1. Saeed A. Khan MD, MBA, FACP © CureMD Healthcare ACOs and Requirements for Reporting Quality Measures © CureMD Healthcare Population Health Management and the Role of EHR Presenter: Dr. Saeed Khan

2. CureMD Population Health Mission 2 To create an all inclusive Population Health EMR by integrating Clinical Data and Quality Measures with Revenue Cycle Management.

3. Goals of US Healthcare Reform 3 Increased access Reduced costs Improved quality

4. Changes in Primary Care 4 Shift from individual to population management Shift from reimbursement for acute episodic illness based on E/M criteria to preventive care and chronic disease management with the new reimbursement model based on the reporting and monitoring of the population’s health status Move to decrease variance in care by the use of evidence based medicine and clinical guidelines

5. New Reimbursement Model 5 Transition from Volume based care [E/M, Procedure, RVU] to Value based care [in addition to acute episodic illness, quantifying care through defined measures and monitoring of such with an emphasis on prevention and minimization of the complications of chronic illnesses through early intervention]

6. Reimbursement Model 6 Based on Measuring defined preventive health metrics of a given patient population Measuring and showing improvement in defined metrics in the management of chronic diseases Accurate coding to capture the patient population true health status and applying appropriate medical risk adjustments [MRA]

7. Market Segments Involved 7 Health Plans/Insurance Companies Large physician groups Small physician practices

8. Health Plans 8 Challenges 1.Financial 2.Wellness and Population Management 3.Changing Delivery Models

9. Financial Challenges 9 Shifting reimbursement and funding. Shrinking profit margins. Increasing cost of doing business.

10. Wellness and Population Management 10 Move towards proactive prevention and wellness rather than retroactive management of acute decompensation in chronic illness Increased patient engagement in healthcare decisions with an emphasis on prevention Focus on Population-based care management Consistency of care

11. Changing Delivery Models 11 Care coordination across the continuum. PCMH and ACOs Transition to less costly platforms of care when appropriate, with the resultant cost savings and avoidance of reduplication of tests and services Move towards more office-based procedures for specialties

12. Physician Practices Challenges 1.Increased cost of business in face of shrinking reimbursements 2.Wellness and Population Management 3.Consistency of Care to Decrease Variances 4.Appropriate and accurate coding to capture the patient’s true MRA score 5.Integration of clinical and quality data into the billing cycle to report required elements for correct reimbursement

13. Population Health Process Outsourcing of tasks that can be consolidated to manage overhead 13 Care delivery organizations can meet the objectives of reducing operational costs, minimizing administrative overheads and maximizing profitability by strategically outsourcing their business processes to specialized service providers. CureMD can help your organization derive efficiencies and reduce costs, improve quality and experience quicker turn- around times while eliminating non-value-adding tasks. CureMD healthcare processing outsourcing enables your organization to outsource administrative and clinical functions including patient registration, eligibility verification, scheduling, medical billing, referrals and patient relationship management. By working with us, you will have the opportunity to free yourself from administrative and operational tasks so you can better focus on your core business – providing quality patient care. And since CureMD provides a comprehensive outsourcing methodology, you will not only free your resources but also save more than 40% in operational costs. Service packages include: Follow-up Appointment Reminder & Scheduling Back Office Services Medical Billing A/R management Denial management Patient Statements Trending and reporting Front Desk services Patient Registration Scheduling & Appointment Management Eligibility Verification Referral Management Appointment confirmation

14. Consistency of Care 14 Variances can be decreased by the use of: Guidelines based on established peer reviewed best practices Hypertension JNC 7 Diabetes Mellitus ADA Congestive Heart Failure AHA and ACC

15. Consistency of Care 15 Hyperlipidemia ACEP COPD/Asthma National Heart Lung & Blood Institute and ATS Depression APA Adult Preventive Care USPSTF

16. Appropriate and Accurate Coding 16 Diabetes with Renal Disease Historically coded as 250.00 [DM Type II w/o mention of complication] with a MRA multiplier value of 0.18 Now appropriately coded as 250.40 with MRA value of 0.508 and with 585.9 CKD unspecified with a MRA value of 0.368 for a total MRA multiplier value of 0.876

17. Correct Coding Tips Co-Existing Conditions Chronic Seven Diagnoses  DM  CHF  COPD  ASTHMA  EMPHYSEMA  PARKINSONS  A-FIB These diseases are generally managed by ongoing medication and have the potential for acute exacerbations if not treated properly, particularly if the patient is experiencing other acute conditions.

18. Top Ten Frequent HCCs by Occurrence (from FFS Medicare data) HCC108- COPD HCC80 - CHF HCC19 - Diabetes w/o complications HCC105- Vascular disease HCC92 - Specified heart arrhythmias HCC10 - Breast, prostate, colorectal and other cancer tumors HCC83 - Angina HCC96 - Ischemic or unspecified stroke HCC38 - Rheumatoid arthritis & infl cond… HCC82 – Acute MI 12.17% 11.17% 10.79% 9.36% 8.93% 6.99% 5.04% 3.97% 3.85% 3.82%

19. Integration of clinical and quality data into the billing cycle to report required elements 19 Quality reporting is Claims based process G codes and CPT II codes used Auto population of measures groups in subsequent visits Integration into Revenue Cycle Management to report PQRS and other required quality data to health plans and CMS

20. RCM Business Processes 20 Revenue Cycle Management -RCM

21. 21 Next Steps Preventive Care Modules with clinical alerts Hybrid Measures Groups, which will capture the requirements for HEDIS, 5 Star program (The Medicare Part C pay for performance incentive program), ACO’s and the PQRS requirements for MU. Incorporation of Evidence-Based Medicine in the form of clinically accepted guidelines from organizations like ADA, AHA for the management of chronic illnesses including diabetes, coronary artery disease, congestive heart failure and so on.

22. 22 Expansion of the existing decision-support systems to incorporate medical acuity decision trees. This includes but not limited to the development of medical risk-adjusted [MRA] coding to identify the true nature of the patient population under care. Extension of the patient portal to include links to popular wellness sites and similar programs, after input from patients, physicians, Health Plans and other stake holders. Expansion of health information exchange [HIE] to maximize the interconnectivity between the insurance carriers, providers and other vendors to maximize flow of information and decrease redundancy and avoid duplication of testing

23. 23 Continue with the current outsourcing of non value added tasks which will minimize missed patient appointments improve patient adherence to care plan and medication adherence through call centers and automated reminder systems. Revenue enhancement by capturing most appropriate MRA through improved decision prompts and identification and coordination of care across the continuum through HIE. Integrate the G code and CPT II reporting into RCM Other initiatives as the market warrants in the future

24. CureMD Healthcare 55 Broad Street, New York, NY 10004 Ph: 212.509.6200 www.curemd.com Enjoy the festivities!