2017 Annual Value Report
We provide superior
healthcare and value through
an integrated partnership
among patients, providers and
community resources.
Mission Statement:
Table of Contents
A Message From Our Executives ...............1
Message from Board Chair, Medical Director, and
Vice President of Clinical Integration
Our Road To Better Health… ......................2
Board of Managers… ..................................3
Advisory Committees ..................................4
2017 Year in Review ..................................5
• MSSP - Quality Result and Trend line with Savings
and Improvements
• BPCI – Performance
• Million Hearts
• Population Health/Care Coordination
2018 Initiatives and Growth .....................10
• Next Gen ACO
• QuE Page with new program
• BPCI Advanced
Thank You Participating Practices .............13
1
The road to better healthcare for our region has its share of twists and turns and even potholes. Since its
inception in 2013, Mary Washington Health Alliance has improved coordination among medical providers
and hospitals in our service area to enhance the value of care provided. Our diligent preparation under
the guiding principles of Learning, Timing and Flexibility, has positioned the Alliance well for a transition to
value based care (VBC), a healthcare delivery model that is replacing the traditional “fee-for-service” model
across the country.
Call it a smoother surface with wider lanes, VBC is redefining the look of quality healthcare by reducing
costs and enhancing patient outcomes. An emphasis on improving the patient experience and long-term
patient health promises to improve the overall health of the population while tying payments to quality of
care and rewarding providers for both efficiency and effectiveness.
Our directions have become more clear as we have gained experience with VBC through our work with
Medicare Shared Savings Program (MSSP), Bundled Payments for Care Improvement (BPCI), and our value-
based commercial contracts. We plan to build on those experiences as we continue to invest in tools that
can enhance data analysis and study of our population’s health trends as well as monitor quality and costs.
We thank our members and the patients they serve for their continued involvement and support on this
healthcare journey. As a physician-led organization, our very structure supports the tenets of VBC and our
efforts will continue to expand our network to include more physicians who are willing to work in concert
with other providers and the Alliance to improve coordination of care across settings with the goal of
improving the health of our patient population as a whole.
On the following pages you will learn more
about the Alliance’s accomplishments and
how we are driving this important shift in
healthcare delivery models for our region.
This is an exciting time in our journey with
the potential to improve health care delivery
and to create long lasting improvements to
the health of the people we serve.
A Message From Our Executives:
We’re on the road to better health.
L to R Travis Turner, SVP Clinical Integration;
Tom Janus, DO Board Chair;
Richard Lewis, MD Medical Director
2
Clinically Integrated Network
Medicare Shared Savings Program (MSSP)
Bundled Payment for Care Improvement (BPCI)
Quality and Efficiency Program (QuE)
Value Based Commercial Contracts
MWHC Sole Equity Ownership
Million Hearts Model Program, Intervention Gr
oup
Next Generation ACO Program
V
V
M
M
M
M
Mary Washington Health Alliance
Our Road to Better Healthcare
3
Board of Managers
Seated L to R Patrick McManus, MD; Jerey Frazier, MD; Kenneth McDowell, DO; Mark Wenger, MD;
Rebecca Bigoney, MD; standing L to R Kurian Thott, MD; Tom Janus, DO; Richard Lewis, MD; Sean Barden;
Fred Messing; Gregory Szlyk, MD; William Boldon; Adam Sims, MD; Daniel Woodford, MD; Brian McDermott, MD;
Travis Turner (not shown Charles Amory, MD; Michael McDermott, MD; Krishna Madiraju, MD; Robert Vranian, MD)
Mike McDermott, MD
MWHC President and CEO
“The Alliance has worked to build positive, mutually benecial relationships with all key
stakeholders. The strength of these relationships, built on trust and respect, is reected in the voluntary
participation of the majority of providers in our community, as well as through successful value-based
collaborations with our payer partners.”
— Mike McDermott, MD, MBA
President and Chief Executive Ocer
Mary Washington Healthcare
4
Advisory Committees
Advisory Committee Chairs
Back row Je Frazier, MD Finance and Contracting; Dan Woodford, MD Clinical Quality;
front row L to R Greg Szlyk, MD IT Committee; Patrick McManus, MD Membership and Operations and Nominating;
Kurian Thott, MD Communications and Education
Nominating
Committee
Information
Technology
Committee
Communication
& Education
Committee
Clinical Quality
Committee
Finance &
Contracting
Committee
CHAIR:
Dr. Jeff Frazier
• Sean Barden (VC)
• Dr. Amory
• Dr. Aaronson
• Dr. Wenger
• Dr. Lieser
• Dr. Larson
• Dr. Muldoon
• Dr. Brosche/Brown
• Dr. Goodwin
• Eric Fletcher
Membership
& Operations
Committee
CHAIR:
Dr. Dan Woodford
• Dr. Bigoney (VC)
• Dr. Janus
• Dr. Sikora
• Dr. Sherwood
• Dr. Vranian
• Dr. Sims
• Dr. Mancini
• Dr. Suthar
• Dr. Leonard
• Dr. Baig/Hafeez
• Dr. Marrow
• Fred Messing
• Eileen Dohmann,RN
CHAIR:
Dr. Gregory Szlyk
• Justin Box, (VC)
• Dr. Vranian
• Dr. Schuette
• Dr. Green
• Dr. Yi
CHAIR:
Dr. Pat McManus
• Dr. Frazier
• Dr. Vranian
• Dr. Dash
• Dr. Schuette
• Dr. Patel
CHAIR:
Dr. Kurian Thott
• Dr. Walsh
• Dr. Edwards
• Dr. Madiraju
• Dr. Patel
• Dr. Workman
CHAIR:
Dr. Pat McManus
• Dr. M. McDermott (VC)
• Dr. Kauffman
• Dr. Woodford
• Dr. Ottolini
• Dr. Jani
• Dr. Schuster
• Dr. Baig
• Dr. B. McDermott
• Bill Boldon
5
MSSP: Medicare Shared Savings Program
Three consecutive
years of cost savings
Third and final year of
participation in Medicare
Shared Savings Program
Graduating to NextGen
(at-risk program) in 2018
2017 Year in Review
6
3-year program ends
in September 2018
BPCI: Bundled Payment for Care
Improvement
Profit generated in
each quarter in which
we participated
Participation in 86
episodes of care
Extraordinary
amounts of data
collected that will
guide future bundled
payment program
opportunities
Knowledge gained
about Post Acute
Care costs and
models
2017 Year in Review
7
MHM: Million Hearts Model
8 primary care practices participating
5 Year program sponsored by CMMI/
CMS to reduce the incidence of first-
time strokes and heart attacks
Controlled, population health-based
study
Started January 1, 2017
10,000+ Medicare patients screened
2,244 patients found to have at least
30% risk of first heart attack or stroke
within 10 years
27% of screened population and 64% of
high-risk population have diabetes
Have already gathered a wealth of
clinical data
2017 Year in Review
8
2017 Year in Review
Population Health Management
The number of covered lives managed by the Alliance grew dramatically in 2017, and the network of care
coordination “roadways” was expanded to meet the demand. By establishing partnerships between a
centralized RN Care Coordination staff and primary care practices, the Alliance has favorably impacted
care for a larger number of patients.
RN Care Coordinators
Resources for Care Coordination grew in proportion to the Alliance’s increasing number of value-based
contracts. The Care Coordination team includes six registered nurses who form the hub of care
management. Their roles include:
• Complex case management for high risk/rising risk patients
• Transitional care management for high risk patients who have an inpatient stay
• Population health outreach (assure appropriate use of services and oversee evidence based quality
measures)
With experience working in diverse settings and combined expertise in the areas of diabetes
management, oncology care, chronic renal failure and pulmonary disease management, the RN Care
Coordinators can support additional development of chronic disease management protocols.
In addition, the RN Care Coordinators work closely with their assigned primary care practices across the
health care community to boost patient engagement.
Alliance Sta RN Care Coordination Team:
L to R Jean Foley, RN,BSN;
Melissa Scheiman, RN,BSN;
Raj Pal, RN; Joan Snyder, RN, MS, Director
Population Health and Clinical Innovation;
Margaret Jennings, RN, BSN;
Terry Sullivan, RN, MSN, CDE
9
2017 Year in Review
The Embedded Care Coordination (ECC) Program
For the Medicare population, the RN Care Coordinators worked closely with primary care practices
participating in the ECC program which expanded to six practices in its first two years. A contact person
from each practice partnered with Alliance staff to extend the reach of care coordination across the
spectrum of care. Targeted activities within the ECC included:
• annual wellness visits
• early follow-up visits for hospitalized patients
• outreach to high risk patients
• evidence-based preventative measures
These teams had interactions with more than 4200 patients in 2017, and their efforts
contributed to a 6.2% reduction in the readmission rate for this population.
The Collaborative Commercial Care Coordination (CCCC) Program
The CCCC program, established in early 2017, quickly spread to 26 participating practices by the end of
the year. Each practice used data to identify a primary area for care management including any or all of
the following:
• outreach to high risk patients
• review of potentially preventable emergency department visits
• discover root causes of readmissions and discuss “gaps in care” with patients to support preventative
health
Preliminary results indicate improvement in the quality metrics for several commercial contracts.
This program also provided
an avenue for the pediatric
practices to participate more
fully in care coordination efforts.
Alliance Sta RN Care Coordination Team:
L to R , Melissa Scheiman, RN,BSN;
Jean Foley, RN,BSN
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2018 Initiatives and
Growth
Next Gen ACO
Medicare ACOs are comprised of groups of doctors, hospitals, and other health care providers and
suppliers who come together voluntarily to provide coordinated, high-quality care at lower costs to their
participating Medicare patients. The Next Generation ACO Model is an initiative for ACOs that are
experienced in coordinating care for populations of patients.
MWHA will build on Mary Washington Healthcare’s (MWHC) rich 100-year history through partnerships
with key stakeholders who share a common mission of improving the health of the population they
serve. After completing (3) consecutive years in the Medicare Shared Savings Program and having
shown savings and improved quality of care, the Alliance is ready to take on the road ahead within the
Next Generation ACO!
“As one of only 51 participants in the Next Generation ACO Model across the country, MWHA will be able to build on the
current level of coordinated care and will provide an enhanced quality of care at lower costs to Medicare patients. The Alliance
chose to participate in the Next Generation ACO Model because we believe that this model allows the best opportunity to shift
patient care away from a clinical model built for the fee-for-service payment environment and towards a whole-person population
health-focused clinical model. By partnering with their patients in care decisions, NGACO Participants will achieve the goals of
better health and better care for Medicare beneciaries.”
—Travis Turner, SVP Clinical Integration
Alliance Sta Operations Team:
Travis Turner, Pamela Johns and
Tiany Dickinson; Dr. Richard Lewis,
Medical Director
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Creates an opportunity to work
with representatives of MWHC
to reduce healthcare costs
Program has resulted in internal cost savings
Savings shared directly with participating
Alliance physicians
No funds are distributed until quality metric
goals are achieved
The Spine QuE program began in 2017 joining
our Total Hip and Knee Replacement and EP QuE
programs. A fourth QuE program (Shoulder
Replacement) is in the development stage
Provides a platform for
physicians to become
more aware of cost-of-care
details
Agostino J. Visioni, MD
Raymond Kirchmier, MD
2018 Initiatives and
Growth
QuE: Quality and Efficiency
12
2018 Initiatives and
Growth
Bundled Payment for Care Improvement
On January 9th, 2018, CMS made its formal announcement of Bundled Payment for Care Improvement
Advanced (BPCI-A). This announcement is clear confirmation that CMS is committed to the growth of
alternative payment models (APM) in general and voluntary bundles of care in particular.
CMS also announced an application process with a March 12, 2018, deadline creating a short window
for acute care hospitals and physician groups to respond as applicants. The application process is non-
binding and creates a limited time opportunity to evaluate and decide if participation in a voluntary
bundling program is a strategic fit, a competitive advantage, a clinical improvement opportunity, a
financial opportunity, or all of these. The Alliance is committed to providing Value through its Population
Health initiatives that further support the Triple Aim © and will be an applicant for 2018 Participation.
“The Centers for Medicare & Medicaid Services (CMS) is committed to reducing costs while preserving or enhancing the quality
of care furnished to… beneciaries. To this end, CMS is interested in working with healthcare providers who are working to
redesign care to achieve these aims. Episode payment approaches, which are designed to improve the eciency and quality of care
for an episode of care, or “clinical episode,” through the use of bundled payments, are potential mechanisms for developing these
partnerships.”
—Thomas Magrino, MBA; Director of Population Health Analytics
Alliance Sta Population Health Analytics Team:
L to R Ezem Ajeroh, Clinical Integration Analytics
Coordinator; Elizabeth Parker, Documentation
Specialist; Donna Summers, Documentation
Specialist; Thomas Magrino, Director Population
Health Analytics; Wendy Libertino (intern);
Nana Boetang, Documentation Specialist
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Thank You to Our
Participating Practices
Allergy
Allergy Partners of Fredericksburg
Virginia Center for Allergy & Asthma
Anesthesia
American Anesthesia Associates
Central Virginia Anesthesia/Anesthesia Concepts
Fredericksburg Anesthesia Services
GAF Sedation
Cardiology
Cardiology Associates of Fredericksburg
Oracle Heart & Vascular LLC
Polaris Heart and Vascular PLLC
Virginia Cardiovascular Consultants
Cardiovascular & Thoracic Surgery
MWMG Virginia Cardiovascular and Thoracic
Surgery
Dermatology
MWMG Plastic Surgery and Dermatology
The Dermatology Center
Virginia Dermatology and Skin Surgery Center
Emergency Medicine
Fredericksburg Emergency Medical Alliance
Endocrinology
Diabetes and Thyroid Associates
MWMG Endocrinology
ENT / Otorhinology
ENT & Facial Plastic Surgery of Fredericksburg
Family Practice
Community Care Clinic
Exigent/Alexandria Immediate Care
Exigent/Allcare Lakeridge
Exigent/Caremed
Exigent/Lorton Immediate Care
Family Care of Fredericksburg
Family Care of Lakeridge
Fredericksburg Christian Health Center
Lee’s Hill Family Physicians, PC
Meridian Independent Physician Group - Banzon
MWMG Family Medicine Ladysmith
MWMG Family Medicine Reese
MWMG Primary Care
North Stafford Family Medical Center
Optimum Care LLC
Rapidan Medical Center, Inc.
Rappahannock Family Healthcare, Inc.
Gastroenterology
Associates in Gastroenterology, P.C.
Fall Hill Gastroenterology Associates
Gastroenterology Associates of Fredericksburg
Rappahannock Gastroenterology Associates
General Surgery
MWMG General Surgery
General Surgery/Bariatric
DHMR Clinics
Gynecology
Gynecology Associates
Hematology/Oncology
Hematology-Oncology Associates of
Fredericksburg
Virginia Oncology Care
Hospitalist
MWMG Hospitalist Services
Infectious Disease
MWMG Infectious Diseases
Internal Medicine
Aquia Family Medical Center
Blue Nile Medical Center
Central Virginia Internal Medicine
Chancellor Internal Medicine
Colonial Internal Medicine Associates, PC
Commonwealth Internal Medicine
Internal Medicine of Virginia PC
McManus & Associates Internal Medicine
MetroHealth Internal Medicine, PC
MWMG Family and Internal Medicine
Serenite Medical & Spa
Stafford Internal Medical Services
WeCare Medical Associates
Nephrology
Fredericksburg Nephrology Associates
Neurology
MWMG Neurology
Neurology Associates of Fredericksburg
Stafford Neurology
Mary Washington Health Alliance values the support and
participation of its membership.
14
Thank You to Our
Participating Practices
Neurosurgery
MWMG Neurosurgery
OB Hospitalist
OBHG Hospitalist
OB/Gyn
Advanced Care for Women
Central Virginia OB/GYN Group
Elite Women’s Health
Fredericksburg Women’s Health Associates
New Beginnings Ob/Gyn
Rappahannock Women’s Health Center, Inc.
William A. Hamilton, MD
Women’s Health and Surgery Center, LLC
Ophthalmology
Access Eye Centers
Mary Washington Eye Care Center
Sieht
Vista Eye
Orthopedics
Central Virginia Orthopedics & Sport Medicine
Fredericksburg Orthopaedic Associates
Orthopedic Specialty Clinic, Inc. & Mid-Atlantic
Spine
The Center for Orthopedics
Pain Management
Meridian Independent Physician Group -
HealthSouth
Rehabilitation Medicine Physicians
Virginia Interventional Spine Associates
Palliative Medicine
Mary Washington Home Health & Hospice
Pathology
Fall Hill Gastroenterology Associates
Pathology Associates of Fredericksburg
Urology Associates of Fredericksburg
Pediatrics
ABC Pediatrics Practice, PC
Caroline Christian Health Center
Century Pediatrics Inc
Chancellor Pediatrics PC
Children’s Health PC
Kids First Pediatrics of Stafford
KidsChoice Pediatrics
Krishnan S. Kumar, MD
MWMG Pediatrics
Peds Plus Primary Care
PL Pediatrics
PL Physicians
Preferred Pediatrics
The Children’s Clinic of Fredericksburg, PC
Yum Pediatrics
Pediatrics/Mental Health
Pediatric Partners for Attention & Learning, Inc.
Perinatology
Maternal Fetal Specialists
MWMG Maternal Fetal Medicine
Physical Medicine & Rehab
Cornell J. Shelton MD, PLLC
Plastic Surgery
Plastic Surgery Services
Podiatry
Brett Chicko DPM Family Foot and Ankle Center
Central Virginia Podiatry
Fredericksburg Foot & Ankle Center
Psychiatry
Gaertner Psychiatric PC
Psychiatric Care Inc.
Pulmonary
Pulmonary Associates of Fredericksburg
Radiation Oncology
Radiation Oncology Specialists of Central
Virginia
Radiation Oncology Specialists of Central
Virginia
Radiology
Medical Imaging of Fredericksburg
Radiologic Associates of Fredericksburg
Rheumatology
MWMG Rheumatology
Sleep Medicine
Central Virginia Sleep Center
MWMG Sleep Medicine
Trauma/General Surgery
MWMG General Surgery and Trauma
Urgent Care
BetterMed Urgent Care
Optimum Urgent Care
Peds Plus Urgent Care, LLC
Virginia Urgent Care, LLC dba NextCare Urgent
Care
Urology
Urology Associates of Fredericksburg
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Contact information:
Mary Washington Health Alliance
2300 Fall Hill Avenue, Suite 308A
Fredericksburg, VA 22401
Phone: 540.741.1557
mwhealthalliance.com
