts in years past.

 

As we move forward, we must strengthen our commitment to collaboration, communication, alignment, and efficiency. Collaboration and communication among our primary care and specialty care physicians is critical for maintaining network referral integrity and successful transitions of care. Additionally, utilizing tools such as Vatica and CPT II codes enables us to manage risk and accurately measure performance."

David Martinke, DO

David Martinke, DO
Chief Medical Officer, CMP

Patient Centered Medical Home (PCMH) is a national recognition for primary care practices. This recognition requires medical offices to develop intradisciplinary care teams with the purpose of improving care coordination and care management of patient populations while aiming to improve safety, efficiency and quality in patient care.

 

During 2018, over 90% of patients in our risk contracts are associated with practices who not only have this accreditation but have maintained their status through the transition of a three year recertification process to the updated annual process. To do so requires much time, dedication, and sustained effort. We strongly believe that our efforts to assist practices to maintain their certifications has and will continue to position each practice to better respond to the changing healthcare landscape and result in benefits for their patients.

PCMH Status Totals

0 Groups
0 Providers
0,0 Patients

Our proactive approach to health-plan initiatives has proven to result in increased practice revenue. Of the many health-plan initiatives that we have supported, two are the Medicare annual wellness visits and closing gaps in care.

  2017 2018
Univera

4534

4795

HealthNow

7366

9383

Vatica has been shown to provide more accurate risk adjusted payments and allow for more gap closures while completing Enhanced Medicare wellness visits. As of 2018, both HealthNow and Univera utilize Vatica to identify opportunities for risk adjustment resulting in enhanced revenue to practices. There has been a significant increase in the percent of Vatica visits completed from 2017 to 2018 resulting in over 13,000 completed visits!

infographic-2

Crimson Population Health Analytics is clinical business tool that provides a "360 degree view" of the patient by aggregating EMR and Claims data on a practice level with the goal of leveraging that data to guide business decisions while improving patient care and reducing healthcare cost. Currently, we have aggregated data for over 800,000 lives in over 60 practices within Catholic Medical Partners, IPA. During 2018, an Advisory Panel made up of Primary and Specialty providers was developed with using a case study focus around Utilization Metrics and Quality measures.

Case studies include:

 
  • Evaluating patient attributions based on claims (cost/amount of care) vs primary care assignment and how this effects health plan payments.

  • Efficiency score methodology for Specialists: How Primary Care providers use efficiency scoring comparatively and how Specialists can affect their own efficiency scoring.

  • Increased education on a commonly used risk score methodology that is used to determine concurrent vs prospective risk and focusing on the costs of those patients along with care coordination efforts in the practice.

  • Assessing the utilization and costs of ER/Urgent care services along with in/out of network care.

Medent eCW other

61%

25%

3%

infographic 3

Within the healthcare industry, quality improvement using national guidelines (HEDIS/STAR metrics) has become the standard for gaining access to clinically integrated funds. As our local health plans have consistently raised the bar, Catholic Medical Partners, IPA has once again met and exceeded many of the goals associated with the Clinical Integration program.

 

Throughout 2018, we have enhanced the health of Western New York in many areas including Diabetes, Hypertension, and Depression. Our trained team of Clinical Transformation Specialists work 1:1 with practices to help them develop workflows and use various quality improvement tools that not only result in more reportable results but also create a higher standard of care within each of our practices.

98%
72%
80%
73%
85%
3%
75%
88%
  Goals
BMI Screening 98%
BP Control for HTN Patients 72%
Breast Cancer Screening 80%
Colorectal Screening 73%
Depression Screening 85%
Diab HbA1c > 9 Screening 3%
Falls Risk Screening 75%
Tobacco Screening 88%

4Clinical Integration Plans

Catholic Medical Partners is an integrated group of over 900 physicians who work together to deliver high quality, coordinated care for the patients they serve, while working towards achieving the common goal of the quadruple aim; Improving quality while reducing unnecessary costs, and improving both patient and physician satisfaction.

 

As the healthcare delivery and reimbursement model advances from volume (fee-for-service) to value-based, CMP serves as a foundational element for the successful deployment of quality improvement and population health management activities. Each year our clinical integration plan aligns the activities we are asking our members to focus on with this transition. This year's quality goals are updated to reflect the HEDIS 90th percentile, and STAR Ratings goals we need to meet to achieve success with our At-Risk CI Metrics with the health plans.

 

Select your specialty to learn more about your 2019 Clinical Integration plan.

Triple Aim icon

Quality/HPHS

At Risk Components Measure HPHS Payment

100%

Chronic Disease Measures

(measured every 6 months)

$10,000 per year adjusted every 6 months

Measures

  0% 50% 100% 110%
HbA1C < 8

< 65

65 - 75

75 - 80

> 80

Medical Attention for Nephropathy

< 82

82 - 93

93 - 98

> 98

Eye Exam

< 50

50 - 65

65 - 80

> 80

Statin Therapy

< 65

65 - 75

75 - 85

> 85

  • Statin Adherence for Patients with Diabetes

These are measures that CMP is at-risk for with the health plans that either have too small of an “n” size to measure each physician/practice individually, or are difficult to measure without claims data. We ask that your practice create reports/alerts within your EMR to help you better track these gaps in care metrics.

 

If CMP achieves these measures as an organization with the health plans it will help to continue to fund the HPHS Program into 2019/2020, and/or provide available dollars for surplus distribution to our membership.

Surplus Distribution

At Risk Components Measure Surplus Distribution Payment*

100%

Overall CMP Budget Met

(surplus through risk contracts)

Distributed in May and November

(Based upon performance of Catholic Medical Partners in the preceding and current years)

*Dollars will be paid out only if the budget has been met and surplus generated.

Quality/HPHS

Monthly HPHS Payment*
 

Fixed

At Risk

Measure Practice Status

50%

50%

Chronic Disease and Preventative Measures

PCMH as of 1/1/2019

0%

100%

 

Non-PCMH

*January-June HPHS payment based upon quality outcomes composite for last cycle of 2018.
July-December HPHS payment based upon first cycle of 2019 (second cycle for EMR reporters).

Measures

  0% 50% 100% 110%
Influenza Immunization (65+)

< 55

50 - 75

75 - 90

> 90

Depression Screening (12+)

< 50

50 - 64

65 - 90

> 75

Colorectal Cancer Screening (50-75)

< 60

60 - 75

75 - 90

> 90

Mammography Screening (50-75)

< 55

50 - 75

75 - 90

> 90

  0% 50% 100% 110%
HbA1C < 8

< 65

65 - 75

75 - 80

> 80

Medical Attention for Nephropathy

< 82

82 - 93

93 - 98

> 98

Eye Exam

< 50

50 - 65

65 - 80

> 80

Statin Therapy

< 65

65 - 75

75 - 85

> 85

  0% 50% 100% 110%
Hypertension BP Control (< 140/90) for Patients with Hypertension (18-85)

< 65

65 - 75

75 - 85

> 85

Cardiovascular Disease Statin Therapy

< 65

65 - 75

75 - 85

> 85

  Vatica EAV Medication Reconciliation
July

20% completion rate minimum

20% completion rate minimum

10% or more discharges have Med Rec or Care Transition Code billed out via claims.

End 2019

75% completion rate

75% completion rate

40% or more discharges have Med Rec or Care Transition Code billed out via claims.

* Payment based on meeting minimum engagement as determined by claims data and Vatica reports. Success on these measures support health plan risk contracts and provide funding for HPHS Payments. Measured by provider.

  • HEDIS Osteoporosis Management

  • Asthma Medication Compliance

  • Statin Adherence for Patients with Diabetes

  • Statin Adherence for Patients with Cardiovascular Disease

These are measures that CMP is at-risk for with the health plans that either have too small of an “n” size to measure each physician/practice individually, or are difficult to measure without claims data. We ask that your practice create reports/alerts within your EMR to help you better track these gaps in care metrics.

 

If CMP achieves these measures as an organization with the health plans it will help to continue to fund the HPHS Program into 2019/2020, and/or provide available dollars for surplus distribution to our membership.

Care Management Measures

At Risk Components

20%

  0% 50% 100% 110%
Annual Assessment & Care Plan Completed for High Risk/ECM Patients

≤ 79

80 - 87

88 - 95

> 95

Address Gaps in Care for High Risk/ECM Patients

≤ 79

80 - 87

88 - 95

> 95

Care Transitions Phone Call for All Hospital Admissions

≤ 79

80 - 87

88 - 95

> 95

Surplus Distribution

At Risk Components Measure Surplus Distribution Payment*

100%

Overall CMP Budget Met

(surplus through risk contracts)

Distributed in May and November

(Based upon performance of Catholic Medical Partners in the preceding and current years)

*Dollars will be paid out only if the budget has been met and surplus generated.

Quality/HPHS

At Risk Components Measure HPHS Payment

25%

TDap /
Postpartum Depression Screening
Baseline Measures in 2019

$10,000 per year maximum, Paid Monthly, based on performance.

75%

Prenatal/Postpartum Visits

* All measures will be analyzed by either an EMR report from your practice, or a sample audit, performed twice per year. For the sample audit, each provider will be given a sample of approximately 20 patients, with a group maximum of 150 patients, who have delivered in the past 6 months at a CHS Facility in Spring of 2019 and the Fall 2019.

** Provider quality performance will be rolled up to GROUP SCORE for each of the metrics, and each member of your group will be paid the same. Your performance on the Spring Audit will impact your payment from July-December. The Fall Audit will impact your payment from Jan 2020- June 2020.

  0% 50% 100% 110%
Prenatal Care

< 75

75 - 84

84 - 89

> 89

Postpartum Care

< 60

60 - 66

68 - 71

> 71

  • HEDIS Osteoporosis Management

These are measures that CMP is at-risk for with the health plans that either have too small of an “n” size to measure each physician/practice individually, or are difficult to measure without claims data. We ask that your practice create reports/alerts within your EMR to help you better track these gaps in care metrics.

 

If CMP achieves these measures as an organization with the health plans it will help to continue to fund the HPHS Program into 2019/2020, and/or provide available dollars for surplus distribution to our membership.

Surplus Distribution

At Risk Components Measure Surplus Distribution Payment*

100%

Overall CMP Budget Met

(surplus through risk contracts)

Distributed in May and November

(Based upon performance of Catholic Medical Partners in the preceding and current years)

*Dollars will be paid out only if the budget has been met and surplus generated.

Quality/HPHS

Monthly HPHS Payment*
 

Fixed

At Risk

Measure Practice Status

48%

52%

Chronic Disease and Preventative Measures

PCMH as of 1/1/2019

0%

100%

 

Non-PCMH

*January-June HPHS payment based upon quality outcomes composite for last cycle of 2018.
July-December HPHS payment based upon first cycle of 2019 (second cycle for EMR reporters).

  0% 50% 100% 110%
Well Child (3 - 6 years)

< 71

71 - 79

79 - 86

> 86

Well Adolescent Visit (12 - 22)

< 62

62 - 65

65 - 69

> 69

Lead Screening

< 87

87 - 88

88 - 92

> 92

These are measures that CMP is at-risk for with the health plans that either have too small of an “n” size to measure each physician/practice individually, or are difficult to measure without claims data. We ask that your practice create reports/alerts within your EMR to help you better track these gaps in care metrics.

 

If CMP achieves these measures as an organization with the health plans it will help to continue to fund the HPHS Program into 2019, and/or provide available dollars for surplus distribution to our membership.

Goals

89.14%

Childhood Combo 10

89.58%

Adolescent Immunizations

Surplus Distribution

At Risk Components Measure Surplus Distribution Payment*

100%

Overall CMP Budget Met

(surplus through risk contracts)

Distributed in May and November

(Based upon performance of Catholic Medical Partners in the preceding and current years)

*Dollars will be paid out only if the budget has been met and surplus generated.

Surplus Distribution

At Risk Components Measure Surplus Distribution Payment*

100%

Overall CMP Budget Met

(surplus through risk contracts)

Distributed in May and November

(Based upon performance of Catholic Medical Partners in the preceding and current years)

*Dollars will be paid out only if the budget has been met and surplus generated.

52019 Important Strategic Initiatives

Strengthening CMP/CHS Network Integrity

The competitive healthcare landscape is rapidly shifting. This is pushing providers to strengthen their partnerships to provide high quality, tightly coordinated care, with providers and health systems that are aligned with similar payment models, and care delivery practices.

 

In 2019 assisting our CMP providers in strengthening this alignment between each other, will be a key strategic initiative. Maintaining network integrity by referring and utilizing in-network providers, facilities, and services, is key to maintaining our mission and vision of achieving the triple aim. Our team will be working with your practices refresh your Referral Agreements, to optimize your practices EMR systems and workflows to achieve improvements in our in-network utilization in 2019. To see a current listing of physicians, facilities and services are in the CMP network, please see our new CMP Provider Brochure.

62019 Meetings

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