Models Of Pay for Performance: The Physician Group Perspective Bart Asner, M'D' Chief Executive Offi

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Models Of Pay for PerformanceThe
Physician Group PerspectiveBart Asner,
M.D.Chief Executive Officer Monarch HealthCare

• California Association of Health Plans
• October 20, 2009

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Monarch HealthCare

• Independent Practice Association in Orange County
  established in 1994
• 2800 physicians caring for 165,000 HMO patients
• All major health plan contracts Senior,
  Commercial, MediCal and PPO
• 17 hospital relationships across OC
• Mission Helping Physician Partners Advance
  Medical Excellence in the Communities We Serve

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Monarchs Commitment to P4P

• Monarch has made a multi year investment in IT to
  maximize its performance on P4P programs
• Monarch has begun to implement an electronic
  medical record and community wide connectivity
• Monarch has hired additional staff to focus on
  the P4P effort, and has created teams for
  efficiency projects
• Patient registries and data warehouse capability
  have led to actionable improvements in clinical
  care

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What Has Monarch Done For Physicians?

• Internet based point of care clinical reminders
  and other learning tools to promote improvement
• Data on physician performance relative to their
  peers provided in a report card format
• Physicians receive biannual bonus payments
  directly tied to individual performance
• High performing physicians are publicly
  recognized and rewarded
• Monarch physicians have participated in statewide
  collaborative on improving patient satisfaction

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Clinical Care Reminders

• Online tool (Ascender) provided to Monarch
  physicians integrated into Practice Connect TM
• Physicians can
• Proactively check P4P measure status for a
  patient in for an upcoming office visit
• Review populations of patients for gaps in
  recommended clinical care
• Compare their performance to their peers

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All P4P Measures
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Patient Search Feature
Physicians can look up patients due at the time
of service
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Running Progress Reports
Physician can run own reports
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Group Bonus Scorecard
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Patient Satisfaction Survey
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Efficiency Metrics

• Inpatient Utilization
• Outpatient Surgery
• ER Visits
• Inpatient Readmits Within 30 Days
• Generic Prescribing

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Admissions/Readmissions

• High risk post discharge home visits
• Senior Touch program
• Medication reconciliation
• PCP/Specialist follow up
• Red flags for patients
• Personal health record for physician visits
• POLST/Advanced care planning
• Readmission rounds

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Generic Prescribing
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Summary

• Monarch has aligned the incentives of the IPA and
  its physicians, while providing convenient,
  actionable information to its physician network,
  to accomplish the goals of P4P
• Monarch is prepared to move forward in the new
  era of accountability for both quality and
  efficiency