On the Beat magazine - Spring 2024

Physician organizations champion members’ successes

In this issue

TPA Leadership Team

Michael R. Madden President & CEO

Cynthia Beilmann Director, Finance

Heather Hall Vice President, Corporate Communications

John Luzier Director, Data Analytics

Michele Nichols Executive Vice President, Administrative Services

Carolyn Rada, MSN, RN Executive Vice President, Population Health Management

Oleg Savka Vice President, Information Technology

Ashley Shreve Director, Practice Transformations

Karen Swanson, MD

Medical Officer

Board of Directors

Dennis Ramus, MD Chairperson

Daniel Megler, MD Vice Chairperson

Trpko Dimovski, MD Treasurer

William Oppat, MD Secretary

Eugene Agnone, MD

Mazen Alsaqa, MD

Bruce Benderoff, DO

Paul Benson, DO

Dennis Bojrab, MD

Marcus DeGraw, MD

Sidney Simonian, DO

Richard Stober, MD

Robert Takla, MD

Robert Zaid, DO

Adam Hull, DO Ex officio

Dear members,

President’s MESSAGE

As we progress into 2024, ‘transition’ is the word that continuously appears in conversations among The Physician Alliance (TPA) team and board members. It is perhaps a word that best describes what 2024 will bring to the local healthcare marketplace for there is much occurring that will transition many areas of our work.

The dominant topic on the minds of our physicians, leadership team and board members is the proposed joint venture between Ascension Michigan and Henry Ford Health. While we continue to seek the most up to date information on the joint venture, we are preparing for the impact of this joint venture on TPA and our physicians.

Since the announcement in October 2023, our leadership team has been researching and reviewing options and created a comprehensive strategy portfolio that will benefit TPA, our members and patients. Several of our board members have begun discussions with Henry Ford and Ascension leadership regarding a relationship the joint venture will have with TPA and our physicians. The strategy portfolio and our future discussions with Henry Ford and Ascension will address many of our physicians’ questions and the innovative options that place our physicians in the best possible position for the future.

TPA’s leadership team has also been meeting with local payers to discuss the pressure on physicians to maintain a growing number of administrative responsibilities while still providing high quality care to their patients. The conversations have been very frank, leading to brainstorming of new ideas and ways to better partner.

As we face many transitions, we keep in mind three of our organization’s key success factors:

1. The number of physician members in our physician organization (2,380).

2. Our ability to successfully innovate in a continuously disrupted healthcare market.

3. The entrepreneurial mindset and support of our board members.

More than ever TPA physicians need to remain united as the largest independent physician organization in Michigan. Our strength is in our numbers and the number of attributed lives we oversee.

TPA is in a unique position to improve healthcare in our region of the state. Our strategic options will allow our physicians to provide the highest quality of care to their patients in the most efficient and effective manner while simultaneously being appropriately compensated. I look forward to sharing details of our work with you.

On behalf of The Physician Alliance board and associates, thank you for your continued support.

In good health,

Michael R. Madden President & CEO

Physician organizations champion members’ successes

Health care changes rapidly for physicians and patients in the United States. It can cause upheaval and uncertainty. Being part of an organization that is dedicated to promoting the interests and well-being of a profession can be very beneficial to navigating these changing times.

Physicians represent the core of any organized delivery system. A physician organization (PO) is formed when a group of physicians or smaller physician groups come together to work positively to influence care delivery, improve patient care and earn incentives from cost savings. A PO represents physicians working toward ‘a common goal of improving the medical profession with which they are associated,’ according to the American College of Physicians.

Physician organizations support their members

A PO can be a powerful ally for its members in patient care, practice revenue, payer negotiations and more.

“Coming together under a physician organization creates strength in numbers,” said Dr. Karen Swanson, TPA’s chief medical officer and a primary care physician. This allows for greater negotiating power, collegial support and representation among payers, vendors, and others. Swanson adds, “This competitive advantage helps physicians be successful in practice performance and patient outcomes.”

A PO also champions its members by providing resources, information and opportunities that assist them in being a successful practitioner in an ever-changing healthcare industry. Member benefits can include additional infrastructure and support to help with physicians in pay for performance programs, patient care, education, coding and billing, advocacy, payer contracts, business service discounts, marketing resources, and other services.

The power of local representation

The Physician Alliance (TPA) formed in 2011 when five local physician organizations came together to provide a unified voice for physicians in southeast Michigan. TPA has grown to become the largest independent PO in the state, representing more than 2,300 members providing primary care and specialty care.

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The Physician Alliance member benefits:

• Participation in incentive-based programs

• Participation in managed care plans through St. John Partners In Care

• Nomination for BCBSM’s Patient Centered Medical Home designation for a 20% – 80% additional value-based reimbursement

TPA members manage over 669,000 lives through multiple payers, including Blue Cross Blue Shield of Michigan, Health Alliance Plan, Blue Care Network and Priority Health. Through participation in BCBSM’s Physician Group Incentive Program (PGIP), TPA members have earned more than $142 million in value-based reimbursement payments since 2016.

“Coming together under a physician organization creates strength in numbers.”

Being an independent organization means that while TPA partners closely with Ascension Michigan and other health systems, the PO is a separate legal entity with its own board of managers and legal, financial and governing guidelines. Physician members are both private practice and employed by Ascension Michigan.

TPA provides practice support through staff and technology assistance, education, patient marketing materials and more. The practice resource team (PRT) also plays an integral role in supporting practices. A PRT member is assigned to a number of practices to help with closing gaps in care, achieve patient-centered medical home designation, earn valuebased reimbursement, ensure practices understand pay for performance program requirements, and more.

Membership in TPA is open to board-certified and board eligible physicians with staff privileges at an accredited acute care hospital in southeast Michigan. Visit www.TPAdocs.com for more information on TPA member benefits.

• Eligibility for 5-10% percent BCBSM value- based reimbursement participating in the Physician Group Incentive Program (PGIP)

• Free education webinars focused on important healthcare topics such as implementing legislative mandates, billing/collections, and technology updates

• Exclusive access to the Affiliate Partners Program, which provides preferred pricing to TPA members on a variety of business products and services

• Ability to participate in disease registry hosted by TPA to provide central repository of data for information sharing

• Opportunities to help TPA pilot new programs

• Networking opportunities with colleagues

• Join a TPA committee to get more involved in your PO, have a voice and interact with colleagues

• Access to digital newsletters full of news, updates and reminders related to the healthcare industry

• Updates on issues pertaining to Michigan health care via special reports, newsletters and meetings

Focus on GAPS IN CARE now to improve patient outcomes

It’s never too early in the year to focus on gaps in care and the diligence it takes to close them. A “gap in care” is defined as the discrepancy between recommended best practices and the care that’s actually provided, according to the National Institutes of Health (NIH).

Only 8% of U.S. adults attain all preventive care recommendations.

A NIH study revealed that while preventative care services and health screenings can help decrease healthcare burdens, “only 8% of U.S. adults attain all preventive care recommendations.”

Closing these gaps in care can help improve quality health outcomes and patient engagement.

Care gaps within a patient population are reflected in Healthcare Effectiveness Data and Information Set (HEDIS) scores. By eliminating gaps, HEDIS quality scores improve. Scores are used to qualify for payor reimbursement and incentives since patient outcomes are related to a practice’s performance.

Why focus on patient outreach now?

Creating an outreach plan to address gaps in care earlier in the year provides more opportunities for patient engagement. It also allows patients time to schedule appointments, such as mammograms and colonoscopies that may be booked weeks or months out.

An annual wellness exam is a great way to get patients into the practice to discuss their health. In fact, research shows that patients completing a wellness visit are “40% more likely to complete additional health actions that are traditionally hard to close ”

Patient engagement tips:

• Foster patient relationships to encourage getting preventive care appointments scheduled.

• Utilize EMR to identify patients who are overdue for immunization and preventative screenings.

• Address any barriers to getting care. The Physician Alliance (TPA) community health worker can help patients get access to non-medical resources (see article on page 7). Practices can log into TPA’s portal to complete the form for patient assistance.

Tips for outreach include:

• reminders in a practice’s patient portal

• phone calls

• text messages

• automated reminders from EMR

• postcards

• waiting room exam room flyers

• messages on visit summaries

Medical assistants and scheduling staff can also mention needed vaccines, screenings and other health topics. Engaging all practice staff in patient outreach helps make it less cumbersome and more likely to be successful.

The Physician Alliance provides gaps in care reports for members on the secure member portal Resources and toolkits can be accessed from the portal to assist practices in closing gaps.

By focusing on achieving higher-quality performance scores and closing care gaps, practices can help patients get appointments scheduled for needed health services and capture payor incentives while seeking better patient health outcomes.

Assisting patients in need

Health disparity and social determinants of health continue to impact access to care and patient outcomes. The Physician Alliance (TPA) provides support to member practices in assisting patients with non-medical resources. TPA’s certified community health worker helps practices support social determinants of health by working with patients to address needs and concerns impacting their overall health. There is no charge to TPA member practices for this service.

What support is available to patients?

TPA can assist patients with a variety of nonmedical needs.

Examples include:

Request patient support

The process is easy to submit a request for patient support!

• Primary care and specialty practices participating in BCBSM’s Physician Group Incentive Program (PGIP) through The Physician Alliance submit a community heath referral form stating a patient’s need(s).

• To submit a request for community outreach to a patient, log into TPA’s member portal at tpareporting.org.* Once logged in, click on ‘SDOH form’ on the left side menu and complete the form.

• Once a referral form is submitted, TPA’s community health worker will contact the patient regarding their need(s) within 2-3 business days.

• TPA will alert the practice via secure email about the patient contact and community resource provided to the patient.

• TPA will follow up with the patient one week after the initial contact to ensure they have been helped.

*Please contact your practice resource team member for assistance accessing the portal.

Key quality measure priorities for 2024

Improving quality metrics ties into improving patient care and practice revenue. While there are many important health topics, The Physician Alliance is focusing on several key quality measures this year. These measures consistently have room for improvement in the physician organization. Throughout the year, TPA will be sharing important information on these health issues to help support members’ efforts to educate and engage patients.

The 2024 key quality measure targets are:

Diabetes management measures:

• Diabetes care – Blood pressure control

• Diabetes care – Blood sugar control (A1C less than 8%)

• Diabetes care – Eye exam

• Diabetes care – Kidney health evaluation

Appropriate use measure:

• Appropriate testing for pharyngitis

• Appropriate treatment for upper respiratory infection

• Use of imaging studies for low back pain

Resources to support quality improvement

The Physician Alliance created resources related to these quality measures that are available at no cost to members. The Gaps in Care and Diabetes toolkits provide templates, social media graphics, coding tip sheets and more. Additional patient education materials and coding resources on the appropriate use measures are also available.

Access these resources and more on TPA’s website at www.TPAdocs.com.

Resources to help improve coding

Appropriate coding impacts patient risk factor scores and practice revenue. Members can access coding resources, including coding tip sheets that cover specific health conditions. Examples include:

• Diabetes CPT II coding updates sheet

• E&M levels of medical decision-making table

• HEDIS Advanced Illness and Frailty Exclusion guide

• Hierarchical Condition Category (HCC) coding and risk coding education tip sheet

• HCC Forever Codes tip sheet

• Low back pain – alternatives in diagnosis coding tip sheet

• Social Determinants of Health (SDOH) Z codes tip sheet

• TPA Adult HEDIS measures tip sheet

• TPA Pediatric HEDIS measures tip sheet

• Transitional care management payor coding tip sheet

On-demand coding webinars and special coding videos are also available to view. View coding resources and videos on TPA’s member portal at tpareporting.org

Coding education helps practices learn and understand how to accurately code for patient health screenings and issues. Save the dates for upcoming coding webinars open to members participating in BCBSM’s PGIP through TPA. Watch TPA’s website for more information and registration.

LUNCH WITH THE CODER: The Importance of Correct Diagnosis Coding

Tuesday, June 18 12–1pm Register now.

LUNCH WITH THE CODER: ICD-10 Updates for FY 2025

Tuesday, September 17 12–1pm

LUNCH WITH THE CODER: CPT Updates for 2025

Tuesday, December 17 12–1pm

Last year’s achievements future successes create

One of the many benefits of joining a physician organization is strength in numbers. In pay for performance or riskbased programs, that can help improve quality metrics and revenue for all participating physicians.

This means that an individual physician’s performance ultimately impacts their physician organization, such as The Physician Alliance (TPA). Staying focused on improving quality metrics, patient risk factors and the overall health of patient populations helps ensure that all members of the organization positively benefit in achieving goals.

While the healthcare industry continues to face transitions and challenges, The Physician Alliance and its members continue to accomplish many positive objectives. Thanks to the dedicated efforts of physician members, practice staff, practice resource team members and TPA associates, many milestones were achieved last year that help pave the path for continued success.

An evolving brand represents a renewed commitment to members

The rollout of a new company brand was a major highlight for The Physician Alliance in 2023. The new brand campaign included updated corporate logo, colors, website/email domain, website, member portal and hundreds of member resources.

The brand represents TPA’s commitment to embracing innovative ideas that ensure the success of members today and in the future. New member resources were launched, including quality toolkits, patient education materials and coding tip sheets.

Quality improvements positively impact revenue

• Clinical excellence continues among TPA members. With 124 primary care practices designated BCBSM patientcentered medical home, over 18,000 capabilities were added last year. These capabilities help improve patient care and outcomes.

• TPA also achieved 99.4% accuracy factor during BCBSM site visits, thanks to the excellent work of the four practices randomly selected for audits.

• These high clinical achievements helped over 1,200 primary care and specialty physicians earn more than $25,595,000 in value-based reimbursement (VBR) in 2023.

Technology advancements support patient care

• Almost 1,600 physicians and practice staff utilize TPA’s secure member portal to review important reports, such as clinical quality initiatives (CLQI) gaps, estimated PGIP payment and Medicare Advantage (MA) Stars progress.

• TPA also supports multiple interfaces between electronic medical record systems and health information exchanges to help improve MA Star rating and commercial CLQI scores. There are currently 36 inbound interfaces updating over 680,000 active attributed patients.

• TPA’s technology team provided much support to practices, resolving more than 1,500 help desk tickets in 2023.

• Supplemental data transmissions continued to be sent to payers. This information is used to improve MA Star ratings and some commercial CLQI scores.

• More than 428,000 supplemental data transmissions representing 13 services were sent to BCBSM.

• Over 95,300 transmissions representing 16 services were sent to Blue Care Network and Blue Care Complete.

• Over 200,000 transmissions representing 31 services went to Priority Health.

• Almost 100,000 transmissions representing 33 services were sent to Health Alliance Plan.

Legislative

LOOP

State and federal legislation impacts everyday lives, often without people realizing it until laws are in place. Legislators make important decisions impacting patients, physicians, and society. They typically have basic knowledge of issues that affect access to care, treatment options, physician revenue, insurance requirements and more. That’s why it’s critical for Americans to use their voice for positive change.

Politics aren’t pretty these days. It’s easy to want to ignore the news or stick your head in the sand and let others get involved. However, decisions are being made that impact healthcare. Legislation on patient care, treatment options, physician revenue, coding requirements, insurance benefits and more are often decided by elected officials with basic knowledge on these issues. Yet their votes carry big impact on physicians and patients.

It’s more important than ever to remind elected officials of their roles in representing constituents.

Being aware of these potential decisions is important. There are often opportunities to use one’s voice to influence change and have a positive impact on society.

Take action to improve care

The legislative activity shared below is a brief glimpse into the activities occurring that can impact physicians and patients (click the bill numbers for more details). The information is shared to help educate and raise awareness of these issues. Feel free to contact your representative to share your feelings on a bill and encourage them to vote yes or no. Any actions taken by members on these issues is at their discretion.

One person’s voice can help influence legislation that impacts physicians and patients.

Click here to find your state representative.

Click here to find your federal representative.

Contact Sen. Debbie Stabenow’s office.

Contact Sen. Gary Peter’s office.

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HB 4719: Copay Accumulator

Michigan legislation

Legislation overview: Co-pay accumulator programs allow the enrollee to use copay assistance (which include both copay coupons and support programs), but the amount of the support does not count towards the individual’s max out of pocket expenses or deductible. A bill was recently introduced in Michigan to make sure all copays count. This is crucial for patients to ensure they can afford medications and healthcare.

Where it stands: HB 4719 was introduced in the House and referred to the Insurance and Financial Services Committee. Patient advocacy organizations are meeting with representatives to gain support for the bill to move to the House floor for a vote. Constituents can contact their representative to ask them to support the bill.

SB 279: Scope of Practice

Michigan legislation

Bill overview: Senate Bill 279 calls for establishing autonomous practice authority for non-physician providers, allowing them to deliver care independent of physician-led care teams.

Where it stands: The bill was introduced in the Senate Health Policy committee in March, but not yet voted on. Michigan physician organizations oppose this bill. Contact your senator to ask them to vote no on this bill (MSMS has a pre-written template available).

HR 4520 and 4521: Enhanced penalties for assault of healthcare worker

Michigan

legislation

Legislation overview: House Bill 4520 and 4521 increase penalties for assault (with or without a weapon) against a health professional or volunteer. These new penalties apply to individuals who are not patients. It also requires a health facility to post signs in a “prominent and visible location describing the enhanced penalty.”

Where it stands: Last fall, the Michigan legislature passed two bills to better protect healthcare workers and volunteers. In December, Gov. Whitmer signed this legislation into law, now referred to as Public Acts 271 and 272 of 2023.

Right to Reproductive Freedom Constitution Article

Michigan legislation

Legislation overview: In 2022, Michigan citizens voted to protect reproductive freedom in the state constitution, which repealed a 1931 abortion ban. The state legislature passed legislation last fall that supports this proposal.

Where it stands: The governor signed the bill, which went into law in February. This law works to ensure that women can receive comprehensive healthcare from Michigan providers.

Save now on business services

The Physician Alliance members receive special savings on products and services through the Affiliate Partners program. Highlights of current partner products and services are listed below. Additional information on each Affiliate Partner can be found on The Physician Alliance website or by contacting the companies.

Cyber and other insurance

Huntington Insurance

Get cyber liability insurance that protects against risks associated with internet access, E-commerce, data storage, and loss/damage involving theft or destruction of data. TPA member benefits include high liability limits, low deductibles, and discounts for multiple physicians. Additional services include Huntington Insurance partnerships:

Spot pet insurance: TPA members, employees, friends/ family can buy pet insurance plans at a discounted rate

Elevate Wellness: Group medical benefits and individual options

Contact: Rick Loss rick.loss@huntington.com, (419) 720-7911

Legal Services

Rickard & Associates

Practices can benefit from comprehensive legal services and assistance ranging from general counsel services to employee issues, contract negotiations, compliance review, and more. Estate planning services are also available. TPA members receive premium services at a preferred rate. Inquire about a free consultation.

Contact: Lori-Ann Rickard info@larlegal.com, (586) 498-0600

Medical and Office Supplies

ODP Business Solutions (formerly Office Depot)

Members receive exclusive savings at Office Depot/Office Max through a discount program featuring low pricing on many business categories and medical supplies. The program has been updated with deeper discounts on more products and a lower order minimum for free shipping!

Contact: Business customer service BSDCustomerCare@odpbusiness.com, (888) 263-3423

Medical Answering Service

Ambs Call Center

A full range of quality HIPAA-compliant medical answering services, including web on-call portal, daytime call management, and customization options, are provided with exclusive TPA discounts:

• additional 8% discount applied to all plans and usage

• 1st month free

• set-up fee waived with annual agreement

Contact: Aaron Boatin or Ryan Ambs sales@ambscallcenter.com, (586) 693-3800

Medical Debt Collection

Transworld Systems (TSI), Inc.

A medical debt collection services company offering automated solutions to improve cash flow and reduce slow pay concerns. Core services for TPA members include profit recovery, phone collections, and insurance resolutions. TSI can assist with past due accounts follow up/reminder statements. TPA members get exclusive pricing on past-due accounts and debt collection services.

Contact: Michael Glass michaelglasstsi.com, (248) 914-0346

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Medical Waste and Secured Document Removal

Superior Medical Waste Disposal

Superior Medical Waste Disposal specializes in the safe and compliant handling of regulated healthcare waste. TPA members save 30% on their medical waste removal, document destruction and recycling contract. Services include:

• Sharps & biohazard disposal

• Pharmaceutical disposal

• Secure document shredding

• OSHA training and compliance auditing

Contact: Gerald Belanger gerald@superiorwastedisposal.com, (734) 656-8843

Vaccine Purchasing Program

Atlantic Health Partners

Atlantic Health Partners (AHP) is the leading vaccine purchasing program in the nation and offers favorable pricing for top vaccines. TPA members also receive great benefits, including:

• Annual rebate eligibility for all vaccine purchases

• Same favorable vaccine pricing regardless of size or specialty

• Free, easy enrollment in AHP’s program

Contact: Kimberly Thompson kthompson@atlantichealthpartners.com, (800) 741-2044