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Mesa County Physician

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Accountable Care for Mesa County Physicians Cooperating to Deliver High Quality Health Care to Our Community Gregory Reicks, D.O., FAAFP President Mesa County ... – PowerPoint PPT presentation

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Title: Mesa County Physician


1
Mesa County Physicians IPA Accountable Care for
Mesa County
  • Physicians Cooperating to Deliver High Quality
    Health Care to Our Community

Gregory Reicks, D.O., FAAFP President Mesa County
Physician's IPA
2
Mesa County Physicians IPA
One of the lowest-cost markets in the country is
Grand Junction, Colorado, a community of a
hundred and twenty thousand that nonetheless has
achieved some of Medicares highest
quality-of-care scores
Grand Junctions medical community was not
following anyone elses recipe. But, like Mayo,
it created what Elliott Fisher, of Dartmouth,
calls an accountable-care organization. The
leading doctors and the hospital system adopted
measures to blunt harmful financial incentives,
and they took collective responsibility for
improving the sum total of patient care.
3
Mesa County Physicians IPA
Price adjusted Medicare Payments/Enrollee 2008
4
Mesa County Independent Physicians Association
  • 35 Year History
  • Risk contracting
  • Clinical Integration
  • 295 Members
  • 40 Primary Care

5
Mesa County Physicians IPA
  • Lines of business
  • HMO
  • Private Pay (Commercial)
  • Medicaid (ASO Contract)
  • Medicare (Cost Contract)
  • Dual Eligible (Medi/Medi)
  • CHP
  • HCO
  • PPO
  • Self-funded
  • Initial claims paid net of a withhold
  • 15 of allowed for HMO, Medicare, HCO-PPO plans
  • 15 of allowed RMHP Medicaid fee schedule
  • 0 of allowed for HCO-self funded plans
  • Withholds released on a profit-sharing formula
  • MCPIPA/RMHP share 55 / 45 in first 9 million
  • Balance shared at 80 / 20 until full W/H returned

6
Mesa County Physicians IPA
7
Mesa County Physicians IPA
Historical Withhold Return
8
Mesa County Physicians IPA
53
9
What the Evidence Shows
  • Delivery System Reform Without Payment Reform
    Does Not Work
  • Investing in Primary Care Works
  • Cost Accountability Works

10
What Do We Mean by Payment Reform?
11
What Do We Mean by Payment Reform?
12
Isnt This Capitation? No.
13
Mesa County Physicians IPA
Thank you
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