Q1: What is New York Medical Partners (NYMP?)
New York Medical Partners (NYMP) is a physician-led organization that intends to align its member physicians, South Nassau Communities Hospital (SNCH), and other community-based providers through a collaborative health care model. NYMP was developed to meet the challenges of managed care and to support the recent changes in the health care delivery and financing system. NYMP is designed to help its members improve quality of patient care, drive practice efficiencies, and succeed in the shift to value-based reimbursement through shared infrastructure and processes.
Q2: What is the difference between South Nassau PHO/IPA (SNPHO/SNIPA) and NYMP IPA?
In 2012, the South Nassau Physician Hospital Organization, Inc. (SNPHO) was created as a member of the physician-led not-for-profit organization aimed to align community physicians with SNCH and the employed physicians while supporting local practices. In 2012, SNPHO joined the Long Island Health Network (LIHN) PHO in collaboration with other PHOs in the region.
When LIHN PHO eventually disbanded, SNPHO officially created the South Nassau Independent Practice Association (SNIPA) to be utilized as the primary driver for clinical integration and any collaborative opportunities. In addition to SNIPA, a “super IPA” known as New York Medical Partners IPA, LLC (NYMP IPA) was formed. This IPA allows SNIPA members to collaborate with other local IPAs whose mission, vision, goals, and values aligned with those of SNIPA. It also allows for independent physicians who are not on the SNCH medical staff to become a member of the IPA and expand the physician network.
Q3: What is the difference between NYMP IPA and NYMP ACO?
NYMP was created to be an all-payer, clinically integrated organization to drive quality, cost, operational, and patient experience improvements. The NYMP IPA is intended to participate directly with commercial health plans, while the NYMP ACO is a special entity formed to participate with Medicare as part of the Medicare Shared Savings Program ACO. However, the overall NYMP organization shares common infrastructure and processes to implement payer-agnostic clinical initiatives.
Q4: How is South Nassau Communities Hospital (SNCH) involved?
Because the key to clinical integration is coordination across care settings, partnerships with hospitals are critical for success. SNCH is a committed partner to its community and physicians, and is investing people and resources into the development and success of NYMP. SNCH views NYMP as a vehicle to improve the quality of care, while supporting physician and private practice autonomy.
Q5: What is clinical integration?
Clinical integration is the alignment of clinical and operational processes, IT infrastructure, and the community of providers to better coordinate higher quality care across primary care, specialists, hospitals, and other community-based providers.
Q6: What is an ACO?
According to the American Academy of Family Physicians, an ACO is “a group of health care providers that agree to take on shared responsibility for the care of a defined population of patients, while assuring active management of both the quality and cost of that care.” Through the Medicare Shared Savings Program, Medicare participates with ACOs who are incentivized based on total cost of care and quality outcomes for their attributed Medicare patients. Clinical integration is necessary for success in an ACO.
Q7: Can I be in multiple IPAs? Multiple ACOs?
While NYMP will not impose restrictions on participation in multiple IPAs, you may need to review your other IPA agreement(s).
Primary care physicians can only participate in one ACO, but specialists can participate in multiple ACOs.
Q8: Do I need to participate in the IPA to be a member of the ACO?
Q9: How does the ACO receive shared savings?
The NYMP Medicare Share Savings Program ACO will enter into an agreement with Medicare for Medicare beneficiaries that will include a potential shared savings award to be received by ACO participating physicians. Medicare determines the attributed patient population for the ACO based on the physician who has provided the majority of primary care services to an individual Medicare beneficiary. A benchmark is determined based on the sum of historical expenditures for the patient population attributed to the ACO’s participants, including for services received outside the ACO itself. At the end of each year, Medicare compares this benchmark to the actual expenditures incurred. At the end of each year, if the ACO is successful in reducing their patient’s total medical expenditures Medicare will reimburse 50% of the savings to the ACO. NYMP will play an active role in supporting physicians drive care interventions that will help reduce the total medical costs for these patients, while also driving improved quality. These savings are achievable by improved transitions of care, improved management of chronic conditions, and elimination of duplicative testing, among many other clinical initiatives.
Q10: What is NYMP’s role in clinical integration and the ACO?
NYMP will support its member practices to drive quality, utilization, and patient experience improvements through key initiatives and shared infrastructure. Some NYMP providers are already participating in the Delivery System Reform Incentive Payment (DSRIP) Program to better serve their Medicaid population. NYMP is also in partnership discussions with commercial payers regarding innovative contracts, and is applying to enter into an ACO agreement with CMS through the Medicare Shared Savings Program ACO. As NYMP prepares for these new partnerships, it continues to pursue the following initiatives, which help lay the foundation for quality and cost improvements, and success in shared savings programs and value-based arrangements:
- Adopting population health tools and programs within the community to enhance care coordination and patient engagement, in order to improve health outcomes.
- Prioritizing an integrated Information Technology infrastructure, including inter-provider EHR and claims data aggregation, care coordination tools, and enhanced analytical and reporting capabilities.
- Developing NYMP mobile clinical teams comprised of care coordinators, IT and analytics support, and process improvement resources within the organization that will educate, engage and integrate the community providers into the coordinated care model and quality improvement processes.
- Leveraging already established evidence-based guidelines to standardize, benchmark, and measure clinical quality and performance (financial, efficiency, etc.) metrics.
Using the Medicare Shared Savings Program ACO as an example, NYMP’s shared infrastructure and dedicated resources to assist practices with coordinated care, health IT, analytics, and process improvement will help drive cost reductions and quality improvement across the organization.
Q11: How will clinical integration impact NYMP IPA’s ability to contract with health plans?
The government views clinical integration as a way for physicians to improve the quality of medical care and to control the overall cost of care through increased efficiency and reduction in the amount of unnecessary care provided. Participation in an effective clinical integration program provides independent physicians the ability to contract collectively without violating antitrust laws. Antitrust laws make it illegal for independent practitioners to negotiate jointly with health plans unless they are financially or clinically integrated. Therefore, a clinically integrated network may negotiate with health plans as a network, thereby improving the opportunity for increased reimbursement in recognition of the efforts to improve performance.
Q12: How will the NYMP IPA contracting model work?
In the short-term while the NYMP IPA develops its clinical integration program, the IPA will offer the services of its provider network, on a non-exclusive basis, to health plans utilizing a "messenger model" arrangement for purposes of contracting with those MCOs.
In the Messenger Model, the IPA acts solely as a communications agent between the physicians and the prospective health plan and does not perform any negotiations with respect to price. The ultimate agreement on price is reached between the health plan and the individual physician. Typically, the messenger process begins with an offer from the health plan that is communicated to all other physicians in the network. Physicians may not share rate information with other IPA physicians, and the IPA will maintain the confidentiality of rate information received from each physician.
Individual IPA physicians must make their own decisions about whether to accept or reject a health plan’s offer, independent of whether other IPA physicians will accept the offer and independent of any influence of the IPA. The FTC believes that any arrangement that in any way involves a discussion of fees or other economic terms on behalf of more than one physician practice is a per se violation of antitrust law.
Q13: Why now?
In light of health reform, payment pressures and increasing demands on physicians, the provider community is looking for an effective response to the changing market. NYMP has been carefully and strategically organized to adhere to these changes. Market realities and rising health care costs are a huge burden. The move toward value-based reimbursement and the need for measurable clinical performance metrics and population health management guidelines are placing increasing demands and payment pressures on private practice physicians. Beginning in 2017, the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) requires physicians to participate in either the alternative payment model (APM) track or the Merit-Based Incentive Payment System (MIPS) program. Commercial payers have continued to shift in this direction as well. In response, NYMP has emerged as a compelling and dynamic business model to support the goals of clinical integration, enhanced quality and financial strength.
Q14: Why should I participate?
When physicians participate as members of NYMP, they can take advantage of:
- NYMP tools and resources to improve access and quality of care, improving the health of patients and strengthening our commitment to the community.
- Upside financial opportunities for physicians through shared savings, care coordination, reimbursement, and quality incentives from payers, as well as increased referrals.
Support in the shift to MACRA:
While we await final direction on qualifying APMs, NYMP’s clinical integration efforts will mitigate risk and penalties associated with the MIPS program, which entails potential penalties of up to 9% on Medicare fee schedule based on the lack of reporting quality measures and meaningful use.
- Resources across aligned community providers that will enable meeting increasing demands at improved efficiency, while allowing physicians to maintain their desired level of autonomy.
Q15: How much does it cost?
For new members, dues have been waived until 2018.
Q16: How do I get involved?
There are many ways to get involved in NYMP:
- Have your practice participate NYMP IPA (email email@example.com)
- Sign the NYMP ACO participation agreement (email firstname.lastname@example.org)
- Talk to us about participating in one of NYMP’s committees (email email@example.com)
- Learn more about the Coordinated Care Program (email firstname.lastname@example.org)