Why should my practice join EvergreenHealth Partners?
There are several reasons to consider joining EvergreenHealth Partners:
What do I have to do to join?
Sign a participating agreement. There is no monetary fee. You’ll be required to submit data from your practice management system to report out quality measures and initiatives.
Will EvergreenHealth Partners members eventually have to repay EvergreenHealth for the initial start-up costs of the network? If so, by when?
Although other similar networks choose to reimburse the hospital partner for start-up costs, that is not the plan with EvergreenHealth Partners. EvergreenHealth will benefit from cost savings realized by providing even better quality care for patients through enhanced coordination with EvergreenHealth Partners member physicians.
How will the negotiations ensure that my rate is no less than what I currently have negotiated outside of EvergreenHealth Partners?
EvergreenHealth Partners is not negotiating the fee for service rate for each practice; what you have will be retained. EvergreenHealth Partners does not need or want to know the fee for service rates a practice is receiving. What we are negotiating are add-on contracts that reward quality, efficiency and cost savings.
How is quality measured by EvergreenHealth Partners? Is meaningful use (MU) guidelines or data being used as a starting point?
The original formation committees initially chose clinical initiatives or measures from the library of more than 600 that Southwind (our consulting group) has developed in support of other clinical integration programs for each specialty. Most will be standard measures, and, at first, all will be based on claims data.
There won’t be a requirement for EMR or for MU, at first. However, the measures will change over time as we achieve success and discard old measures and add new ones. The contracts put in place with payers will drive some choices. Doctors will be choosing measures that are meaningful for our community, for their own patients and for their own specialties and that make sense to the EvergreenHealth Partners Board of Managers.
What IT infrastructure will be in place for data sharing, patient confidentiality, etc.?
EvergreenHealth Partners will facilitate data gathering and sharing through Dimensional Insight, the current EvergreenHealth business intelligence tool. EvergreenHealth IT representatives will work with your current IT vendor to create any necessary data sharing links; any vendor costs will be borne by the practice.
One additional element that must be considered as a part of participation within EvergreenHealth Partners is the inclusion of CPT© Category II codes along with the billing data on a claim, to ensure the quality-based data is collected. This doesn’t mean a total conversion to CPT II coding; you will need to add that coding only to the specific data being collected for your practice’s quality metrics.
How will EvergreenHealth Partners get the quality information for reporting – from the charge master?
Most of the quality data can be derived from claims. Some will require CPT 2 coding, which adds some clinical data to the claim.
Will the database be accessible?
The information will be accessible to physicians and practice staff.
Who owns the data?
The participating physicians and EvergreenHealth Partners will own the data.
We’re concerned about EvergreenHealth seeing physicians’ data; that is the only negotiating power practices have left.
EvergreenHealth Partners and EvergreenHealth are interested in quality data, not in cost or fee-related data.
Will the EvergreenHealth Partners agreement’s confidentiality section prevent me from submitting patient data needed for certification and recertification for my professional boards?
No. The confidentiality section doesn’t prevent any physician from submitting data to their respective colleges for ongoing credentialing purposes. The confidentiality section is there to prevent the recipient (either EvergreenHealth Partners or another EvergreenHealth Partners physician) from disclosing confidential information they receive from the submitter (either a physician or EvergreenHealth Partners).
What is the ownership of EvergreenHealth Partners?
EvergreenHealth Partners is structured as a limited liability company (LLC) under Washington law.
How will physicians agree on the same surgical procedure/process for all patients in order to reduce variation?
Initially, we are showing physicians their own data and how they perform compared to their peers and nationally adopted standards and gaining their collective input on adopting the future clinical initiatives that impact surgeons.
If a group or practice doesn’t participate, what are the negative consequences?
There will be no requirements to join, or punitive actions by the hospital if a physicians chooses not to join EvergreenHealth Partners. Physicians will still be on medical staff, and there will be no effect on private referral relationships or relationships with patients. Quality and cost data will be available for each participating physician.
Eventually, as EvergreenHealth Partners becomes established and working relationships among participating physicians become much closer, referrals may change to be held within the EvergreenHealth Partners participants. Non-EHP practices will not have access to negotiated EvergreenHealth Partners contracts or favorable benefit designs to selected patient populations (e.g., EvergreenHealth employees).
What about groups that practice in multiple locations – do all the physicians have to join?
Physicians who predominantly practice at EvergreenHealth or within EvergreenHealth’s community are highly encouraged to enroll, as are those who sometimes practice at EvergreenHealth enough to produce meaningful quality data. Physicians who practice primarily at another facility should not enroll since there will not be enough measurable quality data available.
What about Medicare contracts? How does clinical integration affect practices that mainly serve Medicare patients?
EvergreenHealth Partners will initially focus on developing relationships with commercial payers. As EvergreenHealth Partners and the payer environment mature, there may be additional opportunities to contract with Health Insurance Exchange plans, Medicare Advantage plans and possibly managed Medicaid plans, depending on the direction of EvergreenHealth Partners leadership. Decisions regarding these future opportunities will be made by the EHP Board of Managers, with significant input from its physician leadership. Although CI programs cannot negotiate with Medicare, participating in a CI program will equally benefit your Medicare patients due to process improvement and better care coordination within your practice and those you refer to. CI also provides a foundation to become a Medicare ACO by participating in the Shared Savings Program if EvergreenHealth Partners decides to pursue that direction.
How will you incentivize physicians? Is the incentive based on volume of patients or profits?
The formal distribution of bonuses will be decided by the physician-run EvergreenHealth Partners Board of Managers. EvergreenHealth Partners physician leaders will make the final decision on how the incentive distribution formula will be developed locally.
How can we learn more about EvergreenHealth Partners?
We're happy to meet with you, or with your entire practice, to answer your questions about EvergreenHealth Partners. Please contact Tiffanie Schaefer (425.899.2600 or TMSchaefer@evergreenhealth.com) to schedule what works best for you.