December 18, 2018
Mount Sinai Health Partners
Clinically Integrated Network Newsletter

Bright Health’s Chief Health Officer, Tom Valdivia, joins Dr. Fields in the latest episode of the MSHP podcast. They discuss how the trust dynamic of an exclusive payer-provider partnership changes everything, what consumers want from health plans in 2018, and how Bright Health looks for unique ways to integrate work between payers and providers to ease providers’ administrative burdens and increase access for consumers. 

Also available through  iTunes  and  Google Play

"Healthcare is the only industry in which we dump all of the components in front of consumers and ask them to organize the supply chain themselves. Our approach is to take that burden back upon ourselves and provide a seamless experience for both consumers and purchasers of healthcare."

Dr. Fields makes a guest appearance to discuss the state of primary care, changing healthcare economics to support population health, and how he uses data in his role at Sinai to address social determinants of health. He and host Saul Marquez finish the episode with a lightning round Q&A.  
Key Announcements
A Look Back at 2018

It has been an exciting but challenging year and we want to take a moment to acknowledge all that we have accomplished together! In 2018: 

  • MSHP negotiated enhanced CIN fee-for-service fee schedules with major commercial and Medicare Advantage payers. We’re talking about 200,000 attributed patient lives! 
  • Nearly 260 CIN primary care physicians were rewarded with year-end incentive payments. You continue to demonstrate your commitment to quality care and we are grateful for your efforts. 
  • MSHP started a monitoring program that helps us understand claims issues with our payers so we can make sure you are reimbursed appropriately. 

We will continue to provide meaningful services to you, but we wanted to take a moment to thank you for your support and dedication. Happy Holidays and we look forward to working with you in 2019! 
2019 Clinical Integration Requirements

Mount Sinai Health Partners’ 2019 Clinical Integration Program for Primary Care Providers (PCPs) was developed by the MSHP Clinical Integration Oversight Committee and approved by the MSHP Board of Managers. In the past, physicians received scores for both their Clinical Integration Participation (CIP) and their Quality Performance Metrics (QPM). In 2019, physicians will not only be receiving a score for their CIP (up to 30 points) and QPM (up to 50 points), but also for their Efficiency Performance Metrics (up to 20 points).
Data will be aggregated on the following Efficiency Performance Metrics: 
  • Potentially Preventable Emergency Department visits per thousand
  • Ambulatory Sensitive Condition Admissions per thousand for adult and pediatric patients
These scores are then added together to determine the PCP’s overall Clinical Integration Index. Click here to download the CI 2019 Program Requirements for Primary Care Providers .
The CI 2019 Program Requirements for Specialists is also available by clicking here.  To hear more about the program, please stay tuned for the December 2018 Town Hall recording in the Clinical Integration Learning Center.
Q4 Voluntary Town Hall Recap

Thank you to all of our providers who attended our Q4 Town Hall! Dr. Papanna Ravichandra, a CIN provider, shared his person-centered philosophy and proactive care, MSHP's Vice President of Population Health Quality and Efficiency and Deputy CMO, Dr. Meena Bansal went over the 2019 CI requirements, Sunny Chiu, MSHP's Chief Administrative Officer explained the Top Tier plan, and Matt Filiault, MSHP's Senior Director of Population Health Solutions discussed our new partnership with Bright Health.

Attendees should have received a link to complete a feedback survey. We appreciate you taking the time to share your thoughts with us so we can continue to improve your Town Hall experience. The survey will close Wednesday, December 19th.

If you missed the Town Hall or would like to review any of the presentations, a video recording will be available through CILC in the upcoming weeks.
Don't Forget to Complete Your 2018 CI Requirements

While the due date to complete these requirements has passed, in order for primary care providers to continue to receive care coordination payments and for CIN providers to remain in the CIN, CIN providers still need to complete these requirements. For more information or assistance, please contact your Provider Engagement Manager .
The 2018 CIN Requirements include:
  1. Care Coordination (First year only): Sign MSHP PCP-specialist compact describing a framework for better communication and safe transition of care between primary care and specialty care providers.
  2. Program Engagement (First year only): Provide actively-used email address for physician and office manager for program communications, complete the CIN 101 module, and complete the Clinical Documentation Quality Improvement (CDQI) module on the Mount Sinai Clinical Integration Learning Center.
  3. Quality Performance: Report CIN quality metrics in a timely manner using practice-specific technologies. Provide, when needed, data regarding quality metrics in Value-Based Contracts in a timely fashion.
  4. Program Education: Attend in-person Clinical Integration Physician Roundtable/Town Hall (1 per year) or view selected recorded content posted on the Mount Sinai Clinical Integration Learning Center.
  5. Practice Engagement: Meet with a provider engagement team member as requested, up to ten times per year for PCPs and two times per year for specialists.
  6. Privacy Training: Complete the Mount Sinai Health System online 2018 Health Insurance Portability and Accountability Act (HIPAA) privacy training module on the Mount Sinai Clinical Integration Learning Center.
You log into   and go to the Clinical Integration page to find the  MSHP 2018 Clinical Integration Program Requirements document .
To complete these requirements , log into the Clinical Integration Learning Center with your MSHP portal email address and password. To confirm whether or not you’ve completed these requirements , please log into   and visit the Performance Tools page and click on Provider Insights , the MSHP primary care physician dashboard for more information. 
Tip of the Month

Don’t forget! Sign into Provider Insights at least 4 times to fulfill an optional participation element and increase your CI Index score and incentive payment for the funds flow program!  
Payer Updates
Bright Health Webinars

As a member of the CIN, you are a participant with Bright Health, a new insurance option for Medicare members. You may already be receiving questions from patients who have enrolled. Bright Health has scheduled webinars for physicians and staff that provide more information on how to do work with Bright Health to care for your patients. 


Please click the date and time above you would like to attend to access the registration page. Once registered, you will receive an email confirming your registration with the information you need to join the Webinar.
Aetna Changes

Aetna has changed their National Precertification List (NPL), clinical payment and coding policy, expanded claims edits, commercial drug lists, and preapproval rules. Read more here .
Population Health in the Literature & Media
Intervention on Inappropriate Medication Prescriptions in the Elderly

Almost one third of all Medicare beneficiaries are prescribed at least one medication on the American Geriatric Society Beers Criteria list of drugs to avoid in the elderly. In a new cluster randomized trial, a pharmacist-led, patient- and provider-directed intervention showed a 43% reduction in inappropriate prescriptions compared to 12% in the control arm. Read this study published in November 13th issue of JAMA .
Quality Corner
November is Diabetes Awareness Month

Diabetes care is an area of intense focus for Mount Sinai Health Partners where we measure ambulatory quality through blood sugar control, rates of nephropathy and retinopathy screening, as well as statin use in patients with diabetes, and adherence to oral diabetes medications. Check out this printable chart on Components of the Comprehensive Diabetes Medical Evaluation
If you have any questions about any of our announcements, please contact your Provider Engagement Manager , email Mount Sinai Health Partners at or call us at 877-234-6667.  
Contact Us
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