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February 9, 2023

In this issue

• Leadership Announcements
• Supporting Your Practice
• Advancing Health Equity
• Epic Updates
• CME



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Colleagues,

Since coming together in 1995, APP has been a physician-led organization with a governance structure that ensures your voice is heard in all decisions that impact the clinically integrated network (CIN). Thanks to your historical performance, APP is nationally recognized as the preeminent CIN and as the leader in value-based care.

Last week, we held our annual Governance Retreat with your APP Board of Directors. Your PHO Presidents participated to share local perspectives as we set strategy to continue to build upon our shared success and culture.

As we have done during our 28-year history, we candidly discussed our performance — where we did well and opportunities to improve at the retreat. We had strong results in many areas, but have seen our performance on Medicare Advantage (MA) and commercial capitation struggle over the last two years — performing worse than national average. APP has a history of taking on and overcoming performance challenges, and the board discussed that 2023 is the year we must improve our MA and commercial capitation performance from below average to top quartile, which will greatly benefit our patients and financially reward our physicians and hospitals.

Click here for key takeaways from the retreat. As always, thank you for your commitment to our patients and each other.

Dr. Gary Stuck, EVP, Chief Medical Officer, Advocate Health | CEO, APP

Don Calcagno, SVP, Chief Population Health Officer, Advocate Health | President, APP

Pranjal Shah, MD, has been appointed Vice President, Population Health for Enterprise Population Health effective Feb. 12. Read announcement.

Mike Logan, MD, has been appointed Interim Medical Director, PHO Population Health for Advocate Illinois Masonic Medical Center. Read full announcement.

Clinical Integration updates: View the latest program update. 

Resolution Center Transition: Effective March 1, the APP Resolution Center is undergoing a transformation and will now be known as the Customer Solutions Center. The goal is to improve outcomes of inquiries received by physician and APC offices/billers and the APP Managed Care payers. Learn more. 

2023 APP immunization fee schedule now available: The APP Immunization Fee Schedule includes 29 codes that have a price under CMS and 29 codes without a price. To price a vaccine where CMS does not have pricing methodology, APP will utilize the Premier McKesson base pricing. The 2023 APP Immunization Fee Schedule is effective as of Feb. 1. Additional details can be accessed here.

Recoupments: In March 2022, we shared a message regarding the Implementation of recoupment notifications. APP began the process to deduct or “take back” from future claims payments for claims in Q2 2022. Similar to the CMS recoupment process, the majority of recoupments are a result of retrospective change to patient insurance eligibility. Recoupments may also be taken for coding issues or coordination of benefits where an APP HMO contract was not primary. These recoupments will appear on the Remittance Advice Summary.

COVID testing update: Effective immediately, we have eliminated COVID testing for asymptomatic patients admitted to the hospital. With a high percentage of the population vaccinated or having immunity from prior infections, the risk of asymptomatic transmission is low, minimizing the need for testing these patients. We’ll continue testing symptomatic patients. Learn more.

Patient outreach: We are conducting patient outreach on your behalf to support quality outcomes and close quality care gaps. Read more.

Pharmacy & Therapeutics Jan. updates: Review the latest Pharmacy and Therapeutics ambulatory and system committees decisions. View summary.

Advancing Research:  

• Winter issue of Journal of Patient-Centered Research and Reviews published
• Grant program now accepting applications: Letters of Intent due March 8
• Excellence in stroke research: The Advocate Health Care research team was recognized during the American Heart Association’s 2023 International Stroke Conference for excellence in a clinical trial that led to the recent FDA approval of pRESET, a new thrombectomy device to treat stroke. Neurosurgeon Demetrius Lopes, MD, served as our principal investigator for the study.

We’re proud to announce that Advocate Health is among the small handful of health systems nationwide accepted to a new federal program focused on promoting health equity and addressing care disparities for underserved communities. Called ACO REACH, this value-based care program will assist us in deploying new tactics to help our patients, including more opportunities for remote patient monitoring, transportation to and from appointments and expanded access to digital solutions. We’re being trusted by federal leaders once again to step up and deliver on the promise of improving outcomes and advancing health equity. Thank you to the Medical Group and 10 APP aligned practices who are participating. 

Epic Update - Ambulatory Epic Connect: ACP navigator – AD status, CancelRX Change and more.

Epic Update - Hospital edition for Physicians and APCs: New timeline activity, CancelRX change, Epic efficiency hours and more.

This month and every month, we celebrate the enduring achievements and contributions of our diverse colleagues. Their impact continues to inspire how we work and who we want to be as an organization: an inclusive workforce addressing health inequities. 

Continuing Medical Education

Implicit Bias Awareness Training 

Research reveals that implicit biases can create harmful disparities in patient care and are one of the leading causes of inequity in the United States. This online course will help you better understand implicit and explicit bias and how to recognize, interrupt and mitigate biases that may negatively impact patient care. This training fulfills the Illinois Department of Financial and Professional Regulation (IDFPR) Implicit Bias Continuing Education (CE) requirement.

Upcoming CME



Feb. 14: Scientific Grand Rounds: Current State of Electrophysiology Research

Feb. 16: MEDtalks: The past, present and future of structural imaging

Feb. 20: Get Climate Smart | Vector borne diseases

Feb. 22: Barrington Health and Wellness Summit (In-person)

Feb. 23/March 2: Acute Kidney Injury (AKI) surgical risk reduction project

March 1: Get Climate Smart | Extreme weather

March 8: Polyvagal theory and treatment of trauma and stress-related diagnosis

March 11: New Developments in Cardiology (In-person/virtual)

March 17: 3^rd Annual Multidisciplinary Critical Care Symposium (In-person/virtual)

March 20: Get Climate Smart | Communication with patients

March 25: 23^rd Annual Cardiovascular Disease Symposium (In-person only/ABIM MOC credit)

April 12: Integrative Mental Health

April 28: Hot Topics in Pediatric Surgical Subspecialties (In-person)