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Hill Physicians Medical GroupHill Physicians Medical Group
Presentation to
Medi-Cal Managed Care Advisory CommitteeJuly 30 2012July 30, 2012
Jennifer PereurJennifer PereurDirector, Government Programs
Hill Physicians Medical Group 2011 Highlights2011 Highlights
Largest Independent Practice Association (IPA) in California Largest Independent Practice Association (IPA) in California 300,000 members, 3,500 physicians Over $44 million paid in performance compensation to our doctors for
i i ffi i d hi i lit f t iimproving efficiency and achieving quality of care metrics; Over $11 million invested in practice-based technology solutions; Our partnership with Blue Shield and CHW designed to reduce
medical costs for CalPERS enrollees continued to exceed expectations, saving over $8 million; and,
Once again we were named one of the ‘Top Performing’ medical groups in California.
Structure
Fully compliant with DMHC financial requirementso Working capital g po Tangible net equityo IBNRo Claims timeliness
Physician-centered Organization Structurey go Board of Directorso Standing Committeeso Primed Management
Executive Membership Peer Review / Provider Review Subcommitteeo Primed Management Peer Review / Provider Review Subcommittee Peer Review / Quality Improvement Subcommittee Nominating Finance Continuing Medical Education Continuing Medical Education Provider IT
How PriMed Services Support Hill Physicians
Contracts with physicians; supports physician leadership
NetworkM tMgmt
Customer Services
Claims
Resolves inquiries regarding payment of claims
Respond to physician office and member
Processes & authorizes payment of physician services
EducationServices
office and member calls about claims, eligibility benefits, etc
Member Education
Provides practice staff and MD education
Practice Support
Primed ManagementConsulting Services
Information Services
Financial S i
Health Services
Mgmt
Provides Formularies and drug assistance to MDsAuthorizes ServicesProvides Case Management assistance to members Provides CAM network to members
Consulting assistance to practices
ContractingServices
Clinical reportingAnalysis of health dataEMR supporteCommerce support to physician offices
Budgeting & profiles for Hill Physicians IPA
Negotiates contracts with hospitals and other facilities
Value to Community
Preserves independent physician community within an organized health care system
Physicians get: Clinical support and services Financial stabilityFinancial stability Investment in technology Access to a large network of quality physicians
P ti t t• Disease management
Patients get: Wellness education and support On-line tools for physician communication and decision
support
programs • Case management services • Group visits • Hospitalist programs • 350 health education classes
f b ff d ll Discounts on yoga, massage and alternative care like
acupuncture Access to a large network of quality physicians
for members offered annually • CME courses • Disease registry • Disease predictability model
2012 QIC Initiatives Childhood Immunization Status Appropriate testing for children w/ pharyngitis Appropriate treatment for children w/URIAppropriate treatment for children w/URI Chlamydia screening in women Evidence-based cervical cancer screening Breast cancer screening Breast cancer screening Colorectal cancer screening Cholesterol management Medication monitoring Medication monitoring Avoidance of antibiotic treatment of Adults w/ acute bronchitis Use of imaging studies for low back pain Adolescent immunizations Adolescent immunizations Asthma medication Optimal diabetes care
AscenderTM
Patient Name
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Patient Name MRN DOB
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Electronic Health Records
NextGen EMR and EPM Implementation, training, and support
provided by Hill Physiciansp y y Pricing partially subsidized by Hill
Physicians Enables better care coordinationEnables better care coordination
Case Management
A t C I
The problems listed below have been identified by our department as the most common reasons for referral to Case Management
Access to Care Issueso Specialist, Second Opinions, Tertiary Centers.o Home Health, Hospice, Infusion Therapy.o DME Supplies Outpatient PT/OT/Speecho DME, Supplies, Outpatient PT/OT/Speech.
Complicated or Failed Treatment Plan Complicated or Failed Discharge Plan
o Multiple Admissionso Multiple Admissions o Inappropriate or Overuse of ER
Acute or Chronic Catastrophic diagnosis or event Exacerbation of Chronic Illness
Performance ManagementHill Physicians has a well-established track record of measuring,
managing, and rewarding physician performance
Joint Operating CommitteeHill Ph i i t ith h f l t lHill Physicians meets with each of our plan partners on a regular
basis to review data and operational issues
Questions?
Jennifer PereurDirector, Government [email protected] @ g
Doug RobertsongRegional Director, [email protected]@hpmg.com
