Greetings from Mary Washington Health Alliance! For those of you that are questioning the new photo headlining this column, it is not a web page layout error that has placed my photo in place of the usual friendly, beaming, smiling face of Dr. Tom Janus. Tom has moved up the ladder of organized medicine to take on the position of the new Medical Director of our soon to be rolled out Mary Washington Medicare Advantage program that you will hear plenty about over the next several months. I have been tapped to carry on in his position as the new Chairman of the Board of the Health Alliance. I would be remiss if I did not take this opportunity to thank Tom for his dedication, enthusiasm, and strong leadership that has transformed this organization from a twinkle in the eyes of our original physician leadership group to the robust multi-million dollar company that exists today. As pointed out at our last Annual Meeting, the company is well ahead of any projections that we planned for by any measure – covered lives, revenue gained, number of risk programs, care coordination, commercial and government contracts, etc. Tom has been at the forefront of this juggernaut and has guided us through many perils, foreseen and unforeseen. If you happen to run into Tom (and you will), please be sure to thank him for his service.

One of the attractions to the field of medicine that spurred my interest as a young student many years ago was the lack of monotony in day to day activities. We, as clinicians, know that walking into our work each day will bring us something new that we have not experienced before. New patients, new disease presentations, new challenges, new problems, present an ever changing and exciting environment that keeps all of us sharper and focused in our workday. The same can be said regarding the ever changing face of population health management. I am continually amazed by the nimbleness of our executive team in managing our day to day operations, in addition to keeping abreast of the constant reiterations of various government and commercial risk based programs. We are in a select group as a Next Generation Accountable Care Organization (NGACO), one of only 41 in the country. In 2018, CMS released a final rule overhauling the Medicare Shared Savings Program. The new approach—called “Pathways to Success”—seeks to accelerate the transition of ACOs into downside risk models and takes effect on July 1, 2019. As we transition into this, there are constant changes in our programs that we seemed to have just mastered. We are phasing out of our Million Hearts program and changes are coming to our BPCI and QuE programs that will likely see them transform to all new programs. The good news, in all of this, is the tremendous foundation of experience and knowledge that we have already gained through our shared experiences, that will carry us well into the coming years.

Speaking of foundations, our Alliance Board has recently approved the rollout of our Epic Connect program. The benefit of qualifying as a NGACO has provided the Mary Washington Health Alliance to provide a substantial subsidy to physicians participating in the NGACO to implement the Epic EMR in their practices at a significantly reduced capital cost and maintenance cost to the individual practices. The waiver provided by the NGACO participation allows us to provide a subsidy without the implication of the Stark Law and Anti-Kickback Statute. This connectivity is a ‘win-win’ for the organization and physicians to allow us to be more cohesive in sharing data, analyzing data and trends, and more importantly, better and more efficient care for our patients.

I am excited for the future of our organization and humbled to be chosen to assist the leadership of this group of excellent clinicians.

Patrick McManus, MD