Leading the Transformation of Healthcare

Letter from our Medical Director

As 2018 comes to a close, I would like to take a moment to express my gratitude to all of you in the Signature Partners family for our shared commitment to improving quality and reducing overall cost of care for our patient population. 2018 brought us many successes which are the direct result of the engagement of our network physicians working in tandem with our staff. With your contribution we have moved the needle on our quality metrics; our YTD quality scores are showing significant improvements compared to 2017.

In 2018 Signature Partners received a high performing ACO award by Premier Inc., based on our “exceptional performance” score of 90.85 out of 100 for 2017 MIPS reporting. This high score translates into a positive reimbursement adjustment of 1.39% change from 2018 in the 2019 Medicare physician fee schedule for all of the eligible clinicians who were part of our ACO in 2017. This is in addition to the 0.5% inflationary adjustment resulting in a total increase of 1.89% in Medicare reimbursements for 2019. Please note, the maximum reimbursement earned by any practice was 1.88% (i.e. a total of 2.38% including the inflationary increase).

Our quality team continues to make strides in effectively onboarding our network primary care practices during individual meetings and engaging our network primary care practices at the quarterly physician “POD” meetings. There were a total of 33 POD meetings held in 2018! We learned from these sessions and have made some adjustments to encourage all of our primary care practices to attend. If you have not had a chance to attend one this year, please plan to do so in 2019. These meetings are a great way to learn all about our payor programs, quality and cost metrics associated with our gain-share contracts, and to meet with your peers to learn best practices for performance improvement.

Our care management team developed and onboarded a Social Worker and a Pharmacist this year to solidify our multi-disciplinary team in an effort to manage the needs of our most complex patients. The team has achieved the care plan targets for the Innovation Health gain-share, and is ready to effectively manage new patient populations part of various payor contracts in 2019. The addition of our pharmacist has had a positive impact, not only in managing the patients with complex poly-pharmacy needs but also in helping guide our network providers toward more cost-effective medications, resulting in savings for patients and payors! This year we also began a pilot with our Group Purchasing Organization, Premier, Inc. and a few primary care practices to determine if the pharmacy discount program offers a greater savings for our providers than they would obtain individually. If the analysis shows favorability, we will be offering it to our entire network in 2019.

Our IT team has made advances toward establishing and validating many EHR interfaces and has achieved data integrity which has established the foundation to produce consistent, reliable and actionable reporting to our providers. This year our analytics team has been able to provide regular and timely reports identifying patient quality metrics gaps, ED utilization, and high cost prescribing by providers. All of these reports support quality and cost metrics performance improvement.

It has been a big year for network contracting with the addition of several major Value Based Contracts (VBC) – Aetna commercial, Aetna Medicare Advantage, Innovation Health Medicare Advantage and United Healthcare commercial plans. With the addition of these VBAs, our network’s attribution will increase to over 100,000 beneficiaries in 2019. Also, with the addition of 70 new providers this year, we have now grown to be a network of over 1700 ambulatory providers.

We have had a great 2018 and this has been possible due to team work and physicians collaboration. Our team is committed to continued improvement in the area of quality metrics performance, and plans to implement strategies required for achieving significant cost reduction as our Medicare ACO prepares to take risk in 2021. Our Quality Committee and the Board of Directors have been guiding us in identifying the top priorities for reducing cost and developing initiatives to be successful under various value based contracts. Based on the recent discussions during Quality and Board meetings, pharmacy and ED utilization reduction are considered to be the areas of focus next year. With your support our team is prepared to achieve success in these and other areas.

We know that our collaborative environment is working, and together we look forward to achieving new milestones in 2019 and beyond!

Thank you.


Neeta Goel, MD
Medical Director for Quality and Population Health

Pharmacy Update

Topical anti-inflammatory medications are becoming routine treatment for patients with osteoarthritis. These offer localized pain relief for patients and do not carry the same potential risk for adverse events as seen with oral non-steroidal anti-inflammatory drugs (NSAIDs). As with most other topical agents, these medications are significantly more expensive than oral medications due to the nature of the production complications associated with emulsion of an active ingredient in a delivery vehicle of either a suspension or a gel. In the topical diclofenac products category, there are several different options for patients. Clinically, there is no significant difference in the efficacy of these products and reduction of WOMAC sores (Western Ontario and McMaster Universities Osteoarthritis Index), but the cost can vary substantially from one product to another. It is important to recognize this cost difference as utilizing the lower cost drugs results in lowering of overall cost of care, which is directly related to the shared savings under value-based contracts. When selecting a topical diclofenac preparation, patients should be prescribed the therapy in a stepwise approach, starting with the 1.0% formulation followed by observation of how the patient responds to therapy before moving on to higher strength. If patients have localized pain, they should first be prescribed traditional NSAIDs, unless they have failed them in the past or have a specific contraindication to them.




Get Ready for MIPS Reporting

Under CMS’ Quality Payment Program, eligible clinicians providing services to Medicare beneficiaries are required to participate in the Merit-based Incentive Payment System (MIPS) which measures performance based on value and patient outcomes. MIPS consists of four categories: Quality, Cost, Improvement Activities, and Promoting Interoperability. If you participate in the Signature Partners Medicare ACO, the Signature Partners team will complete MIPS reporting on your behalf. However, each practice must attest to using a 2014 or 2015 Certified Electronic Health Record Technology (CEHRT) through an EHR to achieve points for the Promoting Interoperability category. The submission period begins on January 1, 2019 and ends March 31, 2019. Please work with your EHR vendor to complete this process. For questions or concerns regarding MIPS reporting for Signature Partners, please contact Jennifer Oppong, MSSP Program Manager at Jennifer.Oppong2@inova.org

Annual Dinner Held On May 8th

This year’s Signature Partners Annual Dinner was held on May 8th at the Fairview Park Marriott and was attended by 200 guests.  Dr. Amy Nguyen Howell, CMO for America’s Physician Groups, gave a riveting presentation on alternative payment models and the shift toward value-based incentives with a specific focus on the value of Medicare Advantage plans. The evening included presentations by Dr. J. Stephen Jones, CEO of Inova, in one of his first public appearances, and Dr. Sunil Budhrani, CMO, CMIO for Innovation Health. Continue reading “Annual Dinner Held On May 8th”

Signature Partners Annual Dinner

Please mark your calendar for Signature Partners Annual Dinner on May 8th from 6 p.m. to 9 p.m. at Fairview Park Marriott. We are excited to have Dr. Amy Nguyen Howell, Chief Medical Officer, America’s Physicians Group (formerly CAPG) as the Guest Speaker for the event. Dr. Amy Nguyen Howell is a board-certified family practice physician. She currently oversees all clinical programs at America’s Physician Groups and supports advocacy work in Sacramento, CA and Washington, DC.

Dr. Nguyen serves on several national committees that provide structure for an innovative coordinated delivery model focused on payment reform and integrated, high-quality, patient-centric care. Some of these include Measures Application Partnership (MAP) Clinician Workgroup, that provides input to the Coordinating Committee at the National Quality Forum (NQF) on matters related to the selection and coordination of measures for clinicians; Technical Expert Panel on MACRA Measurement Development; Steering Committee on the Core Quality Measurement Collaborative; Healthcare Payment and Learning Action Network (LAN) Population-Based Payment Work Group; Clinical Programs and Patient-Centered Specialty Practice Advisory Committees at NCQA.

Dr. Nguyen is a faculty member at USC Sol Price School of Public Policy and continues to serve as a family physician at Playa Vista Medical Center. An invite and agenda will be coming out very soon!

Payor Plans Update

Innovation Health Medicare Advantage Plan: By now you may have begun seeing members of the Innovation Health Medicare Advantage Plan which became effective on January 1, 2018.  Below are a few details about the plan including sample ID cards.

Important things to know

Examples of Innovation Health Medicare Advantage Member ID Cards

Providers can call Innovation Health Medicare Advantage plan at 1-855-249-1282 Monday-Friday from 8 a.m. to 8 p.m. for any questions about the plan. Also, an Innovation Health Medicare Advantage member advocate is available Monday-Friday from 10 a.m. to 2 p.m. (703-635-7143) to assist patients with questions.


Innovation Health Medicare Advantage Member Onboarding:

A list of Innovation Health (IH) Medicare Advantage (MA) patients is being distributed to their primary care providers and can be used for outreaching and onboarding of patients. Innovation Health and Aetna MA program cover Routine physical exam (CPT codes 9938X and 9939X) in addition to Annual Wellness Visits (G0438 for Initial Annual Wellness Visit & G0439 for Subsequent Annual Wellness Visit) during each calendar year. This provides the providers an opportunity to engage their IH and Aetna MA patients at least two times a year in the clinic to help facilitate education regarding quality improvement and utilization reduction. Additionally, since IH MA plan is new this year, an Annual Wellness Visit (AWV) is covered any time regardless of the date of the last AWV in 2017 (all other payors including CMS cover AWV every 334 days or every 11 calendar months).


Outpatient Clinic Flyer Download

Reducing Inappropriate ED Visits

In an effort to improve access and reduce unnecessary ED utilization, Signature Partners would like you to utilize a new telemedicine initiative for your patients who may need to access care after hours. Earlier this year, Inova partnered with American Well to launch a 24 hour, 7 days a week telemedicine service, white labeled as “Inova OnDemand.” Patients with acute, minor conditions are able to access a board-certified physician for a real-time video visit. These physicians are contracted and credentialed through American Well, one of the largest and most successful national telemedicine provider groups. The charge to the patient is $49. When setting up the appointment, patients are asked who their primary care provider (PCP) is, and are directed to follow-up with their PCP after completing the video visit. We encourage you to market Inova OnDemand to your patients as a means to access care for minor symptoms after hours as opposed to going to the ED or urgent care which costs much more. Decreasing ED utilization is one of the key areas where we can reduce total cost of care.


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