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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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NCQA Moves Into the Population Health Sphere With Two New Programs

December 10, 2018
by Mark Hagland, Editor-in-Chief
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The NCQA announced on Monday that it was expanding its reach to encompass the measurement of population health management programs

The NCQA (National Committee for Quality Assurance), the Washington, D.C.-based not-for-profit organization best known for its managed health plan quality measurement work, announced on Dec. 10 that it was expanding its reach to encompass the population health movement, through two new programs. In a press release released on Monday afternoon, the NCQA announced that, “As part of its mission to improve the quality of health care, the National Committee for Quality Assurance (NCQA) is launching two new programs. Population Health Program Accreditation assesses how an organization applies population health concepts to programs for a defined population. Population Health Management Prevalidation reviews health IT solutions to determine their ability to support population health management functions.”

“The Population Health Management Programs suite moves us into greater alignment with the focus on person-centered population health management,” said Margaret E. O’Kane, NCQA’s president, in a statement in the press release. “Not only does it add value to existing quality improvement efforts, it also demonstrates an organization’s highest level of commitment to improving the quality of care that meets people’s needs.”

As the press release noted, “The Population Health Program Accreditation standards provide a framework for organizations to align with evidence-based care, become more efficient and better at managing complex needs. This helps keep individuals healthier by controlling risks and preventing unnecessary costs. The program evaluates organizations in: data integration; population assessment; population segmentation; targeted interventions; practitioner support; measurement and quality improvement.”

Further, the press release notes that organizations that apply for accreditation can “improve person-centered care… improve operational efficiency… support contracting needs… [and] provide added value.”

Meanwhile, “Population Health Management Prevalidation evaluates health IT systems and identifies functionality that supports or meets NCQA standards for population health management. Prevalidation increases a program’s value to NCQA-Accredited organizations and assures current and potential customers that health IT solutions support their goals. The program evaluates solutions on up to four areas: data integration; population assessment; segmentation; case management systems.”



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At the D.C. Department of Health Care Finance, Digging into Data Issues to Collaborate Across Healthcare

November 22, 2018
by Mark Hagland, Editor-in-Chief
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The D.C. Department of Health Care of Finance’s Kerda DeHaan shares her perspectives on data management for healthcare collaboration

Collaboration is taking place more and more across different types of healthcare entities these days—not only between hospitals and health insurers, for example, but also very much between local government entities on the one hand, and both providers (hospitals and physicians) and managed Medicaid plans, as well.

Among those government agencies moving forward to engage more fully with providers and provider organizations is the District of Columbia Department of Health Care Finance (DHCF), which is working across numerous lines in order to improve both the care management and cost profiles of care delivery for Medicaid recipients in Washington, D.C.

The work that Kerda DeHaan, a management analyst with the D.C. Department of Health Care, is helping to lead with colleagues in her area is ongoing, and involves multiple elements, including data management, project management, and health information exchange. DeHaan spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding this ongoing work. Below are excerpts from that interview.

You’re involved in a number of data management-related types of work right now, correct?

Yes. Among other things, we’re in the midst of building our Medicaid data warehouse; we’ve been going through the independent validation and verification (IVV) process with CMS [the federal Centers for Medicare and Medicaid Services]. We’ve been working with HealthEC, incorporating all of our Medicaid claims data into their platform. So we are creating endless reports.


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Kerda DeHaan

We track utilization, cost, we track on the managed health plan side the capitation payments we pay them versus MLR [medical loss ratio data]; our fraud and abuse team has been making great use of it. They’ve identified $8 million in costs from beneficiaries no longer in the District of Columbia, but who’ve remained on our rolls. And for the reconciliation of our payments, we can use the data warehouse for our payments. Previously, we’d have to get a report from the MMIS [Medicaid management information system] vendor, in order to [match and verify data]. With HealthEC, we’ve got a 3D analytics platform that we’re using, and we’ve saved money in identifying the beneficiaries who should not be on the rolls, and improved the time it takes for us to process payments, and we can now more closely track MCO [managed care organization] payments—the capitation payments.

That involves a very high volume of healthcare payments, correct?

Yes. For every beneficiary, we pay the managed care organizations a certain amount of money every month to handle the care for that beneficiary. We’ve got 190,000 people covered. And the MCOs report to us what the provider payments were, on a monthly basis. Now we can track better what the MCOs are spending to pay the providers. The dashboard makes it much easier to track those payments. It’s improved our overall functioning.

We have over 250,000 between managed care and FFS. Managed care 190,000, FFS, around 60,000. We also manage the Alliance population—that’s another program that the district has for individuals who are legal non-citizen residents.

What are the underlying functional challenges in this area of data management?

Before we’d implemented the data warehouse, we had to rely on our data analysis and research division to run all the reports for us. We’d have to put in a data request and hope for results within a week. This allows anyone in the agency to run their own reports and get access to data. And they’re really backed up: they do both internal and external data reports. And so you could be waiting for a while, especially during the time of the year when we have budget questions; and anything the director might want would be their top priority.

So now, the concern is, having everyone understand what they’re seeing, and looking at the data in the same way, and standardizing what they’re meaning; before, we couldn’t even get access.

Has budget been an issue?

So far, budget has not been an issue; I know the warehouse cost more than originally anticipated; but we haven’t had any constraints so far.

What are the lessons learned so far in going through a process like this?

One big lesson was that, in the beginning, we didn’t really understand the scope of what really needed to happen. So it was underfunded initially just because there wasn’t a clear understanding of how to accomplish this project. So the first lesson would be, to do more analysis upfront, to really understand the requirements. But in a lot of cases, we feel the pressure to move ahead.

Second, you really need strong project management from the outset. There was a time when we didn’t have the appropriate resources applied to this. And, just as when you’re building a house, one thing needs to happen before another, we were trying to do too many things simultaneously at the time.

Ultimately, where is this going for your organization in the next few years?

What we’re hoping is that this would be incorporated into our health information exchange. We have a separate project for that, utilizing the claims data in our warehouse to share it with providers. We’d like to improve on that, so there’s sharing between what’s in the electronic health record, and claims. So there’s an effort to access the EHR [electronic health record] data, especially from the FQHCs [federally qualified health centers] that we work closely with, and expanding out from there. The data warehouse is quite capable of ingesting that information. Some paperwork has to be worked through, to facilitate that. And then, ultimately, helping providers see their own performance. So as we move towards more value-based arrangements—and we already have P4P with some of the MCOs, FQHCs, and nursing homes—they’ll be able to track their own performance, and see what we’re seeing, all in real time. So that’s the long-term goal.

With regard to pulling EHR information from the FQHCs, have there been some process issues involved?

Yes, absolutely. There have been quite a few process issues in general, and sometimes, it comes down to other organizations requiring us to help them procure whatever systems they might need to connect to us, which we’re not against doing, but those things take time. And then there’s the ownership piece: can we trust the data? But for the most part, especially with the FHQCs and some of our sister agencies, we’re getting to the point where everyone sees it as a win-wing, and there’s enough of a consensus in order to move forward.

What might CIOs and CMIOs think about, around all this, especially around the potential for collaboration with government agencies like yours?

Ideally, we’d like for hospitals to partner with us and our managed care organizations in solving some of these issues in healthcare, including the cost of emergency department care, and so on. That would be the biggest thing. Right now, and this is not a secret, a couple of our hospital systems in the District are hoping to hold out for better contracts with our managed care organizations, and 80 percent of our beneficiaries are served by those MCOs. So we’d like to understand that we’re trying to help folks who need care, and not focus so much on the revenues involved. We’re over 96-percent insured now in the District. So there’s probably enough to go around, so we’d love for them to move forward with us collaboratively. And we have to ponder whether we should encourage the development and participation in ACOs, including among our FQHCs. Things have to be seen as helping our beneficiaries.

What does the future of data management for population health and care management, look like to you, in the next several years?

For us in the District, the future is going to be not only a robust warehouse that includes claims information, vital records information, and EHR data, but also, more connectivity with our community partners, and forming more of a robust referral network, so that if one agency sees someone who has a problem, say, with housing, they can immediately send the referral, seamlessly through the system, to get care. We’re looking at it as very inter-connected. You can develop a pretty good snapshot, based on a variety of sources.

The social determinants of health are clearly a big element in all this; and you’re already focused on those, obviously.

Yes, we are very focused on those; we’re just very limited in terms of our access to that data. We’re working with our human services and public health agencies, to improve access. And I should mention a big initiative within the Department of Health Care Finance: we have two health home programs, one for people with serious mental illness issues, the other with chronic conditions. The Department of Behavioral Health manages the first, and the Department of Health Care Finance, my agency, DC Medicaid, manages the second. You have to have three or more chronic conditions in order to qualify.

We have partnerships with 12 providers, in those, mostly FQHCs, a few community providers, and a couple of hospital systems. We’ve been using another module from HealthEC for those programs. We need to get permission to have external users to come in; but at that point, they’d be able to capture a lot of the social determinants as well. We feel we’re a bit closer to the providers, in that sense, since they work closely with the beneficiaries. And we’ve got a technical assistance grant to help them understand how to incorporate this kind of care management into their practice, to move into a value-based planning mode. That’s a big effort. We’re just now developing our performance measures on that, to see how we’ve been doing. It’s been live for about a year. It’s called MyHealth GPS, Guiding Patients to Services. And we’re using the HealthEC Care Manager Module, which we call the Care Coordination Navigation Program; it’s a case management system. Also, we do plan to expand that to incorporate medication therapy management. We have a pharmacist on board who will be using part of that care management module to manage his side of things.



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