PCP Incentive Payments
Primary Care Providers (PCPs) in the SOHO HEALTH network are receiving incentive payment checks during the months of August and September from two different sources, SOHO HEALTH and Anthem.
The SOHO HEALTH PCP Incentive program was approved by the SOHO HEALTH Board of Directors to incentivize our current PCPs for their continued work in and increased demands of value based healthcare. In 2017, PCPs will receive $1 per member per month (PMPM) for each of their attributed patients covered under SOHO HEALTH negotiated contracts. This included MSSP, Medicare Advantage and Commercial contracts. Checks will be distributed biannually – the first distribution took place in August. One check per group/TIN was delivered in August to each group’s main office covering the first six months of 2017. Checks ranged up to $10,000 for one solo physician and nearly $19,000 for a two-provider practice.
SOHO HEALTH distributed approximately $450,000 to its 283 PCP providers.
In addition to the SOHO HEALTH-funded PCP incentive payment, SOHO HEALTH negotiated an additional per member per month from Anthem. As with the SOHO HEALTH-funded incentive payment, PCPs receive payments based on their attributed lives under the Anthem contract. These incentive checks will be delivered in early September. The highest solo physician payment was $6,947. One large PCP group’s payment tipped the scales at $78,638.
SOHO HEALTH distributed approximately $264,000 in total to the 181 PCP providers in the SOHO HEALTH Anthem contract.
Another incentive payment from each program will be delivered in January 2018 covering the final six months of the year.
Congratulations to our PCPs for their dedication to excellent patient care!
PCP Earned Funds Program
The goal of the 2017 ACO PCP Incentive Program is to drive provider participation and engagement in the ACO and encourage improved performance under the MSSP ACO contract. Criteria and metrics, for the 2017 program year only, are intended to reward PCP providers for their participation. It is the intent of the SFHCP ACO Board of Directors to add performance criteria as we get more sophisticated and aligned in our program.
For 2017, there are three participation measures where you can earn points:
|Measure||Purpose||Attendance Required||How to Earn Points||Total Points Available|
|PCP and Regional Medical Director POD meetings.|
3 meetings over 9 months
|• ACO education|
• Provider alignment
• Provider engagement
• Network alignment
|Primary Care Provider||Attend 1 meeting = 1 point||3|
|SFHCP Care Coordinator and Practice Meetings. |
4 meetings planned over 9 months
|• More coordinated care for our patients|
• Alignment with care teams
• Education/ understanding of role of care team and services available
|Practice staff including nursing, MAs, providers, and scheduling staff||Attend 1 meeting = 1 point||4|
|All Provider Education Sessions. 4 planned over 9 months||• ACO education|
• Provider alignment
• Provider engagement
• Network alignment
|Primary Care Provider||Attend 1 meeting = 1 point||4|
|Total Points Available||11|
2017 Q1 & Q2 PCP Top Earned Funds Program Performers
|Provider||Practice||Total Points||% of Possible Points Earned 2017|
|Andrew Feller , MD||Asylum Hill/The Family Medicine Center||11||100%|
|Roy Zagieboylo, MD||Asylum Hill/The Family Medicine Center||10||91%|
|Erica Cherry , APRN||Collins Medical Associates||9||82%|
|Maria Annal, PA||Collins Medical Associates||9||82%|
|Robert Safer, MD||Collins Medical Associates||9||82%|
|Susan Wiskowski, MD||Collins Medical Associates||9||82%|
|Daniel Chilton, MD||Daniel Chilton, M.D.||9||82%|
|Patrice Horan, APRN||Prime Healthcare||9||82%|
|Wayne Paulekas, |
|Ronald Szabo, MD||Collins Medical Associates||8||73%|
|Shannon Beausoleil, MD||Collins Medical Associates||8||73%|
|Lalarukh Mufti, MD||Comprehensive Medical Group, LLC||8||73%|
|Judith Mascolo, MD||Judith M. Mascolo, M.D.||8||73%|
|E. Spencer Joslin, MD||Prime Healthcare||8||73%|
|Nanette Alexander, APRN||Prime Healthcare||8||73%|
|Robert Reginio, MD||Prime Healthcare||8||73%|
If you are interested in learning more about upcoming PCP Regional Medical Director POD meetings, please contact Joann Carrasquillo at JCarrasq@stfranciscare.org for the PCP Regional Medical Director POD meetings.
If you need information on the SOHO HEALTH Care Coordinator meetings, please contact Malone Smith at MaSmith@stfranciscare.org.
Visit www.sfhcp.org to find a calendar of the all provider education sessions that are scheduled.
United MA-PCPi Bonus
UnitedHealthcare recently delivered a check for $567,100 to SOHO HEALTH for our 2016 performance on the Medicare Advantage Primary Care Provider Incentive (MA-PCPi) program. The payment was based upon meeting certain quality standards for our attributed United Medicare Advantage patients.
To earn this bonus payment, SOHO HEALTH PCPs needed to achieve a Stars Rating (a national quality rating scale for Medicare Advantage plans) of 4.0 or higher to qualify. Stars rankings are calculated with information submitted to the payors from a variety of sources including; information submitted through the Healthcare Quality Patient Assessment Form (HQ-PAF), services billed by providers (claims data), and supplemental quality data collected and submitted by the SFHCP Quality Data Services team.
PCPs will receive $100.00 per attributed patient under the United Medicare Advantage member roster. Checks will be delivered in September to each PCP group’s main office.
This quality bonus reflects on of the many benefits of being a shareholder/owner in SOHO HEALTH. As always, we are working with you, for you.
Congratulations to our PCPs on outstanding quality care!
LiveWell™ Chronic Disease Self – Management Program
The LiveWell™ Chronic Disease Self-Management Program is an evidence-based program created at Stanford University’s Patient Education Research Center. The goal of the program is to provide tools with which patients can better manage their chronic illnesses and health issues. Saint Francis Healthcare Partners has two healthcare coaches and one social worker certified to facilitate the workshops. Program offerings include Diabetes, Chronic Pain, and Management of Chronic Conditions. This program is offered free of charge to your patients.
The next LiveWell™ series is scheduled to begin on September 19th and run for six weeks. The series will be held at Saint Francis Hospital and Medical Center. September’s sessions will focus on Chronic Disease Self-Management. If you have patients who you feel may benefit from this program or would like more information on the LiveWell™ program, please contact Angelica.VanOstrand@stfranciscare.org .
Did you know that Saint Francis offers medical malpractice insurance at a discounted rate through a unique partnership with Coverys?
• It’s easy to change your policy mid-term. You don’t have to wait until the renewal date.
• You can change carriers without having to buy a “tail”. The program can pick-up your existing retro-active date, covering your prior acts.
• No applications are necessary to obtain a premium indication. You can simply provide a copy of your current Medical Malpractice Declarations page from your policy.
• Applicants have seen savings of 25%-30% by participating in the program.
• Coverys is the 5th largest writer of Medical Malpractice in the US, and the largest writer in Connecticut.
• Coverys is rated A (Excellent) by AM Best.
If you are interested, or would like more information, please contact Kathy Strauch at KStrauch@stfranciscare.org.
A Patient Story
The following story highlights the work of one of our team members, Krista Berardy, on behalf of one of our patients.
Dale Simmons (not his real name) was referred to Krista, one of our Post-Acute Care Manager. Post-Acute Care Managers work with our patients while they are inpatient at skilled nursing facilities and then assist our patients and their caregivers as they transition home. Krista reached out to Dale after he went home to see how he was doing and to determine if he had any needs with which she could assist him. While talking with Dale, Krista was able to identify that he had several obstacles including trouble maintaining his follow-up appointments with his physician office, some anger and depression and that he had “fired” the homecare agency that was to provide support to Dale and his family.
Krista followed up by talking with Dale and his wife. She was able to gather key information regarding Dale’s progress at home including that he was suffering with foul smelling and dark amber colored urine and that he showed signs of distress and combativeness. Krista followed up promptly with the PCP office to let them know that he had some significant barriers to keeping his follow-up appointments and to request a home visit for Dale. Dale’s PCP agreed and a practitioner was sent to Dale’s home for evaluation. That evaluation determined that Dale was suffering with a UTI and bladder infection. He was prescribed antibiotics to clear the infection. Dale also agreed to re-establish the services of the visiting nurses in his home.
Ultimately, Dale felt better and avoided a potential emergency room visit and re-hospitalization due to the coordination and support Krista was able to provide.