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| Paul Buehrens, MD, EHP Medical Director |
In 2014, EHP had its first year of operations with contracts in place to care for real people! As a startup, we finished 2013 without any patients but we did have about 535 participating providers! Last year we began with working with one contract for the EvergreenHealth employees and dependents, and later added a Cigna contract.
We hired Debi Jefferson, RN in mid-year to help us as an RN Care Coordinator, and then Sara Rutherford as Quality Coordinator, and we began to work through developing processes for addressing the three populations we are managing: the sick, the rising risk, and the well. 5% of the population utilizes about 50% of health care dollars, and another 20% of the population is in a rising risk zone to become more unhealthy.
At least 60% of the population is better characterized as consumers than as patients, and are much less engaged than patients. Strategies to work with and for each of these must be in place for EHP to succeed. We are engaged with EvergreenHealth on a broad wellness strategy development as well.
We began to develop a direct to business strategy, and I was privileged last year to join Bob Malte at a couple of business forums to present EHP to the business community, and later I presented EHP to the Medical Quality Assurance Commission in Olympia at their annual meeting. We also engaged with the Pro Sports Club on mutual interests in supporting independent practice and wellness, and that dialog continues.
Contracting progressed, and while we signed early, it took a long time for the Office of the Insurance Commissioner to approve the new Regence Accountable Care Network plan, which is just now being marketed to employers. This is the first plan in a while to have a mandate for patients to choose a primary care provider, which is an enabler of population health management. EHP is one of only four networks being offered, along with Multicare in Pierce County, UW in King County, and The Everett Clinic in Snohomish County.
We also are finalizing an agreement with Aetna, and are engaged with Premera on their ACO initiative. EHP is also a part of the launch of the Puget Sound High Value Network, which includes Overlake, the Franciscans in Pierce County, Virginia Mason, The Everett Clinic, and Puget Sound Family Physicians (Edmonds Family Medicine). We estimated starting 2015 with about 19,000 patients we manage, and have gain-sharing contracts in place for them. My personal goal is to reach 100,000 patients under contracts by the end of 2016.
As the name of the game is population health management, we put forth an RFP for software to help with that, and are in the final stages of choosing a product and a partner for implementation this year. This will provide real tools! The tools will aid the care coordination staff, the patient and family, the primary care physician, and enable robust work on populations that just isn’t currently possible without it. 2015 will be an implementation year.
2015 will see additional contracting activity, growth and operations work. We are just getting started on integrating participant claims into our business intelligence engine for internal reporting, and that will grow markedly this year. We plan to work on educating our primary care doctors on coding for risk adjustment factors to get ready for Medicare Advantage contracting for 2016. If that’s not enough, then we have ICD-10!!
We have a superior team of physicians at the Board of Managers, a super engaged group of docs on the Quality Committee, a very engaged group of practice managers, an engaged and active Payer Committee, and a wonderful team for me to work with at the executive level. We are just where we want and need to be for this year, and poised for good things. I’m looking forward to 2015 with great enthusiasm!
We're proud to be recognized again by Healthgrades as a Distinguished Hospital for Clinical Excellence.