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Paul Buehrens, MD,
EHP Medical Director |
From inception to recruitment in 2013, EvergreenHealth Partners had no contracts and no patients. Starting in 2014, we signed gain-sharing contracts with EvergreenHealth for our employees and dependents, along with Cigna, and Regence (for the Accountable Health Network product) and as of January 2015, with Aetna, our largest commercial payer to date. We have now signed with Premera for its ACO product set to launch on January 1, 2016, and as of yesterday, signed a contract through the Puget Sound High Value Network with the Health Care Authority for the public employee business. We anticipate this contract will be used as a template for King County, L&I, Medicaid, and other lines of business from the State and County. We are serving 20,000 patients through EHP, working to generate benefits to our participants through
these contracts by lowering the cost of care, improving quality, and improving value, patient satisfaction, and engagement: The Triple Aim.
EHP as a contracting vehicle, permits all types of contracting, and engages its participants in a joint effort to gain by reducing waste, lowering overhead, reducing unnecessary services and wrong site services, improving efficiency, making better use of medications through pharmacy management, enhancing care coordination and referral management, better use of behavioral health, and supporting and developing the capacities to advance the patient centered medical home.
The vast majority of quality metrics the payers focus on are about improving the delivery of primary care by “closing care gaps.” National consensus standards on services that “should” be provided but are not delivered constitutes a “gap.” The gaps we identified for priority work include screening young sexually active women for chlamydia, seeing young adolescents for well-visits, updating immunizations, depression screening, and performing pap smears and mammograms.
You might think we are already providing these services, though consider the errors of omission. What about the population that is not seeking care? What do we know about them? EHP knows there are literally hundreds or thousands of opportunities to provide the above services that are not being seized. What’s more, all generate ordinary fees and need no further business case for performance. EHPs contract provides additional revenue for doing so!
We are also implementing population health tools to bring over 50 practices and 40 plus EMRs together. Wellcentive is currently rolling out to our largest primary care units and will then be delivered to smaller units as speedily as feasible. This tool provides new ways to coordinate care, view a patient’s status, benchmark, and provides new opportunities to measure quality.
Dr. Koo from Woodinville Pediatrics has invented a geographic, searchable app for us to find participants among the ~565 providers in EHP. Thank you, Dr. Koo! Moving forward, the participants in the EHP network are committed to improving quality, lowering cost, and sharing data on these transparently inside the network. We are building the capacities to measure quality the way we want to be measured, and faster, across all our book of business to obtain more robust data than any payer in a much more timely and actionable manner than any claims database.
EHP is a startup; an entrepreneurial collaborative physician led and run effort. I’m overwhelmed by the engagement of our physician leaders and by the collegiality I see with everything we do. All of the decisions of the Board of Managers have been unanimous to date! Now that's collaboration!