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Annual Member Meeting May 3, 2016 Confidential Property of Quality Care Providers, Inc.

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Presentation on theme: "Annual Member Meeting May 3, 2016 Confidential Property of Quality Care Providers, Inc."— Presentation transcript:

1 Annual Member Meeting May 3, 2016 Confidential Property of Quality Care Providers, Inc.

2 Slide 2 Agenda Welcome Thank You Election of Class II Directors Annual Member Update Treasurer’s Report Closing Remarks

3 Confidential Property of Quality Care Providers, Inc.Slide 3 Thank You E-Voting Kindle Fire Drawing –Physicians’ Alliance of America www.physiciansalliance.com

4 Confidential Property of Quality Care Providers, Inc.Slide 4 Polling Question Are you communicating with patients online? Y/N

5 Confidential Property of Quality Care Providers, Inc.Slide 5 QCPI Board of Directors Miles E. Brett, MD Joel A. Goldstein, MD S. Catherine Huggins, MD Kenneth E. Jones, MD Michael J. Kinstler, MD Joseph M. Rosenfeld,MD Jitendra “J.T.” Singh, MD Imani D. VanNoy, MD J. Vincent Vigil, MD

6 Confidential Property of Quality Care Providers, Inc.Slide 6 Slate of Class II Directors The Nominating Committee approved the following Slate for Class II Directors, with terms expiring in 2019 Kenneth E. Jones, MD, Family Practice J. Vincent Vigil, MD, Pediatrics Imani VanNoy, MD, Internal Medicine

7 Confidential Property of Quality Care Providers, Inc.Slide 7 Election – Floor Nominations Eligibility Requirements Submit Floor Nominations through Webcast Q/A button Verification of Eligibility Requirements (for nominations from floor) Close Floor Nominations

8 Confidential Property of Quality Care Providers, Inc.Slide 8 Election Opening of Election Please cast your E-Vote/Ballot now –https://eballot.votenet.com/QCPI/login.cfm –Login: last name first initial –Password: date of birth “mmddyy” –Example: John Smith login: smithj password: 010193

9 Confidential Property of Quality Care Providers, Inc.Slide 9 Elections Proxy E-Votes Voting Process –CPA, PYA PC

10 Confidential Property of Quality Care Providers, Inc.Slide 10 QCPI Staff Stephanie Atkinson Steve Robey, MBA, MHA Rebecca Warthen, RN Sherry Vallee, LPN Vera Copeland, CMA Vicki Smith, RN

11 Confidential Property of Quality Care Providers, Inc.Slide 11 Elections Closing of Elections

12 Confidential Property of Quality Care Providers, Inc.Slide 12 Polling Question Are you currently participating in any gain-sharing programs such as ACO’s or PCMH based programs for which you are eligible to receive payments? Y/N

13 Confidential Property of Quality Care Providers, Inc.Slide 13 Annual Member Update BCBSGa HMO/POS Contract Network Updates Clinical Quality Integration Recognize & Reward Incentive Programs Treasurer’s Report Questions

14 Confidential Property of Quality Care Providers, Inc.Slide 14 BCBSGA HMO/POS Contract Financial Model – 3% Increase effective 1/1/16 to the Blue Open Access fee schedules –New Financial Model to commence 1/1/17 Membership growth continues to be in the Blue Open Access HMO/POS Products –Commercial –State Health Benefit Plan –Pathway (Exchange)

15 Confidential Property of Quality Care Providers, Inc.Slide 15 BCBSGA HMO/POS Contract –HMO/POS Products: BlueChoice Healthcare Plan (HMO), BlueChoice Option (POS) Open Access HMO/POS - includes Open Access HMO/POS and Pathway (Exchange) –Technology Metric Availity Usage: for member eligibility, benefits and claim inquiries instead of using the telephone –Clinical Quality Metrics Integrated with our clinical quality integration annual process 2016 Quality Metrics communicated in February – visit qcpi.org

16 Confidential Property of Quality Care Providers, Inc.Slide 16 Network Updates Availity.com MMH+ Platform Imaging Accessibility Pathway (Exchange) Products –Specialty Care Access –Inovalon BCBSGa News –Provider Webinars: May –Upcoming new programs

17 Confidential Property of Quality Care Providers, Inc.Slide 17 Availity: www.availity.com Secure multi-health plan portal with access to claims status (secure messaging is available), eligibility & benefits, AIM Specialty Health link, online remits Self service tools like Interactive Care Reviewer (ICR) to request inpatient and outpatient precertifications for many members covered by BCBSGa plans Ability to find information on a precert previously submitted via phone, fax, ICR, or other online tool

18 Confidential Property of Quality Care Providers, Inc.Slide 18 Member Medical History Plus – MMH+ Provides access to your BCBSGa patients medical and claims history online Free, up to 5 years of information, HIPAA compliant Medical history includes: past diagnoses, medications filled, lab results, procedures performed, other providers seen and care alerts Access via internet URL Contact Rebecca Warthen to sign-up. rwarthen@qcpi.org

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21 Pathway (Exchange): Specialty Care Pathway HMO (no out of network benefits, except in emergency) Pathway POS (some out of network benefits) Specialty Access Support Utilize phone number on back of patient’s ID card for Pre- Authorization Provider Services for Exchange plans: 855-855-2036 UM Pre-Authorization: 855-343-4851 Confidential Property of Quality Care Providers, Inc. Slide 21

22 Pathway (Exchange): BCBSGa engaged Inovalon to meet ACA Exchange health documentation compliance and you may receive requests for SOAP notes Receive $100 per note for completing Electronic Patient Assessment Solution Suite (ePASS®) SOAP notes (this is in addition to your office visit fee), or $50 for paper SOAP notes ePASS® can be used to access a supplemental clinical profile and complete a compliant medical SOAP note Register for an ePASS® Webinar by sending an email to: ePASSProviderRelations@inovalon.com Webinars are on Wednesdays from 3pm-4pm on following dates: May 4, May 11, May 18, May 25 and June 1, June 8, June 15, June 22 Confidential Property of Quality Care Providers, Inc. Slide 22

23 Confidential Property of Quality Care Providers, Inc.Slide 23 BCBSGa News Spring Provider Webinars Tues., May 10, 2016: 10:00AM –11:30AM Wed., May 11, 2016: 1:30PM - 3:00PM Register by email: RSVPblue@bcbsga.com Upcoming New Programs

24 Confidential Property of Quality Care Providers, Inc.Slide 24 Polling Question Does your office use the Secure Messaging feature in Availity for claims questions? Y/N

25 Confidential Property of Quality Care Providers, Inc.Slide 25 Clinical Quality Integration (CQI) Clinical Quality Integration is a process which aligns a physician group’s quality of care with its financial reimbursement on BCBSGa managed care products CQI Program includes both Open Access and traditional HMO/POS products Network is clinically and financially integrated

26 Confidential Property of Quality Care Providers, Inc.Slide 26 Clinical Quality Integration Blue Open Access HMO/POS Products: Commercial HMO/POS: PCP groups are re-tiered at least annually to one of three fee-for-service fee schedules based upon a subset of metrics – applied uniformly to groups Pathway (Exchange) Products: Potential for additional fee schedules as the product grows BlueChoice Healthcare Plan (HMO)/ BlueChoice Option (POS) -Traditional HMO/POS Products: Differential cap tables and fee-for-service fee schedules assigned annually based upon a subset of metrics – applied uniformly to groups

27 Confidential Property of Quality Care Providers, Inc.Slide 27 CQI – Physician Quality Report Physician Quality Report communicates benchmark data to help you understand key factors – quality, utilization, and resource use with the goal of continuously improving the quality of your care Provides feedback to you on how you manage your HMO/POS patient panels relative to other QCPI PCPs Fee Schedule determinations are communicated with Physician Quality Report 2015 Physician Quality Report / notification of new fee schedule assignments mailed next month

28 Confidential Property of Quality Care Providers, Inc.Slide 28 Incentive Program – Recognize & Reward Focused, targeted measures with clear guidelines, rules and potential rewards Incentives are tied to each measure independent of performance on any other measure Programs are open to participants regardless of panel size Gives incentives to you for providing documented, measurable preventive care to your patients Must proactively participate: “Opt in”

29 Confidential Property of Quality Care Providers, Inc.Slide 29 Incentive Program – Recognize & Reward Adult: –Breast Cancer Screening –Colorectal Cancer Screening Pediatric: –Pediatric Developmental Screening –Pediatric Body Mass Index (BMI) Documentation Program ends: June 30, 2016 Website: https://rewards.qcpi.org

30 Confidential Property of Quality Care Providers, Inc.Slide 30 Polling Question Does your practice have a designated Care Coordinator or someone otherwise responsible for clinical care management? Y/N

31 Confidential Property of Quality Care Providers, Inc.Slide 31 Treasurer’s Report Report from Dr. Joel Goldstein, Treasurer QCPI

32 Confidential Property of Quality Care Providers, Inc.Slide 32 Polling Question Is your office currently PCMH certified or in the process of obtaining certification? Y/N

33 Confidential Property of Quality Care Providers, Inc.Slide 33 Questions Please submit your questions through the Webcast Q/A button

34 Confidential Property of Quality Care Providers, Inc.Slide 34 Closing Remarks Stipend for Attending tonight’s Meeting: Please fax your completed Form W-9 to Vera Copeland at 678-399-6332. Download form at http://www.irs.gov/pub/irs-pdf/fw9.pdf Opt-in NOW to the Recognize & Reward Programs at https://rewards.qcpi.org or contact Sherry Vallee, LPN at svallee@qcpi.org or 678-553-4609 for assistance Kindle Fire Drawings for Practice Managers – winners will be notified later this week


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