Committee Corner - Membership & Operations

Message from

Kenneth McDowell, DO

Chair, Membership & Operations

Greetings Colleagues:

The membership and operations committee is the group inside the Alliance who evaluates and recommends to the Board of Managers the financial renumeration for the work done on our performance measures which, in part, drive the reimbursement for us all. As I write this it does seem less important in the setting of the pandemic but we need to be mindful of the eventual return to normal operations and these performance measures and practice improvements will again take on a more prominent role in our clinical day. As we are all preoccupied with the health emergency, and the rules and regulations we took so seriously a few short weeks ago are suddenly not as important today, we are finding ourselves in more uncertain waters.

I recall the debate going on when the Alliance began and the uncertainty we felt over the changing healthcare landscape moving to performance-based reimbursement. We have come a long way as the Alliance took shape and set common goals and practice strategies. For buy-in everyone was paying the same dues and reimbursed largely the same with a bit of extra reimbursement going to primary care physicians. It was clear from the inception of the performance initiatives that primary care physicians were going to be the initial front lines of practice performance. The committee has balanced this work with the contributions of specialist colleagues in coming up with membership guidelines and financial reimbursement for work specialists are doing to enhance the Alliance as well. As Medicare programs have changed and we have moved into a Next Gen model we have seen more focus on largely primary care initiatives and responsibilities for our covered lives. As our Alliance has matured in the program our risk as a group has increased and meeting performance improvement goals are even more important. The committee takes into consideration the changing initiatives and is now moving from a one-size-fits-all distribution model to a more goal centered incentive reimbursement to those medical specialties which perform added work to enhance the overall performance of the Alliance.

With larger stakes come larger rewards and this year membership will see changes to financial benefits for us all, no matter what specialty you are, for being a member of the Alliance NextGen ACO. Our primary care colleagues currently tasked with the lion share of the initiatives will also see added incentive payments as they align with the goals needed to increase Alliance performance. This may change in the future as government programs and Alliance performance goals adjust. Moving our Alliance to a more mature incentive payment structure focused on combined goals for us all will enhance the work the Alliance is doing as a whole and eventually yield higher rewards for all of us in better patient outcomes and better financial reimbursement as a reward for this enhanced level of care being delivered by all of our Alliance providers.

Categories: MWMD Newsletter