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