The Journal of COVER STORY: Pivoting to Telehealth-Overnight, p.14 - America's Physician Groups

 
The Journal of COVER STORY: Pivoting to Telehealth-Overnight, p.14 - America's Physician Groups
The Journal of            Volume 14 • No. 1 • Summer 2020

COVER STORY:
Pivoting to Telehealth–
Overnight, p.14

Post-Pandemic
Partnerships, p.16

Choosing an
MSO, p.34
The Journal of COVER STORY: Pivoting to Telehealth-Overnight, p.14 - America's Physician Groups
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The Journal of COVER STORY: Pivoting to Telehealth-Overnight, p.14 - America's Physician Groups
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The Journal of COVER STORY: Pivoting to Telehealth-Overnight, p.14 - America's Physician Groups
14
TABLE OF CONTENTS

                                                                     ON THE COVER
                                                                     Bill Wulf, MD
                                                                     The APG Chair-Elect shares how Central Ohio
                                                                     Primary Care pivoted to telehealth—overnight.
                     The Journal of
                                                                     DEPARTMENTS                         24
                                                                                                         Preemptive Compliance Reviews:
                                                                     6                                   A Business Development Strategy
                                                                     From the President
                    Publisher
                    Valerie Okunami                                                                      26
                    Editor-in-Chief
                    Don Crane
                    Editorial Advisory Board
                                                                     8                                   Do Oversight Programs Have
                                                                                                         a Measurable ROI?
                    Lura Hawkins, MBA                                News and Events
                    Dianne Glover, MPH
                    Mary Kay Payne, Arch Health Partners
                    Managing Editor
                    Lura Hawkins, MBA
                                                                     10                                  32
                                                                                                         Important Considerations Before
                    Contributing Writers                             Federal Policy Update
                    Brad Ayres                                                                           Accepting Delegation
                    Bill Barcellona
                                                                     APG Advocates for COVID-19 Relief
                    Ute Burness, RN
                    Don Crane
                    Garrett Eberhardt
                    Russ Foster                                      12                                  34
                    Justin Frazer
                                                                                                         Choosing an MSO: 10 Factors
                                                                     Policy Briefing
                    Dawn Maroney                                                                         to Consider
                    Sheila Stephens                                  MHA Grad Implements Telehealth
                    Bill Wulf, MD
                                                                     During COVID-19
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                    4 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS                 Summer 2020
The Journal of COVER STORY: Pivoting to Telehealth-Overnight, p.14 - America's Physician Groups
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The Journal of COVER STORY: Pivoting to Telehealth-Overnight, p.14 - America's Physician Groups
From the President
     A M E S S AG E F R O M D O N C R A N E , P R E S I D E N T A N D C EO
     A M E R I C A’ S P H YS I C I A N G R O U P S

     Members and friends,

     When the ball dropped and we rang in the year 2020, few could imagine the world
     as it is today. As I write this in late July, there are 16.5 million confirmed cases of the
     novel coronavirus around the world, with 4.3 million cases here in the United States.              Don Crane,
                                                                                                 America’s Physician Groups
     We’ve seen countries shut down their borders, states close virtually all businesses,           President and CEO
     and cities come to a complete standstill. The sickness and death, the economic
     devastation, the stress—all brought about by COVID-19. Very few of us have ever experienced anything like this before.

     Like many other organizations, America’s Physician Groups was not immune to COVID-19. Our highest priorities are the
     health, safety, and well-being of the APG community. With that in mind, we made the very difficult decision to cancel
     our Annual Conference 2020.

     As the severity of COVID-19 became more evident, physicians rolled up their sleeves and got to work, putting their
     own health at risk to meet the care needs of the patients and communities they serve. Many of our physician group
     members—in a week or less—transformed their practices from virtually all in-patient visits to virtually all telehealth. Our
     members are finding new and innovative ways to serve—from remote monitoring to virtual yoga. As one APG member
     said, “We’re doing whatever it takes to keep our patients healthy.”

     Your commitment to care hasn’t changed under these trying circumstances. And our commitment to providing you with
     the leadership, advocacy, and educational resources you need remains as strong as ever. Here is what we are doing on
     behalf of our members and others in the value-based care movement:

       • We are hard at work in Washington, advocating to ensure physician organizations receive the resources they need
         to keep their doors open and continue providing care to patients.

       • Through our website, webinars, and other materials, we are educating our members on how to qualify for and
         access vital resources in legislation like the CARES Act. We are providing information on changes to health
         policies and regulations that matter to your practice.

       • While we support our members’ fight against COVID-19, we also remain focused on driving the evolution and
         transformation of healthcare delivery throughout the nation.

     There is no question that millions of Americans are rightfully hurting and fearful of an uncertain future. I take solace
     in a quote from Mahatma Gandhi: “The future depends on what we do in the present.” I couldn’t be prouder to be part
     of an organization whose members are serving on the front lines of this healthcare crisis. Working together, we will
                                                                   answer this global health threat. And we will come out
                                                                   stronger for it.

                                                                             As to the future, I hope you will join us for our Colloquium
                                                                             2020, which will be held as a virtual event November 17-
                                                                             19. The theme is a timely one: “Answering the Call: Value-
                                                                             Based Care in Public Health.” For today, however, I hope
                                                                             you stay safe and healthy.

                                                                             As always, stay tuned and stay in touch. o

6 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS           Summer 2020
The Journal of COVER STORY: Pivoting to Telehealth-Overnight, p.14 - America's Physician Groups
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The Journal of COVER STORY: Pivoting to Telehealth-Overnight, p.14 - America's Physician Groups
News and Events
     WEBINARS                                                 NORTHWEST REGIONAL MEETING
     August 19                                                Thursday, September 24
     Emerging Insights of COVID-19 on Healthcare Delivery     SAN DIEGO REGIONAL MEETING
     August 20                                                Tuesday, September 29
     Racism – A Public Health Crisis in America
                                                              PEDIATRICS COMMITTEE
     August 27                                                Wednesday, September 30
     Reimagining the Physician Role to Serve Seniors in the
     Wake of a Crisis                                         SOUTHEAST REGIONAL MEETING
     (Offered by naviHealth)                                  Tuesday, October 6
     September 28                                             MIDWEST REGIONAL MEETING
     Medical Group Pharmacy Trends and Drug Pipeline          Tuesday, October 6
     (Offered by Ventegra)
                                                              SOUTHWEST REGIONAL MEETING
     PUBLIC RELATIONS/MARKETING COMMITTEE                     Tuesday, October 13
     Tuesday, September 1
                                                              INLAND EMPIRE REGIONAL MEETING
     GENERAL MEMBERSHIP/HUMAN                                 Thursday, October 15
     RESOURCES COMMITTEE
     Wednesday, September 2                                   MOUNTAIN REGIONAL MEETING
                                                              Thursday, October 15
     NORTHEAST REGIONAL MEETING
     Tuesday, September 15                                    CONTRACTS COMMITTEE
                                                              Thursday, November 12
     NORTHERN CALIFORNIA REGIONAL MEETING
     Wednesday, September 16                                  For information on all APG events, visit www.apg.org. o

        The Journal of                               Virtual Colloquium Edition 2020
                                                     “Value Based Care In Public
                                                     Health Emergencies”

       Discounted Rates For
       Members

       For Information contact:

       Valerie Okunami, Publisher
       916-761-1853
       journalofapg@gmail.com

8 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS    Summer 2020
The Journal of COVER STORY: Pivoting to Telehealth-Overnight, p.14 - America's Physician Groups
VIRTUAL
                                                       EVENT
                                                    Nov. 17 - 19!

COLLOQUIUM 2020
            November 17 - 19, 2020

ANSWERING THE CALL: VALUE-BASED CARE
   IN PUBLIC HEALTH EMERGENCIES
      For registration and information visit www.apg.org

                                 Summer 2020   JOURNAL OF AMERICA’S PHYSICIAN GROUPS l 9
The Journal of COVER STORY: Pivoting to Telehealth-Overnight, p.14 - America's Physician Groups
Federal Policy Update
    APG Advocates for COVID-19 Relief
    BY G A R R E T T E B E R H A R D T, D I R EC TO R O F F E D E R A L A F FA I R S , A M E R I C A’ S P H YS I C I A N G R O U P S

    The nationwide response to the COVID-19 pandemic continues. Congress and
    the administration have passed a series of bills and regulations offering financial
    relief and support for various industries impacted by COVID-19 and the resulting
    halt to commerce across the country.

    America’s Physician Groups has been extremely active in advocating on behalf
    of our membership for financial relief and assistance during this pandemic. We
    have also been very active in ensuring that alternative payment models, Medicare
    Advantage (MA), and other risk-bearing arrangements are preserved during this
    public health emergency—so that the move from volume to value-based care can
    continue its momentum.

    MSSP ADVOCACY

                                                                                                                 “Throughout
    APG, along with eight other healthcare organizations, sent a letter to Seema
    Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS).
    The letter provided recommendations in response to policy and regulatory
    revisions related to the COVID-19 public health emergency.                                                      the COVID-19
    The letter’s recommendations focused on ensuring that the Medicare Shared
    Savings Program (MSSP) remains sustainable for accountable care organizations                                   pandemic,
    (ACOs) and physician groups that are on the front lines of COVID-19.
                                                                                                                    APG has been
    “Every day, ACOs and physician groups are among the millions of healthcare
    ‘heroes’ providing care to the communities they serve,” wrote Don Crane,                                        focused on
    President and CEO of APG. “We urge CMS to provide them with the resources
    they need to continue that care.”                                                                               ensuring that
    FUTURE OF APMS WEBINAR
                                                                                                                    physicians
    Brad Smith, Deputy Administrator and Director for the Center for Medicare                                       have a stable
    and Medicaid Innovation (CMMI), joined APG’s recent webinar—co-hosted by
    CareJourney—on the Future of APMs. Valinda Rutledge, Senior Vice President                                      stream of
    of Federal Affairs at APG, and Aneesh Chopra, President of CareJourney, gave
    presentations on:                                                                                               financial
      • What risk-based care will look like as the pandemic continues
                                                                                                                    assistance.”
      • The future state of risk-based models in a post-COVID-19 world
      • The value offered by staying in risk-based models during COVID-19

    Deputy Administrator Smith reiterated his agency’s commitment to risk-based
    models while speaking with attendees. He offered continued support and
    collaboration from CMMI in pursuit of the models’ viability.

    TELEHEALTH RECOMMENDATIONS
    APG also met with CMS leadership to advocate that audio-only telehealth
    services qualify for risk-adjustment payments. In April, CMS announced

10 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS               Summer 2020
that organizations—including those in Medicare             Considering the increased importance of telehealth, the
Advantage (MA)—that submit diagnoses for risk-             letter addressed to Senate Finance made the case for
adjusted payment can now submit diagnoses from             making these changes permanent.
telehealth visits for risk adjustment. However, CMS
insisted that payment eligibility only extended to         APG also submitted letters to Sens. Jeanne Shaheen
audio-video visits.                                        (D-N.H.) and Michael Bennet (D-Colo.), as well as five
                                                           additional Senate offices, in support of their recently
APG sent a letter advocating for extending eligibility     introduced Medicare Accelerated and Advance
for MA risk-adjustment payment to audio-only               Payments Improvement Act. This legislation provides
telehealth services during COVID-19. The letter            physician groups on the front lines of COVID-19 with the
recommended that CMS count diagnoses obtained              financial resources they need to continue providing care
from audio-only telehealth services for MA risk            to the communities they serve. Key components include:
adjustment and offered suggestions on the guardrails        • Authorizing CMS to offer partial forgiveness for
given by CMS—analyzing the obstacles they present             the loans provided by the accelerated and advance
for physicians in providing care.                             payment programs
The letter also highlighted discrepancies in payment        • Lowering the amount withheld from Medicare
for audio-only telehealth visits compared with audio-         service claims from 100% to a much more
visual visits. APG continues to advocate on this issue        manageable 25%
and the extension of adequate payment for audio-            • Lowering the applicable interest rate of repayment
only telehealth services.                                     to 2%

COMMENTS: INTERIM FINAL RULE                               IN CONCLUSION
APG filed comments to CMS on the agency’s                  Throughout the COVID-19 pandemic, APG has been
April interim final rule. The rule offered regulations     focused on ensuring that physicians have a stable
addressing a variety of issues resulting from the          stream of financial assistance—while also advocating
COVID-19 pandemic. APG outlined a host of                  that Congress, the U.S. Department of Health & Human
recommendations in response to the rule, including:        Services, CMS, and other federal agencies work to
  • Expansion of eligible providers for                    alleviate near-term financial concerns so that physicians
    reimbursement for telehealth                           may concentrate on providing care.
  • Reimbursement for physicians for audio-only            APG is committed to transforming our healthcare system
    telehealth services for MA risk adjustment             toward one focused on value-based care and improved
  • Lifting restrictions on e-health and virtual check-    population health, quality, and patient experience. APG
    ins that require providers to track possible follow-   will advocate for additional financial relief as debate in
    up visits and reconcile any follow-up interactions     Washington continues. o
  • Clarity on the types of services that may be
    available to patients on homebound status
    during the public health emergency
  • Incentives to keep healthcare organizations
    enrolled in alternative payment models
  • Pay-for-reporting for all quality measures in
    2020 and 2021

ON CAPITOL HILL
We have also remained active in our advocacy on
Capitol Hill. We sent letters to the Senate Committee
on Finance and the Senate Committee on Health,
Education, Labor and Pensions (HELP). The letters
stressed the importance of telehealth and advocated
for continuing flexibilities for these visits past the
current public health emergency.

                                                            Summer 2020    JOURNAL OF AMERICA’S PHYSICIAN GROUPS l 11
Policy Briefing
    MHA Grad Implements Telehealth During COVID-19
    BY B I L L B A R C E L LO N A , E X EC U T I V E V P, G OV E R N M E N T A F FA I R S , A M E R I C A’ S P H YS I C I A N G R O U P S

                                                    In March 2020, as the COVID-19 pandemic hit California, Yamilett Medrano
                                                    jumped into the deep end of the pool.

                                                    “Yami” Medrano graduated from the University of Southern California’s Master
                                                    of Health Administration Program in 2017. She then began working for Loma
                                                    Linda University Health—first as Telehealth Program Manager and then as
                                                    Program Director for Digital Health. Her job: implement and develop telehealth
                                                    adoption among Loma Linda physician networks throughout Southern
                                                    California’s “Inland Empire.” Loma Linda is a big system, with a network of over
                                                    1,000 providers.

                                                    The job was going slowly and steadily with the usual issues—health plan
                                                    reluctance to incent telehealth adoption and physician confusion over dozens
                                                    of conflicting standards and billing processes. During the first part of 2020,

    “Loma Linda’s                                   though, newly enacted California legislation was accelerating telehealth
                                                    adoption. This was in anticipation of a January 1, 2021, mandate for health
                                                    insurers to cover telehealth services and pay providers in parity with in-person
       earlier                                      visits. But the challenging environment was still impeding adoption.

       preparations                                 The COVID-19 pandemic changed everything.

       provided a                                   AN OVERNIGHT CHANGE

       foundation for                               The Inland Empire, like the rest of the country, suddenly experienced an
                                                    overnight drop in patient visits. Physicians scrambled to keep their offices
       rapid adoption                               open, scrounging for personal protective equipment (PPE). Public officials
                                                    cautioned people to avoid elective healthcare, and patients stayed home. Loma
       across its                                   Linda University Health, like other systems across the nation, had to implement
                                                    telehealth capabilities almost overnight.
       provider                                     Since Medrano was the only full-time employee in the Digital Health
       network.”                                    department, she was tasked with developing expertise and partnering
                                                    with leaders across the organization to prepare the standards, billing, and
                                                    technology aspects for implementation.

                                                    Prior to the pandemic, the system was averaging five to 10 video visits per day.
                                                    In a matter of 72 hours, the number of video visits was increased to include all
                                                    physician-based and hospital-based clinics. By March 17, all clinics had been
                                                    instructed to convert visits to telephone or video.

                                                    At the late April peak, the network was averaging 53% of overall outpatient
                                                    visits completed via video, about 21% via telephone, and another 26% in
                                                    person. E-visits increased volume, but only reached about 1% of overall visits.
                                                    Primary care areas (i.e., family medicine, general medicine, and pediatrics)
                                                    achieved as high as 90% to 95% of total visits completed virtually. These
                                                    encompassed video, telephone, and e-visits.

12 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS                Summer 2020
Since the pandemic began, 651 providers have seen              Patients like the experience as well. Medrano reports
patients via video, and 127 clinic locations have offered      that surveys indicate that patients appreciate the
video visits. This does not include additional hospital and    convenience and feel as if they have more time to ask
skilled nursing facility (SNF) video visits.                   questions and speak with their physician.

                                                               Will telehealth stick? By early May, the network began
A FOUNDATION FOR SUCCESS                                       to add back more in-person visits and procedures/
Like other integrated systems that had embarked on             surgeries into its utilization volume. Loma Linda
adopting telehealth prior to COVID-19, Loma Linda’s            University Health is still averaging 30%-50% of
earlier preparations provided a foundation for rapid           its patient visit volume (it varies across specialties)
adoption across its provider network.                          through telehealth video visits. Medrano estimates that
                                                               the network will reach a level of 20% to 30% virtual
The previous integration of the electronic health record       patient visits over the long term. Both patients and
(EHR) solution, Epic, included MyChart video visits and        physicians have learned to appreciate the convenience
provided a stable platform for provider adoption that          and access provided by telehealth.
was connected to the existing patient record system.
Loma Linda had also contracted with Vidyo to provide           Was the effort worth it? Definitely, says Medrano.
secure, accessible telehealth access to patients across        The quick effort to deploy telehealth solutions
the internet.                                                  across the entire network was a professionally
                                                               rewarding experience, bringing a profound sense of
After the Centers for Medicare & Medicaid Services             accomplishment. An early advocate for telehealth, she
(CMS) issued a HIPAA waiver, Zoom was also                     also participates in the California Telehealth Policy
introduced into clinical workflows. Zoom soon                  Coalition—a stakeholder group that circulates best
accounted for 20% of all video visits. The other 80%           practice resources and advocates for greater adoption
were completed using MyChart or other physician-               of this form of care delivery. The future will bring
preferred video options. Medrano attributes the rapid          greater understanding of the areas in which video
deployment to the availability of the EHR-integrated           visits can be offered, and where they cannot. o
video platform and the huge team effort that helped
Loma Linda respond and transition care successfully.           Postscript: Medrano’s time at USC included courses
                                                               taught by Bill Barcellona, an adjunct professor at USC.
In a matter of days and weeks, Loma Linda also had             He is very proud of Medrano’s work ethic, commitment,
to create patient-facing education—including flyers,           and skills, and he looks forward to her future
FAQs, tips and tricks, and a dedicated webpage. Its            accomplisments.
marketing team rushed to place billboards throughout
the community advertising virtual care. “We continue to
revise and strategize how we educate and communicate
with patients, physicians, and staff,” she says.

The time crunch was just the first hurdle. Loma Linda
University Health was also challenged with connectivity
issues and network infrastructure problems. Audio
difficulties arose from time to time. Medrano identified
a need for a secondary, non-integrated video solution
such as Zoom or Doximity for patients who did not have
a patient portal or did not want to join via MyChart.

WILL TELEHEALTH STICK?
How did the doctors and patients feel about this
transition? A surprising number of physicians that had
previously been resistant to telehealth realized that
the video visit format was comfortable for both them
and their patients. Physicians can learn a lot about a
patient’s environment and background through video
visits.

                                                              Summer 2020   JOURNAL OF AMERICA’S PHYSICIAN GROUPS l 13
ON THE COVER

    APG Member Spotlight
    Pivoting to Telehealth—Overnight
    BY B I L L W U L F, M D

    Prior to March of this year, Central Ohio Primary Care (COPC) did not provide
    telehealth visits. In preparation for a slow launch of video visits in 2020, we
    increased our broadband capabilities in early 2020. Fortuitously, an upgrade from
    eClinicalWorks (eCW) in January improved our ability to deliver a satisfactory video
    visit.

    The plan was to pilot telehealth mid-year with a slow launch in the third quarter.
    Then, COVID-19 came along.

    IT AND TELEHEALTH RESPONSE
    In response to the emerging pandemic—and in accordance with directives from the
    state of Ohio’s Department of Health—we asked our physicians to limit in-person
    visits to emergencies or those deemed clinically necessary. We instructed our
    physicians that no wellness exams be performed in person, for patients of any age,
    beginning March 23.                                                                       “The plan was to
    In just one week, starting March 17, the COPC Information Services Department
    enabled 380 providers to perform video visits. In the six weeks between March 23
                                                                                               pilot telehealth
    and May 8, our staff web-enabled over 16,000 patients who had not previously been          mid-year with a
    accessing our portal, thus enabling an upcoming video visit for these individuals. Our
    physicians used eCW, Updox, and (rarely) FaceTime technology for video visits.             slow launch in
    Patient volumes were maintained at a 65% level compared with 2019, and 65% of
    all visits were done by video during the six weeks following March 23. COPC care
                                                                                               the third quarter.
    management staff reached out to nearly 4,000 high-risk patients to meet both
    social and medical needs. These patients were identified based on age, chronic
                                                                                               Then, COVID-19
    conditions, past emergency room utilization, and on whether they lived alone.              came along.”
    If needed, care management staff went to the patient’s home with an iPad to
    facilitate a video visit with a physician. During this time, an after-hours video visit
    system enabled over 500 video visits during evenings and weekends. Our triage
    system found that nearly half of these patients required a visit within four hours, and
    all were done via video.

    These visits were “picked-up” by waiting physicians within one minute of being
    placed in a queue by an after-hours call center nurse. As of June 18, COPC had
    completed over 90,000 video visits this year. Despite now seeing patients in person,
    we continue to use video for more than 20% of our over 3,500 daily visits.

    SURVEYS SAY…TELEHEALTH IS HERE TO STAY
    We surveyed over 8,000 patients following their video visit, as well as our primary
    care physicians. We found that:
      • 98% of patients were either satisfied or highly satisfied with their video visit.
      • Only 36% of patients said they would prefer their next visit be in-person.

14 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS      Summer 2020
• 90% of physicians planned to continue telehealth as         and even encouraged others to care for our patients
    part of their practice.                                     outside of the limited hours we set for our clinics.
  • 97% of physicians were either confident or                  Fortunately, the nationwide expansion of value-based
    extremely confident in their ability to provide             contracting and the progressive movement to full-risk
    telehealth.                                                 contracting will accelerate the recognition that we as
Continued telehealth services will require adequate             primary care physicians will be expected to assume
reimbursement from commercial and government payers,            an expanded responsibility for our patients’ care. o
as well as employer support. A video visit performed by         Bill Wulf, MD, is CEO of Central Ohio Primary Care
a patient’s PCP within the health record is clearly the         (COPC) and Chair-Elect of America’s Physician
most desirable and clinically efficient telehealth service      Groups.
available. There are surely many visits that can and
should be provided via video.

                                                                   Central Ohio Primary Care (COPC) is an
LOOKING BACK                                                       independent, physician-owned primary care
It is a shame that it took a pandemic to move us to                organization with 435 physicians in 77
telehealth. In retrospect, I believe we as primary care            locations. Ancillary services include a high-
physicians began abdicating some of our responsibility             complexity laboratory, radiology, cardiovascular
years ago—when we turned our phones to an answering                testing, and six urgent care facilities. COPC
service at 5 p.m. each weekday and on weekends.                    utilizes eClinicalWorks and cares for 25% of the
                                                                   population in Central Ohio.
Our recorded message would first instruct patients to
hang up and call 911 or go to the emergency room if                All COPC commercial contracts include a per-
there was an emergency. Next we provided a long list of            member, per-month prepayment used for care
services we could not, or would not, provide after hours.          management and education programs, as well
Finally, we asked the patient to leave a message and               as year-end shared savings. COPC is a CPC+
returned the call sometime later.                                  participant for 35,000 Medicare fee-for-service
                                                                   lives and is in a joint venture with agilon health
This abdication led to the need for urgent care facilities,        in prepaid, full-risk arrangements for 33,000
overuse of emergency departments, and the advent                   Medicare Advantage lives.
of remote telehealth services provided outside of the
patient’s longitudinal record. We have often allowed

                                                              Summer 2020   JOURNAL OF AMERICA’S PHYSICIAN GROUPS l 15
Payer-Provider Partnerships in a Post-
  Pandemic World
  BY DAW N M A R O N E Y

                                      The realities of the COVID-19 pandemic reveal an urgent need for healthcare
                                      providers and payers to work together for the benefit of both patients and
                                      frontline physicians. Infected patients require fast, unfettered access to testing
                                      and treatment. Overwhelmed physicians and their staff must clear the way to
                                      treat urgent patients, while upholding care for their patients struggling with
                                      chronic illnesses and ongoing treatment needs.

                                      As global attention naturally turns toward the crisis at hand, it is important that
                                      stakeholders across the healthcare industry do not lose sight of the role that
                                      payer-provider partnerships will play not only today, but moving forward. The
                                      good news is our industry was moving in this direction even before COVID-19.

                                      In a 2019 SPH Analytics survey of more than 80 providers and health plans,
                                      94% of respondents said they believe collaboration between payers and

  “Partnerships                       providers is now a key determinant of success.1 Partnerships within the
                                      healthcare ecosystem we’re building today will become the foundation for
                                      more sustainable business models that put patients at the center of care,
     within the                       offer efficiency to overburdened healthcare teams, and work toward reducing
                                      unnecessary spending—all ingredients for effective healthcare resilience in the
     healthcare                       future.
     ecosystem we’re                  Last year, Alignment Healthcare formed partnerships with two of California’s
                                      largest regional systems: Sutter Health, based in Sacramento, and PIH Health in
     building today                   Whittier. As the benefits of our partnerships have become more obvious during
                                      the pandemic, we have learned that these relationships work best when our
     will become the                  goals are aligned and our partnerships meet the needs of every patient in the
     foundation for                   ecosystem. While many factors contribute to a successful partnership, we have
                                      discovered that three overarching tenets are critical.
     more sustainable
                                      TENET 1: SIMPLIFY PATIENT ACCESS TO CARE
     business models                  As community hospitals across the country quickly pivoted to address faster
     that put patients                testing and urgent care for coronavirus cases, we saw a concerted effort
                                      to reschedule routine physician visits and non-urgent or voluntary medical
     at the center of                 procedures. It made sense, too: Hospitals were right to preserve capacity for
                                      incoming COVID-19 patients.
     care.”
                                      Necessity becomes the mother of faster adoption. While staying home has been
                                      the recommended strategy for flattening the curve and avoiding infection, we
                                      cannot ignore the importance of general healthcare and the ongoing monitoring
                                      and treatment for chronic illnesses. In response, we’ve seen a dramatic spike
                                      in the adoption of telehealth solutions. This year, the U.S. telehealth market is
                                      expected to reach around $10 billion, with 80% year-over-year growth due to
                                      the COVID-19 pandemic, according to an Arizton report.2 And for good reason.
                                      As TechRepublic recently reported, “Online appointments give doctors greater

16 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS   Summer 2020
flexibility, and with flexibility being one of the key      interests, allowing payers to more easily lower the cost
factors in preventing burnout, that perk is incredibly      trajectory of healthcare costs and offering providers the
beneficial for the provider’s state of mind.” 3             tools to help effectively deliver quality care.” 4

A foundation for our partnerships with Sutter and           Tightly aligned incentives for patients, providers,
PIH is Alignment Healthcare’s ACCESS On-Demand              and payers are a key foundation for our provider
Concierge program. This service empowers Alignment          partnerships. First and foremost, patients must have
Health Plan members to access a national network            the best possible outcomes—or they will take their
of U.S. board-certified physicians by phone or video        business elsewhere. Meanwhile, providers need
24 hours a day, seven days a week. This makes it            accurate, complete interoperable patient data and help
easy for our members to honor shelter-in-place orders       with ongoing consumer engagement. Payers need the
without delaying a diagnosis, treatment, or changes in      highest-quality care for their members, with an eye
prescriptions. It also allows doctors to focus first and    toward staying efficient with resources and cutting out
foremost on their highest-priority patients.                waste.

                                                            In just one example, as the payer in California, we
TENET 2: PROVIDE FLEXIBLE SUPPORT FOR                       implemented a proactive educational communications
STRESSED PHYSICIANS AND THEIR TEAMS                         campaign that engaged nearly 100% of our members
Before COVID-19, physicians already balanced                through email, SMS text, phone calls, telephonic town
limited time with increasing patient loads. As this new     halls, and direct mail, advising them on how to protect
pandemic schedule intensifies, digital solutions that       themselves from COVID-19 and stay at home. We
automate manual tasks, provide a more comprehensive         believe this aggressive member engagement effort
picture of patient health, and allow physicians to invest   contributed to lives saved.
more time in critical cases will become invaluable.
                                                            While the pandemic and all of its social, economic, and
A foundation for Alignment’s provider partnerships is       health impacts have yet to play out, the payer-provider
AVA™, our proprietary data analytics and technology         partnerships we are codifying now will be part of the
command center. AVA hosts our Alignment Healthcare          future of driving value across the healthcare chain for
Patient 360, which gives physicians a snapshot of a         the patient, the doctor, and the greater good—no matter
member’s health and treatment history so they can           what comes next. o
facilitate care coordination and close gaps in care. It
keeps providers engaged with their patients’ care even      Dawn Maroney is President for Alignment Healthcare,
if they cannot see them physically. It also simplifies      a Medicare Advantage company focused on providing
access to additional care that may be needed.               population health management services to health
                                                            systems and provider groups across the country.
Alignment Healthcare has also worked to supplement
physicians’ telehealth backlog—now a growing reality—       References
with Alignment’s network of doctors. We do this via our     1
                                                             Amick, Amy. “Why Payer-Provider Partnerships Need More
Care Anywhere program, a targeted high-risk program         Collaboration.” Physicians Practice. October 2, 2019. https://www.
focused on the delivery of in-home care. Our clinical       physicianspractice.com/view/why-payer-provider-partnerships-need-
                                                            more-collaboration
team, in coordination with a member’s primary care
physician, provides members 24/7 access to a doctor         2
                                                             Arizton Advisory and Intelligence. “Telehealth Market in US – Industry
and data-driven in-home care solutions.                     Outlook and Forecast 2020-2025.” April 15, 2020. https://www.
                                                            prnewswire.com/news-releases/the-telehealth-market-in-us-to-reach-
                                                            revenues-of-over-25-billion-during-the-period-2020-2025---market-
TENET 3: ALIGN INCENTIVES TOWARD A                          research-by-arizton-301040962.html
MORE SUSTAINABLE BUSINESS MODEL THAT                        3
                                                             Bayern, Macy. “Telemedicine Soars Amid COVID-19. Will Virtual
CENTERS THE ECOSYSTEM AROUND BETTER                         Healthcare Be the New Normal?” TechRepublic. May 19, 2020.
PATIENT OUTCOMES                                            https://www.techrepublic.com/article/telemedicine-soars-amid-covid-
                                                            19-will-virtual-healthcare-be-the-new-normal/
Unfortunately, the traditional healthcare landscape
often puts payers and providers at odds around
                                                            4
                                                             Deloitte. “Aligning Health Plans and Providers: Working Together
                                                            to Control Costs.” 2017. https://www2.deloitte.com/content/dam/
misaligned incentives in the patient interaction.           Deloitte/us/Documents/life-sciences-health-care/us-lshc-deloitte-
According to a 2017 Deloitte report, “Value-based care      aligning-health-plans-and-providers-v1.pdf
encourages providers and health plans to align their

                                                            Summer 2020     JOURNAL OF AMERICA’S PHYSICIAN GROUPS                 l 17
How Will COVID-19 Impact Business
  Insurance Premiums?
  BY B R A D AY R E S

  Given the climate of great uncertainty created by the COVID-19 pandemic, how
  will business insurance premiums be affected? To help answer this question for
  the America’s Physician Groups member community, I will share some of the
  recent trends influencing insurance rates and provide guidance on what can be
  expected with premiums in your upcoming renewals. (And please, don’t shoot
  the messenger—I come in peace.)

  FACTORS IMPACTING RATES
  Insurance rates are primarily driven by empirical data but are influenced by
  risk-projection models. Risk is inextricably tied to uncertainty. In this unique
  time of global health, social, and financial uncertainty, insurance premiums are
  increasing, coverage is tightening, and deductible levels are rising for several

                                                                                      “Insurance
  lines of insurance.

  Insurance underwriters are guided by actuaries. These actuaries are supported
  by teams of financial and business analysts that use technology to evaluate and
  determine a given organization’s risk. They take into account one to three years     premiums are
  of historic empirical “experience” data, exposure across coverage categories,
  and the firm’s financial strength, coupled with industry guidance.                   increasing,
                                                                                       coverage is
  AREAS OF ANTICIPATED PREMIUM INCREASES
  We are seeing the greatest rate increases in employment practices liability
                                                                                       tightening, and
  (EPL), followed by directors and officers (D&O) and errors and omissions (E&O)
  insurance. Other lines—including cyber and crime, as well as property and
                                                                                       deductible levels
  casualty (P&C)—are showing lower unilateral increases in comparison. Stop            are rising.”
  loss and employee benefits insurance rates appear to be less directly impacted
  by the pandemic at this point.

  CONTRIBUTING FACTORS
  Layoffs and Furloughs:
  Since the economic impacts of the pandemic hit our industry late in the first
  quarter, carriers have seen wrongful termination claims spike. This is due to the
  widespread furloughs and layoffs many healthcare delivery organizations have
  had to make. The carriers must account for this increase in wrongful termination
  claims in their risk models, and it is now reflected in higher premiums for EPL
  and E&O insurance.

  Working From Home:
  Although deemed “essential,” most health delivery organizations have pivoted
  to having their employees work primarily from home. This dramatic change has
  introduced new risks.

18 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS     Summer 2020
I don’t believe any
healthcare executive                                       COVID-Related Impact on Premiums for
would have predicted
in January that his or
                                                                Risk-Bearing Organizations
her entire team would                                         Q3-20 Through Q1-21 Renewals
operate remotely
from their homes—                                          Anticipated
                                                                                Coverage Change
let alone complete                 Insurance                Premium                                                  Reason
                                                                                    Trends
such a transition in                                         Impact
                          Employment Practices Liability     10% to 50%      Extensive HR-related policy    Layoffs, furloughs, and
under a few weeks.        (EPL)                               increase          updates, signed waiver  workforce changes leading to
The technologies                                                             requirements, RTW policies  more wrongful termination
that were rapidly                                                                       followed                   exposure
deployed, the remote      Directors and Officers (D&O)      10% to 30%           Carrier withdrawals,  Fiscal responsibilities, insured’s
                                                              increase         restrictions in coverage,accuracy in modeling, proper
management and
                                                                               additional underwriting    transparency, oversight of
accountability                                                                           scrutiny                 operations
processes                 Professional Liability/Medical     5% to 10%          Policy limits on liability
                                                                                                       COVID-related employee suits,
established in such       Malpractice                         increase                 decreased          infection-related litigation
short order, were                                                                                        increased, workplace safety
                                                                                                                costs and issues
impressive. It’s been
                          HMO Reinsurance (Provider          5% to 20%       Decreased pharmacy        Pharmacy costs driving majority
a remarkable feat to      Stop Loss)                          increase     coverage limits, increased of costs. Expensive gene therapy
witness the robust                                                            member exclusions             drugs entering market.
changes, particularly     Errors and Omissions (E&O)         5% to 10%     Conservative underwriting,    Business risk measurement
in claims operations,                                         increase          limit constriction      unsettled, operational change
                                                                                                       resulting from economic forces
where teams
                          Cyber Liability, Cyber Crime,      5% to 20%    Additional documentation of Cyber attacks up 25% to 40%
traditionally worked      Privacy & Network Security,         increase      the distributed network        since pandemic. Remote
in office settings.       Network Business Interruption                   security system and policies      employees using more
                          (Cyber)                                                    in place                 vulnerable systems.
But the speed of          Business Property & Casualty     Minimal change                              No direct COVID-19 correlation
this change has also                                                                                                 noted.
created cyber-crime
risks not anticipated
before the pandemic. Healthcare operations are now                  pandemic, attackers are taking advantage of the fact
being run from a widely distributed work environment                that many employees have been working from home,
of home settings, rather than being managed within the              without the technical protections that their corporate
heavily fortified corporate infrastructure. New security            networks often provide.”1
vulnerabilities include:
                                                                    Return to Work:
 • Personal equipment being used for professional
                                                                    When things stabilize, a robust “return to work” strategy
   use
                                                                    will be important to protect the health of your employees
 • Multi-factor authentication (MFA) often not utilized             and your business from avoidable workers’ compensation
   using shared home computers                                      claims. Litigation driven by employees feeling unsafe to
 • Company VPNs established on compromised                          return to work due to the threat of workplace COVID-19
   personal equipment                                               infections is contributing to premium increases.

This presents criminals with opportunities, and                     Recommendations from leading health agencies
the attacks are growing in sophistication and zeal.                 are advising employers to become workplace health
Ransomware and phishing schemes increase during                     gatekeepers to ensure office safety.2 While this seems
high-anxiety periods as more people fall prey to fear               like a necessary step given the crisis we face, such
and hope-based campaigns.                                           practices threaten to infringe on longstanding personal
                                                                    health privacy rights in the name of new models of
A recent Beazley report showed a 25% increase                       workplace safety procedures. Your insurance broker
in ransomware attacks in the first quarter this year
over the prior quarter. The report states, “During the                                                        continued on next page

                                                                      Summer 2020      JOURNAL OF AMERICA’S PHYSICIAN GROUPS l 19
continued from page 19                                     WHAT YOU CAN DO
  should have resources to support your human                When possible, ensure your broker incorporates an
  resources department with carrier-recommended tools        “experience refund” to your premiums. This provision will
  to help you balance this fragile dilemma.                  benefit you if the insurer’s loss experience is less than
                                                             projected. Build in more time during your renewal to
  Expect insurance premium increases with D&O, E&O,          account for the additional supporting documentation that
  and EPL as we travel down uncharted paths littered         carriers are now requesting.
  with HR land mines this year.
                                                             Make sure you are receiving multiple carrier bids. The
  Medical Spend Projected Increases:                         rate variation from carrier to carrier can be 15% to
  The financial effects of the COVID-19-related critical     50% for certain coverage lines. The rate disparity is
  care cases ripple through the entire healthcare            heightened during times of great uncertainty. If you
  ecosystem. There’s also concern about an increase          have not received multiple carrier bids in the past, you
  in hospitalizations coinciding with the flu season this    may have paid hundreds of thousands of dollars more
  fall. With such widespread speculation of the financial    on insurance than necessary. Multiple bids are more
  impact on both public and private entities, underwriters   important than ever.
  are more risk-averse. This is reflected in increased
  rates, higher deductibles, lower caps, and more carve-     SILVER LININGS
  outs written into the policies.
                                                             The COVID-19 pandemic is a global tragedy of
  We’ve also seen stop-loss insurance carriers               incalculable measure. Amidst the great loss, the crisis
  increasingly engage with clients to develop specific       has sharpened us and inspired heroic healthcare
  risk mitigation strategies to help prepare and manage      leadership and innovation. I believe the courageous
  the rise of high-cost exposure. The shared incentive       decisions made in streamlining workflows, empowering
  to manage costs is driving many carriers to extend         individuals, trusting remote employees, widely
  analytic tools and clinical resources to clients.          incorporating telehealth technologies, and proactively
                                                             engaging patients will lead to permanent changes. Some
  Shift From Commercial to Medicaid:                         of these remarkable innovations were highlighted by New
  Millions of former commercially insured members are        West Physicians and Vancouver Clinic in a recent APG
  now on Medicaid. This is due to the highest volume         webinar.4
  of initial filing for unemployment assistance since
                                                             I am hopeful these efforts and breakthroughs will lead
  the Great Depression. For physicians, this shift has
                                                             to lower insurance premiums the following policy year as
  meant reductions in contract rates and fee-for-service
                                                             you demonstrate improved outcomes even in a time of
  reimbursements.3
                                                             crisis. In the meantime, the broker community is here to
  When significant decreases in physician compensation       advocate for you and help ensure you have the necessary
  transpire, an increase in claims fraud traditionally       insurance protection to weather the storms ahead. o
  follows. Investing in a leading claims fraud/waste/
                                                             Brad Ayres is the Senior Healthcare Advisor for Pinnacle
  abuse solution to protect your business will not only
                                                             Brokers, an APG Group Purchasing (GPO) partner.
  protect you during this anticipated trend, but help
  control stop-loss premium increases in the years           References
  ahead.
                                                             1
                                                               Beazley Breach Insights, June 2020. Retrieved July 5, 2020, from
                                                             https://www.beazley.com/news/2020/beazley _breach_insights_
  ADDITIONAL RENEWAL DOCUMENTATION                           june_2020.html
                                                             2
                                                              Centers for Disease Control and Prevention, May 21, 2020. Retrieved
  You can expect more stringent financial reporting          July 6, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/
  and reserve requirements. Carriers are requiring           community/resuming-business-toolkit.html#employer-sheet
  additional financial documentation and tightening          3
                                                               Milliman, April 29, 2020. Estimating the impact of COVID-19
  financial solvency standards. They are also looking for    on healthcare costs in 2020. Retrieved April 29, 2020,
  compliance adherence language pertaining to return-        from Milliman: https://milliman-cdn.azureedge.net/-/
                                                             media/milliman/pdfs/articles/covid-impact-webinar-slides.
  to-work procedures and office health safety (OSHA)         ashx?la=en&hash=9D48FDF7A8D0D4808E8E23961A796B13
  protocols. These updated protocols for each state are      4
                                                              America’s Physician Groups. (2020, April 17). APG. Retrieved July
  available at osha.gov/stateplans/.                         5, 2020, from https://www.apg.org/wp-content/uploads/2020/04/
                                                             COVID-19-Case-Studies-in-Excellence.pdf

20 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS    Summer 2020
ORGANIZATIONAL MEMBERS                              Physicians Group • Hattiesburg IPA • Jest IPA       Dignity Health Medical Foundation: Dignity
                                                                    • KMG • Liberty Independent Physicians Group        Health Medical Group Arizona • Dignity Health
                ACO Management Services, LLC                        • Lighthouse IPA • Little River Canyon IPA •        Medical Group Nevada • Dignity Health Medical
                Kamal Jemmoua, CEO                                  Memphis Mid Town IPA • North Tennessee              Network - Santa Cruz • Foundation Physicians
                Mallory Cary, Regional Director ACO Operations      Medical Network • Prestige Physicians Group         Medical Group • Identity Medical Group • Mercy
                                                                    IPA • Princeton Premier IPA • Providence Medical    Imaging Medical Group • Mercy Medical Group •
                Advanced Medical Management, Inc. *
                                                                    Network IPA • Red Mountain IPA • Renaissance        Woodland Clinic Medical Group
                Kathy Hegstrom, President
                                                                    Physicians Organization • River Region IPA
                Hank Lee, Executive Vice President                                                                      Commonwealth ACO
                                                                    • Rutherford County Physicians Network •
                Groups: MediChoice IPA • Northern California        SCIPA • Southern Medical Physicians IPA • St.       Petar Novakovic, MD
                Physician Network • Seoul Medical Group •           Thomas Med Partners, LLC • Summit West IPA •        Lance Donkerbrook, CEO
M E M B E R S

                Torrance Health IPA                                 Synergy HealthCare • Synergy IPA • Tallaco IPA      Conifer Health Solutions
                                                                    • Tennessee Valley IPA • Trendsetter Physicians     Mary Bacaj, Head of Value-Based Care
                Adventist Health Physicians Network IPA             IPA • TriStar Medical Network • Valley Forge IPA
                Erica Fraguero, Director of Finance, SCR            • Valley Organized Physicians • Walker IPA • West   Groups: Exceptional Care Medical Group • Family
                Arby Nahapetian, MD, CMO                            Alabama IPA                                         Choice Medical Group • Family Health Alliance
                                                                                                                        • Mid Cities IPA • Omnicare Medical Group •
                Aegis Medical Group                                 Cedars-Sinai Medical Group *                        Premier Care of Northern California • Saint
                Carl Patten, General Counsel                        Caroline Goldzweig, MD, Chief Medical Officer       Agnes Medical Group
                Affinity Medical Group                              John Jenrette, MD, Executive VP, Medical Network
                                                                                                                        Cornerstone Health Enablement Strategic
                Richard Sankary, MD, President                      Central Ohio Primary Care Physicians Inc. *         Solutions (CHESS)
                Melissa Christian, Interim VP of ACO Operations     J. William Wulf, MD, CEO                            Yates Lennon, MD, Chief Transformation Officer
                Agilon Health                                       Larry Blosser, MD, Corporate Medical Director       Dan Roberts, Chief Operations Officer
                Ben Kornitzer, MD, Chief Medical Officer            Central Oregon Independent Practice                 Desert Valley Medical Group, Inc.
                Steven Sell, Chief Executive Officer                Association                                         Imran Siddiqui, MD, Medical Director
                AllCare IPA                                         Divya Sharma, MD, Medical Director                  Marie Langley, IPA Administrator
                Matt Coury, CEO                                     Kim Bangerter, Executive Director
                                                                                                                        DFW HealthCare Partners LLC
                Randy Winter, MD, President                         ChenMed *                                           Osehotue Okojie, MD, IPA Chairman
                Allied Physicians of California                     Guarov Dayal, MD, President, New Markets and        Josh Cook, President
                Thomas Lam, MD, CEO                                 Chief Growth Officer
                                                                    Stephen Greene, Chief of Staff                      DuPage Medical Group
                Kenneth Sim, MD, CFO                                                                                    Paul Merrick, MD, President, Co-CEO
                AltaMed Health Services Corporation                 Children First Medical Group                        Mike Pacetti, CFO, Co-CEO
                Castulo de la Rocha, JD, President and CEO          James Florey, MD, Chief Medical Officer
                                                                    James Slaggert, Chief Executive Officer             East Coast Medical Services, Inc.
                AppleCare Medical Group, Inc.                                                                           Ismary Gonzalez, MD, President
                Trish Baesemann, President                          Children’s Physicians Medical Group
                                                                    Leonard Kornreich, MD, President and Chief          Edinger Medical Group
                George Christides, MD, Chief Medical Officer                                                            Stan Arnold, MD, Senior Physician Executive
                                                                    Executive Officer
                Arizona Health Advantage, Inc.                                                                          Denise McCourt, COO
                Tanya Sibrava, DO, Senior Medical Director          Chinese American IPA
                                                                    Peggy Sheng, Chief Operating Officer                El Paso Integral Care, IPA
                Terry Smith, Chief Operating Officer                                                                    Hector Lopez, DO, Chairman of the Board
                                                                    George Liu, MD, President & CEO
                Austin Regional Clinic *                                                                                Tony Martinez, Administrator
                Norman Chenven, MD, Founding CEO                    Chinese Community Health Care Association
                                                                    Cathy Chan, Director of Operations                  EPIC Management, LP
                Anas Daghestani, MD, Chief Operating Officer                                                            Raymond Chan, MD, VPMA & CMO
                Bayhealth Physician Alliance, LLC                   CHOC Physicians Network                             John Goodman, President & CEO
                Evan W. Polansky, JD, Executive Director            Michael Weiss, MD, VP Population Health
                                                                                                                        Groups: Beaver Medical Group, L.P. • Pinnacle
                Joseph M. Parise, DO, Medical Director              Choice Medical Group                                Medical Group • Tri-Valley Medical Group
                Beaver Medical Group *                              Manmohan Nayyar, MD, President
                                                                    Thomas Conjurski, MBA, MSO/IPA Administrator        Equality Health – Q Point
                John Goodman, President and CEO                                                                         Pedro Rodriguez, HMA Board Member
                Raymond Chan, MD, VP Medical Admin/CMO of           CHS Physician Partners IPA, LLC                     Mark Hillard, President
                Epic Health Plan                                    Patrick M. O’Shaughnessy, DO, EVP & Chief
                                                                    Clinical Officer                                    Facey Medical Foundation *
                Bright Health Inc.                                                                                      Erik Davydov, MD, Medical Director
                Martin Serota, MD, Chief Medical Officer            Jonathan Goldstein, MBA, Executive Director
                                                                                                                        David Mast, Chief Executive, Medical Group
A P G

                Rachel Winokur, Chief Exeuctive Officer             Cigna Medical Group                                 Foundations
                Brown & Toland Physicians *                         Kevin Ellis, DO, CMO
                                                                                                                        Good Samaritan Medical Practice
                Kelly Robison, CEO                                  Citrus Valley Independent Physicians                Association
                Joel Klompus, MD, President & Interim CMO           Gurjeet Kalkat, MD, Executive Medical Director      Nupar Kumar, MD, Medical Director
                California Pacific Physicians Medical Group,        Martin Kleinbart, DPM, Chief Strategy Officer
                                                                                                                        Greater Newport Physicians Medical
                Inc.                                                Collaborative Health Systems, LLC                   Group, Inc. *
                Dien V. Pham, MD, CEO                               Anthony J. Valdes, President                        Adam Solomon, MD, CMO
                Carol Houchins, Administrator                                                                           Deeling Teng, MD, Senior Medical Director
                                                                    Colorado Permanente Medical Group, P.C.
                Canopy Health                                       Margaret Ferguson, MD, President & Executive        Hatfield Medical Group
                Mike Robinson, CEO                                  Medical Director                                    David Hatfield, MD, Chief Medical Officer
                Margaret Durbin, MD, CMO                            Claire Tamo, CFO and VP, Business Operations        Maria Barnett, Director of External Affairs
                CareAllies                                          CommonSpirit Health *                               Hawaii IPA
                Joe Nicholson, DO, Chief Medical Officer            Gary Greensweig, DO, SVP Physician Enterprise,      Greigh Hirata, MD, President
                Casey McKeon                                        Chief Physician Executive                           Julie Warech, Administrative & Financial
                Groups: Accountable Care Coalition of Alabama       Bruce Swartz, EVP Physician Enterprise              Manager
                • Baldwin Physicians Network • Ben Franklin         Groups: Catholic Health Initiatives: Architrave     Hawaii Pacific Health
                Physicians IPA • Broad Spectrum IPA • Clarksville   Health • Arkansas Health Network • CHI              Kenneth B. Robbins, MD, CMO
                Medical Network • Cullman Primary Care • Dallas     Franciscan Health • CHI St. Joseph Health •         Maureen Flannery, VP, Clinic Operations
                IPA • DC Qual-Care IPA • Delco Wellness IPA •       Colorado Health Neighborhoods • KentuckyOne
                DFW Healthcare Partners IPA • East Memphis          Health Partners • Mercy Health Network • Mission    Hawaii Permanente Medical Group, Inc.
                Medical Network • El Paso Integral Care • Elite     HealthCare Network • PrimeCare Select • St.         Geoffrey Sewell, MD, Executive Medical Director
                Medical IPA • Emerald Shores IPA • Etowah IPA       Luke’s Health Network • TriHealth • UniNet          Daryl Kurozawa, MD, Associate Medical Director
                • Franklin Medical Network • Greater Chicago

                                                                                          Summer 2020         JOURNAL OF AMERICA’S PHYSICIAN GROUPS l 21
Heritage Provider Network *                                  • Integrated Health Partners • Pioneer Provider     Optum (Formerly HealthCare Partners) *
                Richard Merkin, MD, President                                Network • Premier Physicians Network • Prospect     Amar Desai, MD, President Coastal Region
                Richard Lipeles, COO                                         Medical Group-LA Care • Prudent Medical Group       Don Rebhun, MD, Regional Medical Director
                                                                             • Redwood Community Health Coalition • Watts
                Groups: Affiliated Doctors of Orange County • Arizona        Health Corporation                                  OptumCare Network of Connecticut
                Health Advantage, Inc. • Arizona Priority Care Plus •                                                            Karen Gee, SVP & COO
                Bakersfield Family Medical Center • California               MemorialCare Medical Group *                        Rob Wenick, MD, VP & Medical Director
                Desert IPA • California Physician Network • Coastal          Mark Schafer, MD, CEO
                Communities • Physician Network • Desert Oasis               Laurie Sicaeros, COO, VP of Physician Alignment     Orlando Family Physicians
                Healthcare • Greater Covina Medical Group • Heritage                                                             Medhat Bedros, MD, Chief Medical Officer
                Physician Network • Heritage Victor Valley Medical           Mercy Health Physicians                             Roslynn ORourke, Chief Financial Officer
                Group • High Desert Medical Group • Lakeside                 Michele Montague, COO
                                                                                                                                 Pacific Medical Administrative Group
                Community Healthcare • Lakeside Medical Group •
M E M B E R S

                                                                             Meritage Medical Network                            Donna Mah, MD, President
                Regal Medical Group • Sierra Medical Group                   Wojtek Nowak, CEO                                   Michael Chang, MD, Executive Director
                Hill Physicians Medical Group, Inc. *                        J. David Andrew, MD, Medical Director
                                                                                                                                 Pediatric Associates
                David Joyner, CEO                                            Monarch HealthCare *                                Peter Shulman, MD, CEO
                Amir Sweha, MD, CMO                                          Bart Asner, MD, CEO                                 Scott Farr, COO
                Hoag Clinic                                                  Ray Chicoine, President
                                                                                                                                 Peoples Health Network
                Kris Iyer, MD, Sr. Vice President & Chief Administrative     Montefiore Medical Center/IPA                       Warren Murrell, President and CEO
                Officer                                                      Stephen Rosenthal, SVP                              Brent Wallis, MD, Medical Director
                Scott Ropp, Vice President and CFO
                                                                             Monterey Bay Independent Physician                  Groups: Health Prime, LLC • Independent
                Innovare Health Advocates                                    Association                                         Physician Association of New Orleans, Inc. •
                Charles Willey, MD, President & CEO                          James N. Gilbert, MD, President & Chairman of the   Memorial Independent Physician Association, Inc.
                Paul Beuttenmuller, CFO                                      Board                                               • North Shore Independent Physician Association,
                IntegraNet Health                                            Michele Wadsworth, Network Management               Inc. • Pontchartrain IPA, Inc. • South Louisiana
                Lawrence Wedekind, CEO                                       Associate                                           Independent Physician Association • University
                Jaime Duarte, MD, Medical Director, Outpatient                                                                   Medical Group, LLC
                                                                             Mount Sinai Health Partners *
                Intermountain HealthCare *                                   Niyum Gandhi, EVP & Chief Population Health         PHM MultiSalud, LLC
                Rajesh Shrestha, COO                                         Officer                                             Roberto L. Bengoa Lopez, President
                                                                             Robert Fields, MD, Senior Physician Leader on       Lynnette Ortiz, MD, Medical Director
                In Salud, Inc.                                               Population Health
                                                                                                                                 Groups: Advantage Medical Group • Alianza de
                Armando Riega, President
                                                                             MSO of Puerto Rico *                                Medicos del Sureste • Centro de Medicina Familiar
                Carmen Ramos, CPA, Executive Director
                                                                             Richard Shinto, MD, CEO                             del Norte • Centro de Medicina Primaria Advantage
                Iora Health Inc. *                                           Raul Montalvo, MD, President                        del Norte • Centros Medicos Unidos del Oeste •
                Rushika Fernandopulle, MD, MPP, CEO                                                                              G.M.D.C., Inc. • Grupo Advantage del Oeste • Grupo
                Tyler Jung, MD, CMO                                          NAMM California *                                   Medico de G.M.B., Inc. • Grupo Medico de Orocovis
                                                                             Leigh Hutchins, CEO
                Jade Health Care Medical Group, Inc.                         Ken Cohen, MD                                       Physicians Care Network
                Edward Chow, MD, President & CEO                                                                                 Mary Anderson, MD, Medical Director
                                                                             Groups: Coachella Valley Physicians of PrimeCare,   Denis McDonald, Executive Director
                Thomas Woo, Manager of Operations
                                                                             Inc. • Empire Physicians Medical Group • Mercy
                John Muir Physician Network *                                Physicians Medical Group • Primary Care             Physicians DataTrust
                Lee Huskins, President & CAO                                 Associated Medical Group, Inc. • PrimeCare          Kathi Toliver, VP of IPA Administration
                Ravi Hundal, MD, CFO                                         Medical Group of Chino • PrimeCare Medical          Lisa Serratore, COO
                                                                             Network, Inc. • PrimeCare of Citrus Valley •
                Key Medical Group, Inc.                                                                                          Groups: Greater Tri-Cities IPA • Noble AMA IPA •
                                                                             PrimeCare of Corona • PrimeCare of Hemet Valley
                Brent Boyd, CEO                                                                                                  St. Vincent IPA
                                                                             Inc. • PrimeCare of Inland Valley • PrimeCare
                James Foxe, MD, Medical Director                             of Moreno Valley • PrimeCare of Redlands •          Physicians of Southwest Washington, LLC
                Landmark Medical, PC                                         PrimeCare of Riverside • PrimeCare of San           Melanie Matthews, CEO
                Michael H. Le, MD, President                                 Bernardino • PrimeCare of Sun City • PrimeCare      Gary R. Goin, MD, President
                                                                             of Temecula • Redlands Family Practice Medical
                Leon Medical Centers, Inc.                                   Group, Inc.                                         PIH Health Physicians
                Rafael Mas, MD, SVP & CMO                                                                                        Rosalio J. Lopez, MD, SVP & CMO
                Julio G. Rebull, Jr., SVP                                    NaviHealth, Inc.                                    Andrew Zwers, Chief Operating Officer
                                                                             Jay LaBine, MD, CMO
                Loma Linda University Health Care                            Gina Bruno, MBA, VP, Clinical Strategy              Pioneer Medical Group, Inc. *
                J. Todd Martell, MD, Medical Director                                                                            Jerry Floro, MD, President
A P G

                                                                             New West Physicians, P.C. *                         Andrew Zwers, Chief Operating Officer
                Managed Care Management and Educational,                     Ken Cohen, MD, CMO
                LLC                                                                                                              Portland IPA
                Luis Deliz Varela, MD, Medical Director                      Northwest Permanente, P.C. *                        Susan Clack, MD, President and Board Chair
                Guido Lugo Modesto, Esq., Administrator                      Colin Cave, MD, Director of External Affairs,       Pamela Bauer, CEO
                                                                             Government Relations and Community Health
                Marshfield Clinic, Inc. *                                    Marilyn Weber, Chief Financial Officer              Preferred IPA of California
                Narayana Murali, MD, EVP & CSO                                                                                   Mark Amico, MD, Medical Director
                                                                             Northwest Physicians Network of                     Zahra Movaghar, Administrator
                Martin Luther King, Jr. Community Medical                    Washington, LLC
                Group                                                        Jesse Gamez, COO                                    Premier Family Physicians
                John Fisher, MD, MBA, President                                                                                  Kevin Spencer, MD, CEO and President
                Laurie Gallagher, Practice Administrator                     Ochsner Clinic Foundation                           Mat King, CFO
                                                                             Philip M. Oravetz, MD, Chief Population Health
                Medicos Selectos del Norte, Inc.                             Officer                                             PriMed Physicians
                Mildalias Dominguez Pascual, MD, President                                                                       Mark Couch, MD, President
                Fernando A. Garcia Cruz, MD                                  Ohio Integrated Care Providers                      Robert Matthews, VP of Quality
                                                                             Cindy M. Baker, CEO
                MedPOINT Management                                          Patrick Goggin, MD, Quality Improvement Medical     Prisma Health *
                Kimberly Carey, President                                    Director                                            Angelo Sinopoli, MD, Chief Clinical Officer
                Rick Powell, MD, CMO
                                                                             OHSU Health IDS, LLC                                Privia Medical Group LLC
                Groups: • Associated Hispanic Physicians of Southern         Katrina McPherson, MD, Chief Medical Officer        Keith Fernandez, MD, National Chief Clinical Officer
                California IPA • Bella Vista Medical Group, IPA •            Jeff Conklin, Chief Executive Officer               Graham Glaka, VP, New Product Development
                Centinela Valley IPA • Crown City Medical Group •
                El Proyecto del Barrio, Inc. • Family Care Specialists       Omnicare Medical Group                              ProHealth Physicians, Inc.
                IPA • Global Care Medical Group IPA • Golden                 Toni Chavis, MD, President                          Jack Reed, President & CEO
                Physicians Medical Group, Inc. • Health Care LA IPA          Ashok Raheja, MD, Medical Director                  Rich Guerriere, MD, SVP & CMO

     22 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS                            Summer 2020
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