Crain's Health Pulse
Oversight panel swoons over doctor-led network
Friday, February 20, 2015
Advocate Community Partners was the highlight of yesterday’s meeting of the panel tasked with reviewing the DSRIP project scores for 25 Performing Provider Systems. The group is the only physician-led PPS of the bunch.
DSRIP Project Approval Oversight Panel member William Ebenstein called the network the most exciting and innovative the oversight body had reviewed. He heralded the use of community physicians as the key to reducing avoidable hospitalizations. That tactic, he said, differed from other PPS networks that had underutilized doctors in their plans.
Panelist Judy Wessler, who is critical of academic medical centers applying for DSRIP funds, was impressed by the application. She said it fully addresses cultural competence, the issue of how providers will address health disparities in their community and improve understanding of the health care system among residents.
Dr. Ramon Tallaj, chief executive and medical director of AW Medical, presented on behalf of the PPS. He emphasized the importance the network has placed on primary care and treating patients in their communities with providers who are capable of speaking to them in their native languages.
ACP had the largest patient attribution in the state, at 769,089 New Yorkers.
“There is a tremendous amount riding on their success,” state Medicaid Director Jason Helgerson said of the network.
The PPS spans Manhattan, Brooklyn, Queens and the Bronx. AW Medical, the PPS lead entity, represents 2,500 providers, including 2,000 physicians, who are members of eight independent practice associations and three accountable care organizations.
North Shore-LIJ, which has five hospitals in the PPS’ service area, partnered with AW Medical and will provide a number of administrative functions for the PPS.
Panelist Stephen Berger offered the only skepticism, questioning how the governance structure will be “the glue” that will hold a broad network of physicians together.
The panel awarded an additional 3.92 points to Advocate's score across various sections—the greatest increase for any of the 17 networks reviewed so far. Based on Mr. Helgerson’s estimate that a single point could be worth about $1 million to $3 million in funding to a large PPS, the panel’s adjustment could be worth as much as $12 million.