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Continuum Provider Partners IPA Formation and Clinical Integration


									Continuum Provider Partners IPA
Formation and Clinical Integration

                                 July 2012

Continuum Provider Partners IPA
Continuum Health Partners, Inc. (“CHP”), - Beth Israel Medical Center,
St. Luke’s Hospital, Roosevelt Hospital, and New York Eye and Ear
Infirmary – in collaboration with its voluntary and employed providers,
is establishing a clinically integrated network to address the future of
health care delivery.
Through the establishment of this network by means of an
independent practice association, the IPA will improve the quality and
efficiency of care provided to our communities and offer meaningful
value to payers.

Continuum Health Partners Goals for IPA Formation

  •To achieve a high-performing, seamless system of care across the IPA
  network in partnership with payers and other providers.
  •To improve performance on the key dimensions of quality, cost and
  patient and provider satisfaction.
  •To prepare for the emerging healthcare environment:
      4 Value-based  purchasing (pay for performance, shared savings)
      4 Bundled payments

      4 Financial penalties for avoidable care

      4 Formation of accountable care organizations (“ACOs”).

  •To strengthen our ability to attract patients.

Steering Committee Members
                 Name                               Title                                    Organization
  John Collura             EVP/CFO                                                Continuum Health Partners

  Gail Donovan             EVP/COO                                                Continuum Health Partners

  Beth Essig, Esq.         EVP, General Counsel                                   Continuum Health Partners

  Frank Cracolici          President                                              St. Luke’s/Roosevelt Hospital

  Harris Nagler, M.D.      President                                              Beth Israel Medical Center

  Nina Brodsky             Senior Associate, General Counsel                      Continuum Health Partners

  Richard Amiraian, M.D.   Medical Director CMG/Co-director MHI                   St. Luke/Roosevelt Hospital

  Brendan Loughlin         SVP, Finance                                           Continuum Health Partners

  Gary Burke, M.D.         Vice Chair of Internal Medicine, SLR/Co-director MHI   St. Luke/Roosevelt Hospital

  D. McWilliams Kessler    President/CEO                                          New York Eye and Ear Infirmary

  Adam Henick              SVP, Ambulatory Care and Medical Enterprises           Continuum Health Partners

  Michelle Leone           SVP, Revenue Cycle Operations and Managed Care         Continuum Health Partners

  Ed Lucy                  VP, Managed Care, Physician Contracting                Continuum Health Partners

  John Aljian, M.D.        Attending, Department of Ophthalmology                 New York Eye and Ear Infirmary

  Alan Santos, M.D.        Chair, Anesthesia                                      St. Luke’s/Roosevelt Hospital

  Maurice Alwaya, M.D.     Attending, Pulmonology                                 Beth Israel Medical Center Brooklyn

  Russell Berdoff, M.D.    Attending, Cardiology                                  Beth Israel Medical Center

  John Cornwall, M.D.      Sr. Attending, Internal Medicine                       St. Luke’s/Roosevelt Hospital

  Susan Boolbol, M.D.      Chief, Breast Surgery                                  Beth Israel Medical Center

Clinical Integration

“An active and ongoing program to evaluate and modify the clinical
practice patterns of the physician participants so as to create a high
degree of interdependence and collaboration among the physicians to
control costs and ensure quality.”*

Components of Clinical Integration
• Mechanisms to monitor utilization, control costs, and assure quality
  of care.
• Population health management across the continuum of care.
• Use of common IT to ensure exchange of all relevant patient data.
• Development and adoption of clinical protocols.
• Care review based on and adherence to implemented protocols.

*FTC/DOJ Statements of Antitrust Enforcement Policy in Health Care, #8.B.1 (1996)

What the FTC looks for (No Cookie-cutter Approach)

Components of CI
• Mechanisms to monitor utilization, control costs, and assure quality of care.
• Selectivity of physician participants.
• Significant investment of monetary and human capital.*
• Use of common IT to ensure exchange of all relevant patient data.
• Development and adoption of clinical protocols.
• Care review based on the implementation of protocols.
• Mechanisms to ensure adherence to protocols.**

FTC Tests for CI
• Is the CI “real”: authentic initiatives actually undertaken?
• Are the initiatives of the program designed to achieve improvements in
  healthcare quality and efficiency?
• Is joint contracting with fee-for-service plans “reasonably necessary” to
  achieve the efficiencies of the CI program?**
*FTC/DOJ Statements of Antitrust Enforcement Policy in Health Care, #8.B.1 (1996)

**FTC/DOJ, Improving Health Care: A Dose of Competition Ch. 2, p.37 (July 2004)

Messenger Model For Managed Care Organizations

  Participation Overview

       clinical integration is under development, IPA may serve as
  messenger for voluntary physicians.

  •As messenger, IPA may coordinate and analyze information and
  communicate with payers on behalf of individual voluntary
  physicians, but it cannot negotiate on behalf of them or make
  recommendations about participation.

  •IPAmust communicate with each voluntary physician individually
  about acceptable contract terms, including fees.

Messenger Model For Managed Care Organizations

  Participation Overview

  •Each voluntary physician must make his or her own independent
  and unilateral decision whether to accept a contract.

  •Competitively  sensitive information, which includes but is not
  limited to rates, obtained by IPA as messenger is confidential and
  cannot be shared with other physicians, even with those acting in
  their capacity as IPA officers and directors.

  •IPA’s  directors, officers, and members cannot query IPA’s staff,
  officially or unofficially, about IPA’s contracting activities as
  messenger, except whether the activity has commenced, is in
  progress, or has concluded.

  •Each voluntary physician and payer retains the right to contract
  with one another without IPA participating as a messenger.

Provider Participation
Eligible Providers
Physicians, podiatrists, dentists, behavioral health professionals,
hospitals, ambulatory surgery centers, diagnostic and treatment
centers, FQHCs, and other ancillary providers.
•Licensed/Certified/Registered providers or accredited facilities.
•Member of the medical staff (in any capacity) of at least one CHP
member hospital.
•Board certified in declared primary specialty (unless waived by IPA’s
credentialing committee).
•Complete and sign IPA application.
•Review and sign Provider Participation Agreement.
•Pay annual membership dues.
•Be credentialed by the IPA.
How to Join

        •     Beginning in July, CHP will send electronic and hard copy mailings of
              an introduction package to potential provider participants.
        •     The application and provider participation agreement will be
        •     A central communication line will be staffed to provide additional
              information and to answer any questions providers have.
        •     A website is being established to facilitate online enrollment in the
              IPA; additional details and links to the website will be announced in
        •     Providers will complete the documentation either online (preferred)
              or in hard copy and mail it back to the IPA.
IPA Key Facts and Milestones

• IPA established as an LLC and approved by NYS: August 2012.
• Initial provider enrollment period: July to September 2012.
• IPA operable for messenger model contracting: September 2012.
• IPA operable for clinical integration contracting: 2013.
• Initial membership dues: $250 per year.
• Continuum Health Partners Hospitals provide initial capitalization.
• Balance of physician and hospital leadership on Board of Managers.


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