Mesa County Physician’s IPAAccountable Care for Mesa County
Physicians Cooperating to Deliver High Quality Health Care to Our Community
04/19/23
Gregory Reicks, D.O., FAAFPPresident Mesa County Physician's IPA
Mesa County Physician’s IPA
“One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare’s highest quality-of-care scores”
“Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care”.
Price adjusted Medicare Payments/Enrollee 2008
Mesa County Physician’s IPA
Mesa County Independent Physicians Association
35 Year History• Risk contracting• Clinical Integration • 295 Members
– 40% Primary Care
Mesa County Physician’s IPA
Lines of business:HMO Private Pay (Commercial) Medicaid (ASO Contract) Medicare (Cost Contract) Dual Eligible (Medi/Medi) CHP+
HCO PPO Self-funded
Initial claims paid net of a withhold:• 15% of allowed for HMO, Medicare, HCO-PPO plans• 15% of allowed RMHP Medicaid fee schedule• 0% of allowed for HCO-self funded plans
Withholds released on a profit-sharing formula:• MCPIPA/RMHP share 55 / 45 in first ~$9 million• Balance shared at 80 / 20 until full W/H returned
CommercialHCO(PPO)
HMOMedicare Medicaid
CHP+
Profit Sharing PoolGross operating Income +
Gross Withold
Profit Sharing PoolGross operating Income +
Gross Withold
Profit Sharing PoolGross operating Income +
Gross Withold
Total Profit Sharing Pool
RMHP MCPIPA
45% 55%
Mesa County Physician’s IPA
Mesa County Physician’s IPA
Historical Withhold Return
Mesa County Physician’s IPA
+ 53%
What the Evidence Shows
• Delivery System Reform Without Payment Reform Does Not Work
• Investing in Primary Care Works
• Cost Accountability Works
What Do We Mean by Payment Reform?
What Do We Mean by Payment Reform?
Isn’t This Capitation? No.Isn’t This Capitation? No.
Mesa County Physician’s IPA
Thank you
