October 2017 Newsletter


MACRA/MIPS Update
Payor Partnerships
Medical Benefits 2018
Electronic Prescribing of Controlled Substances
SOHO HEALTH Physician Liaisons
Medical Malpractice Insurance Testimony
Value Added Program Update
Upcoming SOHO HEALTH Events
Annual Shareholders Event
A Patient Story


MACRA/MIPS Update

October 2, 2017, marked the start of the final 90-day reporting period for 2017 under the Merit Based Incentive Payment System (MIPS).  Your performance and reporting for 2017 will affect your 2019 Medicare fee schedule.

All providers participating in the SOHO HEALTH Medicare Shared Savings Program Accountable Care Organization (MSSP ACO) will automatically receive identical scores in the Quality and Clinical Practice Improvement categories.  There is no need to individually report in these categories.

The Cost category is eliminated for MSSP ACO providers.  SOHO HEALTH is already in a financial arrangement with CMS.

All SOHO HEALTH MSSP ACO Providers/Groups must submit data in the Advancing Care Information (ACI) category.  This is the new name for Meaningful Use (MU) and relates to the use of your EMR system.  Data must be submitted prior to March 28, 2018.

SOHO HEALTH encourages all providers to submit at least the base score component of ACI which covers the following four areas:

  1. Security Risk Analysis
  2. E-Prescribing
  3. Patient Access (Patient Portal)
  4. HIE Function (Send a Summary of Care document)

The ACI scores for all SOHO HEALTH MSSP ACO providers will be averaged to obtain a final ACI score.  That score is applied to all SOHO HEALTH MSSP ACO providers and will be added to the Quality and Clinical Practice Improvement categories scores for the ACO to reach the final MIPS Composite Score.

The MIPS Composite Score will be identical for all SOHO HEALTH MSSP ACO providers.  This score is used to determine the adjustment to your 2019 Medicare fee schedule.

Working with you, for you!

Please contact Ronald Kimmel, M.D., Vice President and Chief Medical Officer at Rkimmel@stfranciscare.org if you have any further questions.

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Payor Partnerships

We continue to see market evolution in terms of alternative network models and product designs.  The latest movement toward narrow network products designed to drive business to high performing providers accelerates with three new agreements planned for January 1, 2018.

Aetna Whole Health is a co-branded commercial and Medicare Advantage product with a statewide narrow network created to offer a 10% medical cost difference to consumers compared to broad network products.  In addition to all SOHO HEALTH and Trinity Health Of New England hospitals and providers, the network includes: Griffin, St. Vincent’s, Middlesex, Danbury, Norwalk and New Milford hospitals and their aligned physicians.  Other entities that are either preferred or exclusive, depending upon product design, include ProHealth Physicians, Connecticut Children’s Medical Center and aligned physicians and other specialty physicians to fill specialty gaps.  Regardless of product design, SOHO HEALTH and Trinity Health Of New England providers will be the most cost effective option for consumers.

UnitedHealthcare Nexus ACO is a new national network commercial product to be rolled out statewide. The product utilizes a tiered network that will include SOHO HEALTH and Trinity Health Of New England providers in the most favorable Tier 1.  The product will be designed with a 20-30% benefit differential between Tier 1 and other providers.  Nexus ACO will target national companies with employees throughout the country (e.g. CVS).

ConnectiCare Passage is a narrow PCP network commercial and Medicare Advantage product.  In addition to SOHO HEALTH PCPs, the network includes ProHealth Physicians, CliniSanitas Centers and the Connecticut State Medical Society IPA.  SOHO HEALTH specialists and hospitals are also in network.

The inclusion of SOHO HEALTH in these narrow networks speaks highly of the care rendered by our members and the work we have done together over the years to make SOHO HEALTH a premier partner with payors seeking value based relationships for their members.

Please contact John Sunde, Vice President Payor Partnerships & Strategic Initiatives, at John.Sunde@stfranciscare.org or 860.714.1532 if you have any further questions.

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Medical Benefits 2018

Affordable health care is a challenge for many families in our community.  As we re-evaluate our health and wellness benefits coverage for 2018, we have found an opportunity for our members and community practice employees to potentially participate in a medical benefit program with competitive rates and a robust offering.

We are excited to announce our partnership with Engage; one of the nation’s leading Professional Employer Organizations specializing in providing health care professionals with cost effective employee benefits, human resource management, payroll and workers compensation. Coming together as a larger group will reduce medical insurance costs by sharing the risk with others while giving you access to in-network pricing discounts.

We will be reaching out to our membership soon with more detailed information.

If you are interested in learning more about this valuable opportunity, please reach out to Kathy Strauch at kstrauch@stfranciscare.org or 860.714.1245.

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Electronic Prescribing of Controlled Substances

The State of CT has passed a new regulation that requires providers to use electronic prescribing for controlled substances starting January 2018. The law requires providers to use “2-Factor Authentication,” which means that you need to have at least 2 out of the 3:

  1. Something you know – Your password
  2. Something you are – e.g. Your fingerprint
  3. Something you have – e.g. receive a one-time code on your phone

More details about the legislation can be found on the CT State website: An Act Preventing Prescription Opioid Diversion and Abuse.  A summary of the bill, which includes descriptions of exemptions, can be found at this link: https://www.cga.ct.gov/2017/ba/2017HB-07052-R000186-BA.htm.

If you are using Epic EMR:

The Epic team is working on electronic prescribing functionality with the 2-Factor authentication capability. More details will follow from the Epic team.

If you are using a different EMR:

SOHO HEALTH recommends you contact your EMR provider.  Some questions you should ask your vendor:

  • Are they aware of the CT regulation?
  • What 2-Factor Authentication will they use?
  • Will this require additional hardware, software or cost?
  • What is the timeline for implementation?

If you have further questions, please contact Ronald Kimmel, MD Rkimmel@stfranciscare.org or Sudeep Bansal, MD Sbansal@stfranciscare.org.

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SOHO HEALTH Physician Liaisons

As you know, SOHO HEALTH has a long standing commitment to our members and the patients our members support. Our liaisons are here to connect you, with the resources and tools SOHO HEALTH provides including:

  • Working with you to navigate your needs as a member
  • Advocating on your behalf
  • Introducing and connecting you to area colleagues
  • Assisting you to stay up to date with the education and training SOHO HEALTH provides

In short, they are here to provide you with direction to get the answers you are looking for.

Our liaisons are working with you, for you!

Please contact our Physician Liaisons; Kelly Bluestein at kelly.bluestein@stfranciscare.org Michael Pratt at mpratt@stfranciscare.org, for more information, or if you have any questions regarding your membership.

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Medical Malpractice Insurance Testimony

Mark Salsbury, Practice Administrator, at Cottage Grove Cardiology said, “We realized a savings of $50,000 which is a 35% reduction in our annual premium. Wow!  Great job!”

There are currently 100+ clinicians enrolled in our Connecticut Affiliated Physicians Purchasing Group (CAP-PG) program.  By becoming a CAP-PG member, you and your practice can access the program and begin saving money on your malpractice insurance premiums.

If you or your practice is interested in learning more about this value added program, please contact Kathy Strauch at 860.714.1245 or kstrauch@stfranciscare.org.

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Group Purchasing Program Update

SOHO HEALTH reaches $300,000 in savings for its members who have joined the SOHO HEALTH AdvantageTrust discount medical and office supply program!

SOHO HEALTH has provided its members with a group purchasing program to make a positive impact on the financial success and sustainability of our member practices.  Our goal has been to provide you with highly competitive pricing off medical and office supplies to drive savings for your practice.

Would you like to save money like your member colleagues?  If so, please contact Kathy Strauch at 860.714.1245 or sign up directly at http://purchaseclinic.com/SFHCP/

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Upcoming SOHO HEALTH Events

SOHO HEALTH has a Practice Managers Meeting coming up on November 14 and another two Provider Educations scheduled for December.  Have you signed up yet?

Did you know that you can RSVP directly to us and see a full list of all upcoming events at SOHO HEALTH on our Events Page of the website?  You can view them here.

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Annual Shareholders Event

Join SOHO HEALTH leadership and your colleagues to learn about the new withhold funding model, as well as new programs and initiatives for you and your patients.

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A Patient Story

The following story highlights the work of one of our team members, Maria Agudelo-Chan, RN-BC, has done on behalf of one of our patients.

HISTORY

Tom (not his real name) is a 48-year-old patient who was referred to Maria Agudelo Chan, RN-BC, CHF Navigator from Susan Marcantonio, RN, COPD Community Healthcare Navigator as an interdisciplinary referral. Tom had been engaged with Susan Marcantonio as he had been diagnosed with COPD. Consultations by an APRN with Saint Francis Hospital’s COPD program revealed that Tom really suffered from restrictive lung disease secondary to obesity. After intensive conversations regarding the his needs, the COPD APRN believed that Tom would benefit from disease management for diastolic heart failure.

Between January 2017 and June 2017, Tom had six inpatient stays and three emergency room visits at Saint Francis Hospital and Medical Center. He routinely missed follow-up appointments with his providers – specialty and PCP – and as a result had been discharged from his primary cardiology practice.

ENGAGEMENT WITH CARE COORDINATION SERVICES

Maria was able to engage Tom in navigation and care coordination services and identified key barriers hindering his care.

After building a rapport with Tom, Maria identified that he struggled with severe anxiety and confirmed his non-adherence to follow-up appointments. Maria worked with Tom to arrange follow-up appointments with visiting nurses, his primary care physician, pulmonology and cardiology. After several cancellations with his primary cardiologist, Maria coordinated a timely disease management follow-up with Saint Francis Hospital and Medical Center’s CHF Clinic and worked with his PCP office to submit a referral for a new cardiologist.

Today Tom uses SOHO HEALTH’s navigation services on a regular basis and wants to take control of his health and manage his symptoms. Maria has educated him on healthy lifestyle changes and diet choices.  She has stressed the importance of attending follow-up appointments with his specialty providers and his primary care physician as well as the importance of attending behavioral health services to review coping strategies and ways to manage anxiety, stress, and health issues.  In addition, she has encouraged Tom to seek out information from his PCP and specialists on ways to manage chronic conditions and identify prevention strategies to avoid exacerbations of his COPD.

Since engaging with care coordination services in June, Tom has only had one  admission to the hospital. Tom routinely follows up with his providers, has lost more than 30 pounds since July and has said he wants to engage in more activities to better his health.

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