AHP Practice Managers Quarterly Meeting-Q&A Session Thursday, March 19, 2015 Gainsharing: If the dollars saved are shared between payer and network, where are the savings for healthcare? The dollars retained by the payer represent fewer dollars the payer had to spend on care for the population covered by the contract. If payers and networks can continue that trend, the overall cost of healthcare for a population can decrease over time, and those savings can translate into lower overall costs for healthcare consumers. How do you document the quality? Presently, we are in the process of connecting the primary care EMRs to a data analytics product called Arcadia. Arcadia will extract quality metric data related to AHP’s gainsharing contracts, and measure the physicians’ performance against those metrics. The extractions will occur on a daily or weekly basis, thus allowing the care teams within the practices to identify gaps in care and develop timely and effective care plans for those particular patients. Will the gainsharing be spread out between all 1,701 physicians in the network? No decisions have been made regarding the distribution of gainsharing across the network. AHP’s Finance Committee will work over the next three months to recommend a distribution methodology to the AHP Board of Managers. The Finance Committee represents a cross-section of AHP’s key stakeholders, and its members understand AHP’s finances sufficiently well so as to make a well-informed recommendation. Do GRIPA practices qualify for gainsharing? The Finance Committee will determine eligibility for gain-sharing. How did practices get on the Arcadia WAVE list? AHP’s IT department has created a robust work plan to connect over fifty primary care practices to Arcadia. The implementation timeline is seven weeks per practice, and includes data mapping, integration of claims data, front end configuration, and data validation. There are twelve implementation “waves”, with an average of four to six practices in each wave. The wave groupings were based on practices with the same or similar EMRs, thus allowing IT to identify and rectify any issues specific to that EMR product across multiple practices. The first wave of Arcadia implementation kicked off in February, and the last one is scheduled for midSeptember. A lot of patients are confused over the two employee healthcare plans offered by the University of Rochester. Can you explain how the deductibles are applied? The UR 2015 Employee Benefit Plan Resource Guide contains a full explanation of the cross applying deductibles. The Resource Guide may be downloaded here: http://ahpnetwork.com/urresources/ 135 Corporate Woods · Suite 320 · Rochester · NY 14623-1466 · phone: 585.758.7823 FAX: 585.424.1268 [email protected] Will we be able to get a printed directory of AHP Providers? Like many networks, AHP’s Provider Directory is only available online. It is updated on a daily basis, and may be accessed at http://ahpnetwork.com/search-provider/ Please contact the Provider Relations Department if you have a specific request, and we can provide you with a customized report. Are Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives Tier 1 or Tier 2? For the purposes of the UR health plans, Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives that bill under an AHP-participating practice’s group TIN are considered tier one providers. What should I do if claims for my Nurse Practitioners or Physician Assistants are processed as Tier 2? First, contact the Provider Relations department at Aetna/Excellus to ensure that the provider’s name is listed under the group’s TIN. Then contact AHP to ensure that our records include the provider’s information. Anesthesiology presents a hole in the process at Ambulatory Surgery Centers, where a UR health plan patient may get hit with a fee from a Tier 2 provider. Is that what’s called a “Surprise Bill?” No. While ASCs are untiered, Anesthesiologists are tiered. If an anesthesiologist participates with Aetna and Excellus, and s/he is a member of AHP, the claims will process as tier one. If the anesthesiologist is not a member of AHP, but is par with Aetna/Excellus, the claims will process as tier two. In this situation, the disclosure requirements of the Surprise Bills law do NOT apply. However, if the Anesthesiologist is par with neither Aetna nor Excellus, then the claim will process as tier three, or out-of-network. In that situation, the disclosure requirements of the Surprise Bills law would apply. 2