2015 Practice Manager Meeting

Memorial Health Partners
Practice Manager Meeting
November 10, 2015
Mercer Auditorium
Agenda
Practice Manager’s Luncheon Meeting
Agenda
11:30-12:00 Registration
12:05-12:15 – Welcome and Introductions – David Dorminey
12:15-12:30- EPIC– Kathryn McClellan
12:30-12:40 – Partners In Quality Update – Misty Kennedy
12:40-12:45 – MHP Noteworthy Reminders – Jennifer Hastie
12:45-1:00 – Core – Bryan Wagoner
1:00-1:20- Memorial HRA Plan – Nannette Richardson
1:20-1:50 – Gulfstream HSA Plan – Kim Dowd
1:50-2:05 – MHP Employer Benefits– Jennifer Hastie
2:05-2:15 – Survey and Giveaways
Presentation available online: mhp.memorialhealth.com
WELCOME
David Dorminey
Executive Director MHP & Managed Care
MHP Team Contacts
Tyler Henderson - Manager Network Development & Contracting
[email protected] 912-350-2347
• Network management
•
Employer Requests for Proposal
•
Product Development
•
MHP Network claims payment/other issues
•
Network Expansion opportunities
Jennifer Hastie -Manager Provider Services & Credentialing
[email protected] 912-350-9472
• Provider Services
• Contracting & Credentialing (New & Existing Providers)
• Provider and Client issue research to resolution
• Provider Network Quality audits
• Payor reporting
MHP Team Contacts
Misty Kennedy – Sr. Manager Client Relations & Quality
[email protected] 912-350-6043
•
Client Relations
•
Quality Services/Issues
•
Wellness
•
Populations Health Management
•
Partners in Quality
•
Value Added Products
Kathryn McClellan
Memorial Health CIO
EPIC
Memorial Health Partners
– Practice Manager’s Meeting
Kathryn McClellan
Memorial Health CIO
11/10/15
Blood Bank
Registration
Scheduling
Bed Planning
Transport
Patient Movement
Dragon
Reading
Palettes
Integration to Core Apps
PACS/CPACS
MHUP Integration
New Epic Tools
Enterprise Integration
Other physicians
New Portal
Access for Office
Lab Integration
Pathology
Pre Surgical Testing
Case Request Process
Intra Operative Tools
Bedside Charting
MAR
Flow sheets
Clinical Decision Support
Order Entry Process
Anesthesia
Automation
Ped Onc
Med Onc
Rad Onc
Unit Clerk Role
Pharmacy BCMA Hyperbaric Sleep Lab
Wound Center
OP Rehab
Hospital Billing
Payor Integration
ED Registration
Enterprise Integration
Conifer
ED to ….
Integration
Workflows
Real Time Physician Order Entry
Dragon—Voice to Text Notes and documentation
• Over 25,000 Active
Users
• Appointment
Scheduling
• Viewing of Results
• Communication with
Providers
• Prescription Refill
Misty Kennedy
Sr. Manager Client Services
Partners In Quality Updates
2016 Update
What Is PIQ And How Does It Work
Partners in Quality (PIQ) is a program operated by
Memorial Health Partners (MHP) and sponsored
by employer groups that is used to incentivize
physicians and patients to use preventative care
to:
• Reduce the impact of disease on patients.
• Reduce the cost to the members and the
employer groups of self-funded health plans
which pay for medical services.
PIQ 2016 Changes
• Measurement year runs Jan. 1, 2016 thru Dec. 31,
2016.
• EMR and Eprescribe surveys will be removed.
• Pediatric Measure will begin Jan. 1, 2016
1. Appropriate Testing for Children with Pharyngitis
2. Medication Mgt for People with Asthma
3. Follow-up care for children prescribed ADHD
Medication
4. Appropriate Treatment for Children with Upper
Respiratory Infection
• PCP Designation for patients has been changed to
reduce duplication of patient designations.
Designation of Presumptive PCP
Things To Remember
• Applies to in-network Primary Care, OB/GYN,
Pediatric Physicians.
• Physicians do not sign up for this program.
• Measurement Year is a Calendar Year: Jan. 1, 2016
through Dec. 31, 2016.
• Interim Patient Lists are available mid-year upon
request. (No audit required at this time).
• Final Reports are completed after February 2017.
Things To Remember (Continued)
• Individual Physician scores are not published.
• If the physician reaches or goes above the set threshold for the
measurement year, then he/she qualifies as a Distinguished Quality
Physician (DQP).
• The physician then receives a bonus based on their final score and a
percentage of $24 per E&M code.
• Physicians receive the Partners in Quality logo listed by their name
on MHP’s provider search webpage.
PIQ Information Can Be Found:
http://www.memorialhealth.com/
partners-in-quality.aspx
Questions
Jennifer Hastie
Manager Provider Services & Credentialing
MHP Reminders
Memorial Health
Partners Reminders
MHP Provider Directory On-Line
Go To
www.mhp.memorialhealth.com
Click on Find a Provider
MHP Provider Search
Memorial Health Partners’ Website
Home
About Us
Find a Provider
News
Contact
Us »
•Home
•About Us
•Find A Provider
•News
Provider driven.
Client focused.
Professionally
managed
MHP Provider Search
Memorial Health Partners
Reminders
• Directory available on-line with a PDF printable version.
Updated monthly.
• Always update demographic and contact changes with MHP.
Please supply your contact email address as well as the
physician’s e-mail address when applicable.
• Referrals to specialists or for additional services must always
be to an MHP provider.
• Submit re-credentialing documentation timely.
• Agreements and applications must be complete and signed.
Double check for missing pages before submitting.
• Make certain that the Certificate of Insurance is included.
Memorial Health Partners
Reminders
• Make sure application includes previous last names.
Credentialing process could be delayed if the name on the
application does not match the name used upon graduation
and we are unable to verify.
• Include the sponsoring physician name for all mid-level
applications.
Bryan Wagoner
Director of Business Development
Core Community Care
MHP Community-Based
Employee Healthcare Program
Provider Driven, Client Focused, and Professionally
Managed
Certainties In The Healthcare Marketplace
 Declining patients, reimbursements, and allotments
 Insurers are now playing hardball and reducing fees paid to providers

28%+ reduction in fee schedule (BC/BS) (United) (Others?)

Providers no longer paid Medicare fee +200 - 300 %!
 Your own medical practice healthcare costs are rising.
 ICD 10 Conversion = a time sink!
 Consolidation of Carriers is #1 threat to us all.
 It’s a volatile market to say the least!
 Those that survive will be both progressive and strategic.
How to not only SURVIVE – but PROSPER
 One Fundamental Tenant for a Successful Practice and
Hospital – GROW!



Target opportunities to grow your patient-base while reducing
costs.
Be pro-active and not re-active.
Insulate your hospital and practice from external forces.
 MHP Community Based Healthcare Program: A proprietary/network
labeled, community-based health insurance program that provides
employee groups with direct access to a progressive, partially self-funded
healthcare platform.
MHP Core Community Care Program
 The Premise:
 Deliver MHP healthcare services direct to the local community with a
comprehensive insurance benefit product.
 Background:








Launched in July of 2015 (2 year development)
Unique approach that allows the employer group to be self governing
Five plan designs (ACA compliant)
Available to employer groups in the MHP footprint
> 30 Counties
16 Hospitals
> 2,400 Medical Providers
A high performance, network sponsored group healthcare program
MHP Core Community Care Program
 Unique Program Qualities:
Integrated MHP Value Added Services






Population Health Metrics
Wellness
Case Management
Utilization Review
Network access fee efficiency
Many others
Local TPA – GA Domiciled
Local PBM
Local Reinsurer
One toll free number access to all components
Unique Member ID Cards – MHP and employer group logo
All fully integrated with costs protective redundancies
Moving Towards Our Combined Success
Community
Agency
Program
Administrator
Healthcare
Provider
Business
Populations
Identified
Insurer
Design Plans
and
Affix Rates
MHP’s Core Community Care Program
 The Challenge:
 Identify businesses that have a moderately healthy employee populous.
 Are receptive to utilizing a “high-performance” 2,400 provider network
for medical services.
 #1 Question:
 Can my own medical practice participate?
#1 Answer: Absolutely, Yes



Two strategies
Enrolled employee base over 50 EE
Enrolled employee base under 50 EE
 #2 Question:
 How do I receive more information – point of contact?
MHP’s Core Community Care Program
 Bryan Wagoner
Director of Business Development
Core Management Resources Group
[email protected]
515 Mulberry Street Suite 300
Macon, GA 31201
Marietta, GA 30066
Office: 404.983.4619
Toll-Free: 1.888.741.2673
 Memorial Health Partners
100 Riverview Drive
Suite 306
Savannah, GA 31404
Office: 912-350-6608
[email protected]
MHP Community-Based
Employee Healthcare Program
Provider Driven, Client Focused, and Professionally
Managed
Nannette Richardson
Memorial Health Benefits Manager
Memorial Health HRA Plan
2016 Team Member Medical Benefits
Presented by:
Nannette Richardson, Manager, Benefits
Self-Funded/Self-Insured Health Plans
What are they?
 A health plan where an employer (Memorial)
provides health or disability benefits to its Team
Members with its own funds.
 Memorial pays the actual cost of claims for out-ofnetwork services and the discounted rate for innetwork claims.
Health Reimbursement Account (HRA)
What is an HRA?
 An HRA is an account funded annually by
Memorial to reimburse Team Members for out-ofpocket expenses such as:
 Deductibles
 Co-insurance amounts
 Any unused amounts carry over to the next plan
year up to the out-of-pocket maximum.
 Additional HRA dollars can be earned by
participating in Healthy For Life wellness
initiatives.
2016 Medical Plan Enhancements
1. HRA wellness incentives

Participation in Healthy For Life wellness program allows TMs to
earn additional credit to reduce deductibles and medical
insurance premiums.

TMs enrolled in Medical Plan - Up to $500 additional HRA
Dollars or PTO hours
2. Skin cancer preventive screenings
3. Speech therapy for autistic children

Memorial will provide speech therapy up to $10,000 annually for
children (up to age 5 years old) diagnosed with autism.
HRA Plan A - Highlights
Team Member (TM) Only
Team Member + Child/Spouse
Team Member + Family
$1,500
$2,500
$3,500
Memorial HRA
Contribution (Up
front)
$250
$500
$750
Wellness
$500
$500
$500
Out-of-Pocket
(OOP) Deductible
$750
$1,500
$2,250
$4,500
$9,000
$13,500
HRA Plan A
In Network
Deductible
OOP Max. (Includes
Deductible)
Coinsurance
Co-Pays
(HRA $ Do Not Apply)
Emergency Room
Memorial pays 80% of disc. rate.
TM pays 20% of discounted rate up
to OOP max (for in network
claims).
$25 – Primary Care
$50 – Urgent Care
$250 if NurseOne is contacted
$500 if NurseOne is not contacted
Memorial pays 80% of disc. rate.
TM pays 20% of discounted rate up to
OOP max (for in network claims).
$25 – Primary Care
$50 – Urgent Care
$250 if NurseOne is contacted
$500 if NurseOne is not contacted
Any unused portion of your HRA for current plan year will roll over up to your out-of-pocket maximum.
Memorial pays 80% of disc. rate.
TM pays 20% of discounted rate up
to OOP max (for in network
claims).
$25 – Primary Care
$50 – Urgent Care
$250 if NurseOne is contacted
$500 if NurseOne is not contacted
HRA Plan B - Highlights
HRA Plan B
Team Member Only
Team Member + Child/Spouse
Team Member + Family
$3,000
$5,500
$7,500
Memorial HRA
Contribution (Up
front)
$250
$500
$750
Wellness Incentives
$500
$500
$500
Out-of-Pocket
(OOP) Deductible
$2,250
$4,500
$6,250
Out-of-Pocket Max.
Includes Deductible
$6,850
$12,000
$13,950
Memorial pays 80% of discounted
rate.
TM pays 20% of discounted rate up
to OOP max (for in network claims).
Memorial pays 80% of discounted
rate.
TM pays 20% of discounted rate up
to OOP max (for in network claims).
Memorial pays 80% of discounted
rate.
TM pays 20% of discounted rate up
to OOP max (for in network claims).
$25 – Primary Care
$50 – Urgent Care
$25 – Primary Care
$50 – Urgent Care
$25 – Primary Care
$50 – Urgent Care
In Network
Deductible
Coinsurance
Co-Pays
(HRA Dollars Do
Not Apply)
Emergency Room
$250 if NurseOne is contacted
$500 if NurseOne is not contacted
$250 if NurseOne is contacted
$500 if NurseOne is not contacted
Any unused portion of your HRA for current plan year will roll over up to your out-of-pocket maximum.
$250 if NurseOne is contacted
$500 if NurseOne is not contacted
HRA Balance Detail
Wellness
Credits
Earned
HRA
Debits
(HRA
Dollars
Used)
HRA
Balance
Health Flexible Spending Account (FSA)
 Health Care FSA – TM’s may save up to $2,550
tax-free, to use on eligible medical expenses like
their deductible, copayments and coinsurance.
 2015 FSA dollars must be used by March 15, 2016.
 2016 FSA dollars must be used by March 15, 2017.
Important Numbers
Integra BMS
(Verification/Precertification)
www.Integrahealth.com
866-298-3179
Memorial Health Partner
877-342-0280
Nurse One
800-420-9355
Questions?
Kim Dowd
Gulfstream Benefits
Gulfstream HSA Plan
Benefits Presentation
MHP Providers
November 10, 2015
HR Confidential - Not For Distribution
Agenda
• 2016 Medical Plan
• Vendors
• Transition
HR Confidential - Not For Distribution
Medical Plan
HR Confidential - Not For Distribution
2016 Gulfstream Medical Benefits
• Moving to a high deductible health plan only effective
1/1/2016
– Has been an option since 2011
– Currently, about 15% of population is enrolled
– Applies to active employees as well as pre-65 retirees
• Extensive communication plan to extend into 2016
HR Confidential - Not For Distribution
Personal Health Account Plan (PHA)
Health Savings
Account (HSA)
Comprehensive
Medical &
Prescription Drug
Coverage
(Gulfstream
contributes, and
employee can too)
• Covers same medical services
as PPO Plan
• Provides access to the same
network of providers and
discounts
• Can be used now or in
the future
• Tax-free savings vehicle
HR Confidential - Not For Distribution
2016 PHA Plan Options
• We are offering two plan options
• Both options have the same design and work the same way
Seeded PHA
Unseeded* PHA
Gulfstream contributes
to the HSA
Gulfstream doesn’t contribute
to the HSA – premiums are
lower (up to the seed amount)
*Employees with coverage in a non-high deductible plan, such as Medicare and TRICARE,
are not eligible to contribute to an HSA, according to IRS regulations, so they must select the unseeded PHA
HR Confidential - Not For Distribution
How the Personal Health Account Plan Works
Preventive Care – covered at 100 % (in-network)
Deductible – amount member must pay
before plan pays
May use funds from HSA to pay
these expenses
Coinsurance – plan and member share
the cost
May use funds from HSA to pay
these expenses
Out-of-Pocket Maximum – all eligible expenses covered at 100%
HR Confidential - Not For Distribution
2016 PHA Plan Options*
Seeded (ee
only)
Seeded
(family)
Unseeded (ee
only)
Unseeded
(family)
Deductible
$1,500
$3,000
$1,500
$3,000
Coinsurance**
10%
10%
10%
10%
Out of pocket
maximum
$2,300
$4,600
$2,300
$4,600
GAC seed
$1,100
$2,200
$0
$0
*This assumes utilization of in-network providers.
**Applies to most services. Preventive care, including some medications, will have no out of pocket cost for the employee.
HR Confidential - Not For Distribution
Vendors
HR Confidential - Not For Distribution
CoreSource
• Third-party administrator
• Average 4-day claims turnaround
• Mycoresource.com
– Check eligibility
– View accumulators (deductible, out of pocket maximum)
– View claim details
HR Confidential - Not For Distribution
HealthEquity
• Health Savings Account administrator
• Employee can make payment at point of service with debit
card
• Employee can direct payment to provider through Health
Equity’s website via vCard
– Day after initiated by employee
– Mail or fax(if provider signs up for fax option)
– Provider can reject and request payment via check
HR Confidential - Not For Distribution
Transition
HR Confidential - Not For Distribution
We Need Your Help
• Change
– Stay positive
• Point of service payment and refunds
– What is your policy?
– Would you be willing to file the claim and wait until the claim is
adjudicated to bill the patient?
– Would you be willing to accept payment similar to a copay until
claim is adjudicated?
HR Confidential - Not For Distribution
Questions?
HR Confidential - Not For Distribution
Jennifer Hastie
Manager Provider Services & Credentialing
MHP Plans Benefits
Current MHP Employer Partners
Dan Vaden Chevrolet
McKee Court Reporting
Evans Memorial Hospital
Meadows Regional Medical
Center
Georgia Eye Institute
Gulfstream Aerospace
Hunter, Maclean, Exley & Dunn
Jeff Davis Hospital
(eff 1/1/2016)
Memorial Health System
Savannah College of Art &
Design
Thomas & Hutton Engineering
MHP Numbers:
Mailing Address:
912-350-6608 or 877-342-0280
Memorial Health Partners
www.mhp.memorialhealth.com
100 Riverview Dr. Suite 306
Savannah, GA 31404
Employer Group
Dan Vaden Chevrolet
Evans Memorial Hospital
Georgia Eye Institute
Gulfstream Aerospace Corporation
HunterMaclean
Jeff Davis Hospital
Meadows Regional Medical Center
Memorial Health, Inc.
McKee Court Reporting
TPA and Address
(Benefits, Claims, Eligibility)
HealthGram
PO Box 11088
Charlotte, NC 28220-1088
HealthGram
PO Box 11088
Charlotte, NC 28220-1088
HealthGram
PO Box 11088
Charlotte, NC 28220-1088
CoreSource, Inc
PO Box 105
Arnold, MD 21012
Meritain
PO Box 853921
Richardson, TX 75085-3921
Core Management Resources Group
PO Box 90
Macon, GA 31202-0090
Core Management Resources Group
PO Box 90
Macon, GA 31202-0090
Integra
PO Box 1178
Matthews, NC 28106
Lifestyle Health Plans
345 N. Riverview Dr Suite 600
Wichita, KS 67203
UMR
Savannah College of Art and Design PO Box 30541
Salk Lake City, UT 84130-0541
HealthGram
Thomas & Hutton
PO Box 11088
Charlotte, NC 28220-1088
Electronic
Payer ID
Medical Manager
56144
HealthGram
56144
HealthGram
www.healthgram.com
800-446-5439
56144
HealthGram
www.healthgram.com
800-446-5439
CB624
Active Health
www.coresource.com
CoreSource: 855-402-8831
Fax: 866-542-0914
Active Health: 866-698-3504
64157
Meritain
www.meritain.com
800-476-9971
58231
Core Management Resources Group
www.corehealthbenefits.com
478-741-3521
888-741-2673
58231
Core Management Resources Group
www.corehealthbenefits.com
478-741-3521
888-741-2673
56139
Integra
www.integrahealth.com
866-298-3179
Professional
27005
Institutional
2700U
MedCom
www.lifestylehealthbenefits.com
LifeStyle: 866-824-6607
MedCom: 844-643-5104
39026
UMR
www.umr.com
888-265-3760
56144
HealthGram
www.healthgram.com
800-446-5439
Website
www.healthgram.com
Contact Numbers
800-446-5439
Dan Vaden Chevrolet
Office Visits
$40 co-pay
Specialty Doctor Office Visits
$40 co-pay
Evans Memorial
Coinsurance after Deductible
*Evans Memorial
90%
*Memorial
70%
*Evans Memorial
$25 co-pay
*MHP
$35 co-pay
Office Visits
Specialty Doctor Office Visits
$50 co-pay
Georgia Eye
Office Visits
$40 co-pay
Specialty Doctor Office Visits
$50 co-pay
Georgia Eye
Hunter McLean
HunterMaclean
Calendar Year Deductible (Individual)
$300
Family Deductible
$900
Coinsurance after Deductible
80%
Jeff Davis Hospital
Effective 1/1/2016
Plan Type
Plan A Gold
Plan E Bronze
Calendar Year Deductible (Individual)
$1,500
$3,500
Family Deductible
$3,000
$5,000
Coinsurance after Deductible
80%
75%
Individual Out of Pocket Max.
$3,000
$6,600
Family Out of Pocket Max.
$6,000
$13,200
Preventive Care Services
No cost
No cost
Office Visits (labs/X-rays)
$30 co-pay
$50 co-pay
Specialty Doctor Office Visits
$50 co-pay
$75 co-pay
Urgent Care Center
$75 co-pay
$75 co-pay
Jeff Davis Hospital
Effective 1/1/2016
McKee Court Reporting
Plan Type
Healthy100 3000
Calendar Year Deductible (Individual)
$3,000
Family Deductible
$6,000
Coinsurance after Deductible
Preventive Care Services
0%
100%
Office Visits
$30 co-pay
Specialty Doctor Office Visits
$50 co-pay
Allergy Treatment
$25 co-pay then 100% to $100 per visit
Urgent Care Center
$50 Co-pay then 100% to $300 per visit,
then deductible
McKee Court Reporting
Meadows Regional Medical Center
Plan Type
Gold
Silver
Bronze
Calendar Year Deductible (Individual)
$2,000
$3,500
$5,000
Family Deductible
$4,000
$7,000
$10,000
*MRMC Facility
80%
80%
80%
*MRMC Doctors
80%
80%
80%
*MHP Providers
80%
80%
80%
Individual Out of Pocket Max.
$4,950
$5,400
$5,850
Family Out of Pocket Max.
$9,900
$10,800
$11,700
Preventive Care Services
100%
100%
100%
PCP and Specialist Office Visits
80% after Deductible
80% after Deductible
80% after Deductible
Specialty Doctor Office Visits
80% after Deductible
80% after Deductible
80% after Deductible
Urgent Care Center
80% after Deductible
80% after Deductible
80% after Deductible
Coinsurance after Deductible
Meadows Regional Medical Center
Savannah College of Art and Design
Plan A
Plan B
Plan C
Office Visits (labs/X-rays)
$25 co-pay
$35 co-pay
80%
Specialty Doctor Office Visits
$45 co-pay
$55 co-pay
80%
Plan Type
Savannah College of Art and Design
PLAN A
Savannah College of Art and Design
PLAN B
Savannah College of Art and Design
PLAN C
Thomas & Hutton Engineering Company
Questions
Anyone???????
This Presentation is located:
www.mhp.memorialhealth.com
Providers
Provider Forms
2015 Practice Manager Meeting
Giveaways & Don’t Forget to Complete
Your Survey!!!
&