Mount Sinai Health Partners
Clinically Integrated Network Newsletter
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In this episode, Dr. Fields conducts his first podcast interview with a frontline provider – his own PCP, Dr. Margaret Kearns-Stanley. They discuss the challenges and pleasures of being a family physician in New York City given the current healthcare landscape, the business of being a doctor, how being a part of MSHP impacts her practice, and more. Don’t miss
our spotlight interview with Dr. Kearns-Stanley
, where we dive deeper into her journey as a physician and how that has shaped her practice today.
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Dr. Jonathan Ripp, Senior Associate Dean for Well-Being and Resilience at the Icahn School of Medicine at Mount Sinai, joins Dr. Fields to discuss the movement in healthcare systems to promote wellness and combat burnout among providers, graduate fellows, and others. They discuss the sense among physicians of lack of control, advocating for regulations that make sense, a model of population health that doesn't contribute to burnout, and more.
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Provider Spotlight:
Dr. Margaret Kearns-Stanley, Family Physician
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We sat down with Dr. Margaret Kearns-Stanley, a family medicine physician on the Upper East Side to discuss her journey as a physician, her passion for family medicine, and how treating people as individuals with an understanding of their culture is critical for keeping them healthy. As an 8-year old, Dr. Kearns-Stanley’s grandmother was diagnosed with lung cancer and it was that experience that led her to the pre-med track as an undergrad. But she says it was the time she spent in Oakland that really shaped her career and her approach to medicine.
Read more
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March 29, 2019:
- Care Coordination requirement due
- Portal Access optional element due
April 19, 2019:
- 2019 Q1 Quality reporting due for PCPs only
Stay tuned for the 2019 Clinical Integration Program Reference Guide with deadlines for all the 2019 CI Program Participation Requirements (
for PCPs
) (
for Specialists
).
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Changes in CI Requirements for PCPs and Specialists in 2019
Similar to previous years, primary care providers (PCPs) and specialists will have to complete their
Clinical Integration Program Participation requirements
in 2019 (
PCPs
) (
Specialists
). The
Quality Performance Metrics
remains as another component of the Cl Program but one new program element for PCPs, the
Efficiency Performance Metrics
is introduced in 2019. These three components will impact the overall calculation of a PCP’s individual clinical integration index, which will dictate your individual incentive payment.
For specialists, the quality reporting process changes slightly. As a reminder, you must complete participation requirements to remain in the CIN and for PCPs to receive eligibility to receive an individual CI Program incentive payment.
Key changes for PCPs:
- Efficiency Performance Metrics – These are a newly introduced set of metrics and data for these metrics will be pulled from claims data received from MSHP-contracted payers. No additional reporting will be required by PCP providers.
- Data will be aggregated on the following Efficiency Performance Metrics:
- Potentially Preventable Emergency Department visits per thousand
- Ambulatory Sensitive Condition Admissions per thousand for adult and pediatric patients
- Quality Performance Metrics – This is a component you may recognize from previous years. However, for some PCPs data for this will be pulled using claims data we receive from our contracted payers. The data will be loaded into a system called Accountable Delivery System Platform (ADSP) run by Lumeris, MSHP’s business partner. The goal is to streamline the task of quality reporting and reduce the administrative burden for your office staff. More information will be shared with you over the next few weeks.
Key changes for Specialists:
In 2019, specialists will only be asked to report their quality metrics biannually, instead of quarterly. The first biannual submission will be due 7/12/2019 and the second biannual submission will be due 1/17/2020.
We reviewed requirements and changes at the December 2018 Town Hall. The recording is available in CILC. To access the video,
click here
and then click “Learning Events” and check “Voluntary Town Hall” under “Categories.”
You may also view the
PCP
or
Specialist
Clinical Integration Program Participation requirements.
Note CIN providers must complete the five Tier 1 participation requirements listed to receive quarterly base payments and the Tier 2 element to receive annual incentive payments under the 2019 Funds Flow Program. PCPs have the option of completing an additional element to earn additional points towards their annual CI Index.
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Care Compact
Care coordination is essential to our CIN in providing better care to our patients. As a reminder when you joined the CIN, you have committed to this effort by signing a MSHP care compact. This is a framework for how primary care and specialty care providers should communicate and work together to improve patient care.
Click here
to download a summary of this care compact.
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2018 Q4 Voluntary Town Hall Recording Available in CILC
Did you miss our last Town Hall? We talked about the 2019 CIN requirements, heard from Dr. Ravichandra, and discussed Bright Health as an option for CIN providers. See it here in our
Clinical Integration Learning Center
. You will need to click on “Learning Events” to view the full list of available courses.
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Updated Quick Guides Available
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Be sure to visit our Relationships page after you log into the Provider Portal at
mshp.mountsinai.org
. You’ll find information and rates for top codes with CIN-contracted payers.
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Bright Health Webinar: Thursday, January 17 – 12:30 PM
As a member of the CIN, you are a participant with Bright Health, a new insurance option for Medicare members, effective January 1, 2019. Join us on January 17 from 12:30 PM to 1:30 PM for a webinar to learn more about how to work with Bright Health to care for your patients.
Click here to register
.
Once registered, you will receive an email confirming your registration with the information you need to join the Webinar.
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Aetna Laboratory Selection Form
Aetna has released a Laboratory Selection Form. You will need to indicate that you will direct your Aetna patients to LabCorp and Quest. Please complete this as soon as possible.
This form,
while labeled draft, has been confirmed by Aetna representatives as the final form. For questions, please direct them to Aetna's customer service line at
https://www.aetna.com/health-care-professionals/contact-aetna.html
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Population Health in the Literature & Media
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Using Pharmacy Claims to Identify Patient Non-Adherence
MSHP uses pharmacy claims to help identify patients who are non-adherent. According to a December 2018 JAMA literature review pharmacy claims data correlates with more precise measures of adherence such as electronic pill bottles. In addition, the use of pharmacy claims data has been associated with improvements in clinical markers (e.g. LDL-C). The review also explores Clinical Pharmacist consultation in co-management of chronic illness, and reports promising evidence of both increased medication adherence and improved clinical markers.
Learn more by reading this review
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P: 877-234-6667
F: 212-523-5775
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