Message from Patrick McManus, MD

Chair, Membership & Operations Committee, Board of Managers

Membership and Operations committee continues to meet on a routine basis throughout the year primarily to review membership concerns and continually reassess and plan our distribution formula and incentives. The committee is made up of a broad cross section of specialists and primary care physicians both hospital and community based.

The Board of Managers approves the total amount of funds to be distributed annually once the Finance Committee has determined the monies needed to sustain the Health Alliance. The surplus funds are distributed to the physicians using the distribution formula developed by the Membership & Operations committee.

As a matter of review, we have set forth as a committee and approved by our board of managers, Core Eligibility Criteria that must be met by the entire system before any distribution of shared savings occurs. The savings is then distributed based on a formula weighted differently for specialists and primary care providers according to achieving certain benchmarks for quality management.

Our core eligibility criteria include:

• Timely payment of dues - annually
• Review of Individual Quality Cards, attested annually

The total available monies will be distributed based on:

Shared Savings realized (all or none)

1. Core network metric improvement for all specialties

• Unplanned readmission rate
• Admissions per 1000 lives
• Emergency Department visits per 1000 lives
• Generic fill rate

2. PCP specific metric improvement

• Attribution of lives: weighted per physician
• Preventative metric: yearly hemoglobin A1c check in diabetic patient
• Utilization: annual flu vaccine
• Medication adherence: including blood pressure medications, statin therapies, oral diabetic medications
• Anthem Personal Enhanced Healthcare program compliance with program web portal (Access portal monthly)
• Next generation ACO-Risk Adjustment Factor (RAF) compliance (Completion of at least 85% > of RAF forms pays 10%)

The weighting of each of these categories is illustrated below:

(Please note Metric 10 does not apply to Pediatricians as they do not have a sufficient number of RAF forms to comply. The metrics 5-9 will be weighted 6% each.)

As we as an organization continue to grow with our multiple contracts, now > 75,000 lives, we as a committee are continually discussing how to avoid making the distribution formula too complex that it is difficult to understand and measure but also to avoid over simplification of the process to provide incentives to and reward those physicians that improve quality of care with cost savings most effectively.