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Summit Health: A Pioneering New Jersey Medical Group Expands its Reach Out West

September 14, 2017
by Mark Hagland
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A pioneering New Jersey medical group is expanding its reach—through its management company—to Arizona and Oregon

A pioneering multispecialty medical group based in northern New Jersey is expanding its reach—literally—across the country. The 500-physician, Berkeley Heights, New Jersey-based Summit Medical Group on Sep. 14 announced that its recently created Summit Health Management (SHM) management company has “unveiled transactions today that will extend its highly effective patient care and physician group management model outside of New Jersey,” according to a press release made public this morning. “In Oregon, a Letter of Intent to provide administrative, clinical and financial management services has been signed with Bend Memorial Clinic (BMC), the largest independent multi-specialty physician group in its region, with 120 providers,” the press release stated. Meanwhile, “In the Greater Phoenix area, SHM will join 51 providers currently affiliated as Arizona Primary Care Physicians (APC) to form Summit Medical Group Arizona as of January 1, 2018. Additionally, APC has entered into a comprehensive management services contract with SHM to facilitate the partnership and transition,” the press release noted.

“The rapidly evolving health care landscape is requiring independent physician groups across the country to make pivotal decisions that will shape their future and the delivery of patient care. We are delighted that Bend Memorial Clinic and Arizona Primary Care have chosen to partner with us to retain their physician-owned and governed structures and patient-centric philosophy,” said Jeffrey LeBenger, chairman and CEO of both Summit Health Management and Summit Medical Group, in a statement in the press release. “We’ll help both of these partners to thrive and expand by sharing our resources and expertise in population health management and other emerging value-based care models. We are committed to a culture of collaboration across geographic boundaries with shared learning and uniform adoption of best practices.” SHM will provide Bend Memorial Clinic with comprehensive administrative, clinical and financial management services. 

Meanwhile, in Arizona, the press release stated, “Summit Medical Group Arizona will align like-minded medical providers in a physician-led group with a culture of caring and a patient-first philosophy. Utilizing SHM’s care and practice management model, it will deliver greater value and increased quality for the residents of Arizona.” Summit Medical Group Arizona is bringing together several separate practices affiliated under the identity of Arizona Primary Care, and which care for patients across the broader Phoenix metroplex.


Jeffrey LeBenger, M.D.

For Dr. LeBenger and his colleagues, Thursday’s announcement marks a natural progression for an organization that has been pioneering advanced medical management strategies and processes back home in New Jersey. Back in July, Dr. LeBenger told Healthcare Informatics that “We’ve done very, very well in our population health process, meaning that we beat the market in PMPM [per member per month] costs in the state of New Jersey by almost 8 percent in the past year. What we found out” in terms of how to achieve success under risk-based contracts, he said this summer, “is that you must share data with your physicians, meaning that you have to scrub it, you have to fix it, and you have to work with financial and clinical data together. And it has to be timely data—you need timely data from the payers. And you have to put the right data into the right health information exchange. And you have to understand where your high-cost points are in your model of healthcare.”

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Meanwhile, the level of physician aggregation and operational management on the part of an established medical group, outside of established physician-led health systems like the Mayo Clinic and Cleveland Clinic, that was announced Thursday morning, remains unusual in U.S. healthcare. Given that, Dr. LeBenger made himself available to Healthcare Informatics Editor-in-Chief Mark Hagland for an exclusive interview, in order to elaborate on the strategies articulated in Thursday morning’s announcement. Below are excerpts from their interview about the announcement.

What would be the correct way to refer to the relationships between your organization and the physician groups in Bend and Phoenix?

In Phoenix, we are a minority owner in the Summit Medical Group of Arizona. Summit Health Management is a minority owner in Summit Medical Group of Arizona, and we have a long-term management services agreement for all management services. Summit Medical Group in New Jersey… Summit Medical Group of Arizona’s physicians will also be shareholders in the management company. And when you have physicians with the same mission, vision, and values—and focused on the value proposition of honesty, trust and transparency—you’re able to move the healthcare dollar to put the patients first—this is always about the patients.  This is about how we take care of patients; that’s what physicians are born and bred to do. So by creating a management company with similar drives and values as the group, and the same ownership structure, you can enhance a very well-integrated model.

And what is the correct terminology to describe the relationship with Bend Medical Clinic?

Bend Medical Clinic will continue as it is. Summit Health Management will assume all debt, hard assets, and workforce, and have a long-term management services agreement with the Bend Medical Clinic.

How do you see expanding your vision into these other markets that are quite different from the northern New Jersey healthcare market?

We have very good corporate talent here as Summit Health Management. And there’s good management talent in Bend and in Phoenix, on the medical management side. And we’re looking at best practices, in order to reach the Quadruple Aim—high quality, low cost, great patient experience, and high provider engagement. And we bring management skill and capital, and we bring maturity in governance and leadership, to be able to commit to a way of integrated healthcare practice.

One metric I love to talk about is that we’ve grown from 125 to 800 providers in the past six years, with less than 1 percent turnover. So having that dual ownership and management of the groups—we all have the same vision going forward.

How did you end up in these particular markets?

Our relationship with the physician group in Bend came from an investment bank, where we looked at their book of business. With regard to the group in Phoenix, we had met their senior leaders at conferences and meetings, and we ended up initiating a dialogue, and found what their constraints were as a loosely organized IPA [independent practice association] that has an overarching management company that offered contracts. And we started to speak with them, because they needed some capital, and the cultures of these groups were similar to ours. And that started a dialogue about moving in this direction.

Both groups are operating in markets in which there are progressive health plans whose senior executives have expressed the desire to collaborate further with providers. Do you see a fair amount of potential there?

Absolutely. In New Jersey, we have one of the most advanced commercial risk products, and we understand Medicare Advantage, and we understand NextGen [the NextGeneration accountable care organization program under the Medicare program]. And we feel there’s great opportunity to bring great quality at lower cost, with great patient satisfaction, and physician engagement.

And so you see great potential for partnerships with progressive health plans, in both markets?

Yes, I do.

How are you going to address physician social insecurity in the face of policy and payment changes? In other words, how are you addressing physician culture issues and challenges?

That’s number one for us. We would not have spoken to the physicians in either Phoenix or Bend, had they had not had a culture similar to ours. That was of utmost priority to us. If they didn’t have a similar culture of putting patients first, in the group practice context, we wouldn’t want to talk to them.

So you and your colleagues did your cultural due diligence, then, correct?

Yes, absolutely, that was first and foremost. I joke about this, but it’s like getting married! You really have to do your due diligence, and see what their culture is, whether it’s similar to yours or not. If not, it’s not worth it, because they wouldn’t have the same type of belief system, and that would make it impossible to move forward in the way we would want.

It seems as though this is a time of opportunity for physician group leaders with vision and who know what they’re doing, as policy and payment trends shift?

I have to say this, and it’s not rocket science, and I don’t want to sound arrogant. But if you develop a business model—we grow our primary care attribution, work closely with specialists—if you manage all transitions of care, and use the hospital as a center for tertiary and quaternary care, but keep 95 percent of care on the ambulatory side—that’s a recipe for success.

What should CIOs and CMIOs at hospital-based health systems be thinking about these developments?

Health systems always look at us as something of a threat; they think we’re trying to cull their network. That’s not the case. We view hospitals in a neutral way, even as we’re focused on the ambulatory side. We feel we can grow a network and take care of the patients on the ambulatory side, while finding ways to partner with hospitals on the inpatient side. We don’t look at hospitals as threats, and we never have. We look at hospitals as partners in performing good patient care, as we move patients as much as possible onto the ambulatory side. There is a good way to do this and to improve quality, collaboratively.

Meanwhile, at some point in the future, you’ll be expanding your operations further?

Yes. We are out in the market now, looking at opportunities in various markets.

 


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Precision Medicine Alliance Brings Democratization of Precision Medicine

October 5, 2018
by Damon Hostin and Robert Weil, M.D., Industry Voices
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The goal is for every patient to have access to the best treatment possible, when and where they need it.

Hospitals are built on data. Most often, medical data for research pile up in silos instead of being appropriately shared to develop more innovative ways to treat patients.

At Catholic Health Initiatives and Dignity Health, we have started to think differently about the possibilities that surround the data and expertise our clinicians bring to solving our patients’ care needs.  It’s why we joined forces to create the nation’s largest precision medicine partnership.

Because of that spirit of innovation, investment and the information-sharing agreements we established under the Precision Medicine Alliance, LLC, about 12 million patients in 16 states will have access to more promising treatments based on a genetic understanding of their disease.

The alliance currently is focused on advanced diagnostic tumor profiling. However, we are preparing ourselves to provide more specific diagnostic and personalized therapies for a number of genetic and acquired conditions, including cardiovascular medicine, neonatology and pharmacogenetics.

Before the alliance was formed, access to precision medicine-based care was inconsistent to all populations, making it available primarily to the well-insured and those with the personal wealth needed to pay for the specialized tests.

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In a sense, the alliance represents the democratization of precision medicine. That’s because, for the first time, we have created a cost-efficient program that allows community-based hospitals, both large and small, to become partners with the alliance and introduce these vital programs locally.

The alliance highly complements national oncological programs at CHI and Dignity Health, which together serve more than 100,000 patients annually. Starting this fall, each oncology patient at active sites will be matched to all biomarker-appropriate therapeutics and will be screened for eligibility to enroll in a clinical trial. This makes Englewood, Colo.-based CHI and Dignity Health, which is headquartered in San Francisco, the first health systems in the nation with their own precision medicine program with reach across a national footprint. Together, the two systems have 139 hospitals and hundreds of other care sites.

The alliance couldn’t have happened soon enough amid the rapid pace of advancement in cancer treatments. Identifying new genetic markers and their effects on cancer occurrence, prognosis, and treatment options occurs at a staggering pace. Even the best-informed physicians may struggle to keep up with new treatment regimens for the most common cancers, let alone rarer forms. 

The alliance is working to accelerate change. It is switching how we view and treat oncology patients throughout our network as well as working on wellness and prevention among our higher risk populations.

By actively screening patients and learning more about how genetic makeup and some environmental factors may influence health and care, we are far better positioned to identify and intervene earlier.

We already have hundreds of thousands of patients under management in the system today—a mega-community of actionable medical information. That community is enabling CHI and Dignity Health caregivers to share—in real time—their insights and outcomes on patients with cancer.

At CHI and Dignity Health, we see our early work as a catalyst for furthering this emerging science, using next generation strategies, technologies and a strong partnership.  Our precision medicine alliance is not centered on discovering the next major genetic marker.  We view our purpose as creating a model that disseminates the benefits of precision medicine to more patients and more caregivers.  Access is equity and it is dictated by our mission.

Through the alliance, CHI and Dignity Health caregivers can more effectively identify the best drug therapies and possible clinical trials for their patients. Besides changing the way we treat some of our patients, we are also creating a repository of data to drive better clinical decision-making and treatment discoveries for generations to come.

We believe our early commitment to precision medicine through the alliance has helped set the stage for even greater and wider use of this promising methodology. With that, every patient can have access to the best treatment possible, when and where they need it.

Damon Hostin is the CEO of the Precision Medicine Alliance of Catholic Health Initiatives and Dignity Health.  Robert Weil, M.D., is senior vice president and chief medical officer of Catholic Health Initiatives and a board member of the Precision Medicine Alliance.


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On Staten Island, a Highly Innovative Program That's Redefining What’s Possible Under Medicaid

September 17, 2018
by Mark Hagland, Editor-in-Chief
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Healthcare leaders on Staten Island have been achieving exciting success in care management and population health management in their community’s Medicaid and uninsured populations

Even as one hears constant complaints and concerns about the challenges facing healthcare leaders who are attempting to help shift the U.S. healthcare system from volume to value, more and more truly encouraging stories are emerging about pioneering organizations that absolutely are moving the needle, in the present moment. One of those encouraging stories absolutely revolves around the Staten Island Performing Provider System (SI PPS), a unique organization whose leaders describe it as a “Medicaid redesign program implementation enterprise.” Under the leadership of Joseph Conte, Ph.D., CPHQ, its executive director, SIPPS has been forging a path forward around robust population health for Medicaid recipients on Staten Island, the New York City borough that is the by far the smallest in population (479,000, compared to Brooklyn, at 2.6 million in population) yet third-largest in land mass, among the city’s five boroughs.

The Staten Island Performing Provider System has been participating very successfully in the Delivery System Reform Incentive Payment (DSRIP) program under the aegis of the federal government. What is involved in New York State’s DSRIP? As NYSDRIP’s website notes, “DSRIP is the main mechanism by which New York State will implement the Medicaid Redesign Team (MRT) Waiver Amendment. DSRIP´s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25 percent over five years. Up to $6.42 billion dollars are allocated to this program with payouts based upon achieving predefined results in system transformation, clinical management and population health.” The federal Centers for Medicare and Medicaid Services (CMS) approved New York State’s Medicaid waiver requested in the amount of $8 billion over five years, in April 2014.

And SI PPS manages the care of 130,000 Medicaid recipients on Staten Island, in addition to managing the care of 50,000 uninsured Staten Islanders.

According to SIPPS leaders, “Staten Island Performing Provider System (SI PPS) is an alliance of clinical and social service providers focused on improving the quality of care and overall health for Staten Island’s Medicaid and uninsured populations, which include more than 180,000 Staten Island residents. We are co-led by Staten Island University Hospital and Richmond University Medical Center. Our network of over 70 partners includes skilled nursing facilities, behavioral health providers, home health care agencies and a wide range of community-based hospitals, clinical facilities, treatment centers, social service and community organizations, primary care physicians and medical practices across the island. SI PPS is expected to bring more than $200 million to Staten Island over 5 years if successful in transforming our care delivery system. Our mission is to engage partners and stakeholders in the planning and implementation of DSRIP as we move towards a value-based payment model for Medicaid in New York State.”

Among the goals that SI PPS leaders have set for themselves:

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> Develop an infrastructure that lays the foundation for delivery system reform by transforming the Staten Island community through investment in technology, tools, and human resources that will strengthen the ability of providers to better serve our community

> Improve health literacy and share cultural competency knowledge

> Expand access to the appropriate level of care for all patients, including reducing barriers to care

> Expand outpatient and community services including home care, ambulatory detox, behavioral health/substance abuse, and primary care to reduce avoidable hospital/emergency department use on Staten Island

> Improve coordination of care and develop an integrated network

> Improve care management and disease management for high-risk patients, including patients with chronic conditions and behavioral health diagnosis

> Improve population health by addressing social determinants of health

> Integrate technology to allow for the secure exchange of health information across the PPS

> Reduce the per person cost for providing care

> Engage the uninsured, and underutilizing/low utilizing Medicaid patients and connect them to primary care and social services

> Implement innovative and evidence-based care models throughout the care continuum

> Implement training programs and learning collaborations between PPS partners that allow for the sharing of best practices

SI PPS leaders state that “These goals are being reached by implementing 11 DSRIP Projects, identified by a Community Needs Assessment, to address primary care, mental health, substance abuse, chronic disease, long term care, social determinants of health, and population heath.”

SI PPS leaders add that “We leverage a seamless platform that gathers data from multiple sources -- claims data, core reports, department of health information and the like -- and that data is inserted directly into the electronic data warehouse. With geo-mapping, we can identify areas that are lacking in key services. In creating maps of the population, we can filter in on specific conditions, and if we hover over a specific area within a specific map, we can see three years of claims data. We can figure out utilization trends, including hospitalization, medications, etc. We can also filter by demographics, types of chronic illness, etc.” Among the data sources they are make use of include direct data feeds from partners; lead providers’ clinical data; other partners’ clinical and billing data; data from care management partners; and public data; among other sources.

In addition, the SI PPS leaders have plunged into behavioral healthcare management. They note that they are pursuing “a population-health and community wide effort that aims to build capacity across systems by leveraging and developing partnerships to provide a quality integrated health care system, effective, high quality, person-centered care that supports improved health outcomes and optimal physical and emotional well-being. BHIP priorities focus on increasing and sustaining mental health/SUD provider service capacities, assisting community members to navigate behavioral health services, providing support to individuals and providers through education and technical assistance, addressing co-morbidities and co-occurring disorders, and reducing stigma and raising awareness about behavioral health wellness.” Among the numerous individual programs encompassed by the Behavioral Health Infrastructure Program (BHIP) are programs to expand the capacity of professionally certified peer workers in addiction and mental health, to help tackle the substance abuse program; the engagement of patients in the Emergency Department with substance use issues by clinicians and certified Peers to expedite linkages to behavioral health providers and reduce preventable ED visits; an innovative pre-arraignment diversion program designed to redirect low-level drug offenders to community-based health services instead of jail and prosecution; and numerous other programs.

Recently, Dr. Conte spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding the progress being made at SI PPS, and the implications of his team’s work for transformation across the U.S. healthcare system. Below are excerpts from that interview.

Can you explain the basic funding mechanism or model that is supporting your organization?

The New York State Department of Health negotiated a waiver with CMS, and received $7.2 billion over five years to fund the program. About 50 percent of that was guaranteed for pay-for-reporting and program implementation, and 50 percent was set up as pay for performance, so it is very much a pay for performance program. There are 6 million people on Medicaid, and the state spends $65 billion a year, and the federal government pays for half of that; that’s why it’s very much in their interest to fund population health; it pays dividends to everyone.

To take care of the entire Medicaid population on Staten Island?

It’s interesting. We do not pay claims or intervene on behalf of providers, with managed care companies. Our sole purpose is to create innovation and reach population health milestones with providers in the community. So the hospitals, nursing homes, FQHCs, physicians, continue in their payment systems. We exist solely to create innovation and to incent innovation. It’s very much a pay for performance program.

Tell me about some of the main programs that you and your colleagues have been involved in, around this work?

The main initiatives relate to creating integrative care models where we bring in behavioral health providers to work with medical providers and medical providers who work in behavioral health organizations, so people don’t have to shuttle around to access care. We’ve done a great deal in the prevention of avoidable use of EDs for medical and behavioral care; that’s down over 60 percent in the past three years. And a lot of that has to do with looking at data form multiple sources and identifying where initiatives should be implemented. So we have a very big focus on asthma and a very big focus on diabetes. And a lot of the work involves engaging patients with peer educators who suffer from these conditions themselves.

One of the biggest innovations has been doing this with people who have alcohol and substance abuse disorders. We have peers in the EDs 24/7; and the number of people who have engaged in treatment services has tripled in the past few years. We’ve paid the salaries for these individuals, we’ve paid their training, have paid them to go get certified; and as they’ve become certified, they’ve become hired by the organizations, because their services are actually billable. So it helps the individual, helps the patient care organizations, helps the community. And it all comes out of high-level data analytics, doing hot-spotting, geo-mapping, bringing in social determinant of health factors, looking at housing, crime statistics, poverty, graduation lists, things like that. So we’ve done things very fundamental to services, to healthcare services, but in a very smart way. The workforce transformation is also very important; we spend a lot of time and training preparing people for new roles.

What have your biggest lessons been learned so far?

I would say it is that the kind of collaboration that it takes to create transformation is something that people really want to do; but they need organizations like ours that can bring these high-level analytics and resources together. And that includes training to give people new education; as well as providing to organizations high-level opportunities to identify patients most in need. You know, you can hunt for ducks with a shotgun, but it’s not a good idea when you’re trying to conserve ammunition, right? So we’ve helped people put a fine aim on things that need to be worked on, and the community coalitions are very powerful; you can’t go it alone, so working with local governmental units is very important. Also, bringing in information form as many sources of information as possible essential. We bring in ambulance data, social determinants of health data, school data, community data; all are essential.

Have you done geo-mapping or hot-spotting? How did you figure out how to obtain those various types of data?

When we started up, we were a complete start-up; so we didn’t have any legacy systems. So we hired very bright IT people and analysts, and brought the right tools to bear so that we could really be focused on how the resources were applied; that was our core investment.

What advice would you offer the senior healthcare IT leaders in patient care organizations, including the CIOs, CMIOs, CQOs, chief data officers, etc., in terms of what they should think about around all of this?

I would tell them that turning data into business intelligence is critical, and that’s true with respect to everybody. For the medical people, it’s medical business intelligence; for the finance people, it’s financial business intelligence. Don’t get overwhelmed with data; use it to create good information for clinical and business practices, and that will allow you allow you to be successful.

What will happen in the next couple of years?

There are about 13 states that have Medicaid redesign waivers in place now; CA and TX have received extensions, and we’re hoping for an extension. We’re also looking for other opportunities to extend our work; we’ve set up an ACO. We’ve set up a form of consultancy as well.

Where do you hope to go in terms of accomplishments in the next few years?

The important thing is for us to do things that are sustainable in the community whether we continue on or not, and that’s a lot of the work we have done—it is to grow capacity in organizations in the community. And that’s why the workforce work is so important. When people have new skills and training and ability to bring change into their organizations, these certainly are sustainability factors that are important.

Is there anything you’d like to add?

I would say one thing that we’re spending much more time on now, is continuing to try to work in the behavioral health space, because especially in the Medicaid population, any number of people have co-occurring conditions—they have medical and behavioral problems. And these are the patients with the most problems and who need the most services. So giving them access to more services is important, but also being able to be more predictive about when they’ll need those services, so we can be smarter about it; that is really important.

 

 

 

 


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