YOUR GUIDE TO MAKING A WELL-INFORMED DECISION

Transcription

1 YOUR GUIDE TO MAKING A WELL-INFORMED DECISION

2 Independence and Centralized Support 1 Your Own Revenue: 7 Other Support and Benefits: 2 Your practice s fee-for service revenue and expenses are yours and not shared with other care centers or practices Greater Control of Office: Network of experts and peers Support with practice acquisitions and succession plaing Practice start-up, onboarding and integration You control your staff, compensation, hours, employee deployment, office operations, and clinical care Physician recruitment support New business development and implementation Medical Benefits: You have a choice of benefits packages for your staff Leadership: Physician owned and governed Governance 1:7 members are involved in governance Corporate management team is paired with physician leaders Executive Team: Access to Advocare s President/Chief Executive Officer and Executive Vice President/Chief Operating Officer 8 Strategic plaing Information Technology Support: Information Technology hardware/software application management services: Practice Management Scheduling Electronic Health Record Population Health Analytical System Electronic Medical Records one common EMR with integrated data throughout the organization. Highly customized information systems and data reporting. Training and support services Help Desk services 6 Dedicated executive and management team to support physician practices Management team reports to Advocare s Executive Council: High Physician/Patient Satisfaction: On-site installation/support Automatic upgrades , Microsoft 365 Cloud-Based Solution, latest document management Appointment reminder system The ability to influence patients care and their outcomes 9 Practice Management: Practice Management Support, Business Informatics and reporting

3 Clinical 1 Evidence-Based Medicine: 2 Ability to make decisions at a practice level based on evidence-based medicine and implement improved care care Clinical Support: Dashboards, analytics and process improvement initiatives are available Provide comprehensive analytics, as well as operations, financial and clinical support with key programs: Chief Medical Officer (CMO) dedicated to our physicians and organization Our CMO works to optimize doctor s workflow in value-based medicine and acts as a liaison between physicians and the leadership of Advocare MIPS (Merit Based Incentive Payment Systems) APMs (Alternative Payment Models)

4 Payer Relations & Contracting/ Population Health Services Payer Relations and Contracting: 1 4 Value-Based Programs: As a physician-owned and governed organization, a physician and executive oversee negotiations for our nearly 600 providers. Advocare payer contracting is driven by physicians, for physicians. Our contracting strategy is developed and executed by executives and physicians with years of experience in contracting and value based arrangements Contracting strategies and payer agreements are approved by Advocare s Contracting Committee and Executive Council Advocare maintains strategic relationships with payers, allowing us to effectively negotiate fee-forservice and value-based arrangements with payers 5 Advocare participates in and supports value-based programs across multiple patient populations. These programs include: Shared Savings Programs Pay for Performance and Quality with Commercial Insurers Medicare Advantage and Medicaid Programs MIPS (Merit-Based Incentive Payment System) reporting Medicare Chronic Care Management and CPC+ (Comprehensive Primary Care Plus) Clinically Integrated Network: Advocare resolves payment and contractual disputes Advocare supports and facilitates physician participation in Clinically Integrated Networks (CIN) 2 3 Population Health Resources: Advocare provides dedicated population health resources to support Advocare physicians and Care Centers/practices To transition to value-based care, we support a new set of capabilities, including, engaging patients and providers across the care continuum, managing financial outcomes under risk-based payment, transforming care delivery for population health management, and more Predictive Analytics: 6 We provide network participation support and credentialing Advocare s President/CEO, Howard Orel, MD was the Founder and First Chairman of 1,500 Physician CIN. As an industry expert, he is frequently consulted. Care Management Services: Advocare manages a centralized Care Management/Coordination Team, comprised of Registered Nurses and Licensed Social Workers, who are committed to providing support for Transitions of Care Advocare has invested financial resources and persoel to manage and report this data to providers Our team supports each Care Center to provide episodic case management for patients who are linked to our Value-Based programs Advocare utilizes a systematic approach, leveraging clinical and claims data, to identify at risk populations and offers interventions to improve health and reduce risk Our centralized Care Management team works collaboratively with our Care Centers to manage at-risk patients to improve quality and reduce risk We support clinical integration while providing cost analytics

5 Payer Relations & Contracting/ Population Health Services 7 Patient Navigation: Advocare offers clinical patient triage and an after-hours Call Management Program Patient navigation and after-hours Advocare Access Service is provided by Registered Nurses, answering calls from 5:00 pm 8:00 am and 24 hours Saturdays/Sundays/Holidays: Urgent/emergent clinical call triage services Linkage to Care Center and providers who are on call Real-time clinical documentation within patient s electronic medical record n n New Jersey for our Pediatric Care Centers. EAP provides satellite urgent care services for weekends and holidays. Call Us First Program Organizational initiative targeting continued reduction of uecessary Emergency Department and Urgent Care Utilization that fosters primary care continuity of care Reduce leakage to Emergency Department and Urgent Care while maintaining continuity of care Referral Development Next day/sick appointment scheduling facilitation We support an internal Referral Development Program to maintain our narrow network Linkage/referral to Advocare s Extended Access Program (EAP) in both Southern and Northern We encourage referrals to our high-quality provider network

6 Management Services 1 Management Services: 5 Credentialing: These services often referred to as back office functions include, but are not limited to: Initial/renewed provider and Care Center credentialing with payers Revenue Cycle Management Privileging and re-appointments with all hospitals 2 3 Finance Information Technology Credentialing Implementation and onboarding of new groups Human Resources Marketing Coding Education Compliance Revenue Cycle Management: Billing and collection services Accounts Receivable management patient statements, credit management and insurance follow-up Billing - protocols for sending out bills and pre-collection letters Reports - productivity reports/activity reports generated for review and action Finance: Accounting including financial statements and taxes 6 7 Payer follow-up with updates, changes and edits Initial, and renewals of all licenses Medical license, DEA and CDS Initiate CAQH data Implementation: Evaluate management and business process and provide re-engineering support Provide training and education to new office operations, systems, and computer usage Track and provide support and troubleshooting assistance to resolve any issues that arise during implementation Human Resources: Develop and administer company policies and procedures Create Employment Agreements for employees and member physicians Administer 401K Program and retirement plaing Health insurance with multiple plan options Payment of practice expenses and cash management Banking Capital funding available Employment Practices Liability Insurance coverage Paid time-off plans and standardization Payroll - process bi-weekly payroll, filing of all payroll taxes, and time-clock support 4 Information Technology (IT): Electronic Medical Record and Practice Management Systems IT hardware, software and support services

7 Management Services 8 Marketing Support: 13 Financial Operations: Development of branded marketing materials (internal and external marketing) Dedicated in-house financial team led by Chief Financial Officer and Treasurer Updating/development of news/journal articles, collateral material, website and social media Public relations and press releases Financial statements production of Schedule K-1s, review of financials, tracking of fixed assets and depreciation, tax return preparation, and periodic financial reviews 9 Patient educational and promotional communications Coding: Coding review, compliance, education/training Compliance chart review and periodic chart audits Budget development and plaing Accounts Payable and cash management services allocating and distributing funds Credit line access/management and company banking 10 Compliance: In-house Compliance Officer Compliance Plan regulatory and legal compliance Regulatory compliance oversight and management 11 Insurance Review and Verification: Verify and update insurance information Claims Manager software to reconcile payments against contracts 12 Group Purchasing Power: Group purchasing price reductions for medical and office supplies, malpractice insurance, etc. Request for Proposal and vendor development support Vendor contract negotiations and ongoing management Lease support for equipment

8 Ready to make a positive change? Join Advocare and share in the benefits associated with one of the country s most successful, independent, multi-specialty groups. The Right Choice. Advocare s Executive Council Howard N. Orel, MD President & Chief Executive Officer Michael T. Schlitt, MD Vice President Michael T. Snyder, MD Treasurer Mahbod Mohazzebi, MD Secretary Saba Aftab, MD Joseph DelGiorno, MD H. Michael Jung, DO Burton H. Langer, MD Anthony N. Mishik, MD John Murphy, MD Jason Pecarsky, MD Karen Peters, DO Florence Rosen, MD YOUR HEALTH. OUR PURPOSE. Advocare Management Chuck McQueary Executive Vice President & Chief Operating Officer DeWayne Hiebert Chief of Payer Relations & Population Health Jon L. Mackler Chief Strategy Officer Todd Mallon Chief Financial Officer John M. Murphy, MD Chief Medical Officer Advocare, LLC Lake Center Executive Park Route 73 North Building 10, Suite 320 Marlton, NJ 08053