15:54:11	 From  Michael Mueller : Hi all, I'm here but don't think my computer has audio. 
15:54:19	 From  Francine Jetton : we see you!
15:55:05	 From  Erika Baker : michael you can talk now
15:55:07	 From  Erika Baker : I had you muted
15:55:08	 From  Erika Baker : sorry
15:55:12	 From  Scott Joy : Hi everybody!
15:55:19	 From  Michael Mueller : Thanks! I have audio coming through but no audio/video from my end
15:59:52	 From  Erika Baker : try turning the volume up on your computer Mark
16:05:07	 From  Francine Jetton : make sure you identify yourself in the chat box so I can track attendance - welcome everyone!
16:07:36	 From  Gaby Frank : make all hospitalizations a single status ( no more obs vs. inpatient)
16:07:44	 From  Amy Baughman  : Eliminate 3 day requirement for SNF admission
16:07:47	 From  Gaby Frank : Sorry, that was Gaby
16:07:48	 From  Jennifer Bracey : medication formulary availability and why it differs between insurance plans, etc
16:07:49	 From  dianne goede : Oh I like that Gaby!
16:07:51	 From  Maura George : Reimbursement for effective strategies to improve outcomes, not just clinic visits (phone calls, group visits, home visits)
16:07:52	 From  Sarah Candler : Hi--Sarah Candler here. I think the model of changing payment structure outpt allows to focus more on quality care rather than checking boxes.
16:08:16	 From  dianne goede : Eliminate the ability of insurers to change formularies yearly
16:08:22	 From  Gaby Frank : I like yours Amy
16:09:06	 From  Sarah Candler : Quality is focused on checking boxes still...It's tricky. 
16:13:10	 From  Sarah Candler : The VA is already very far along, but now we're burning out with box-checking to still "show" the quality and keep up with the expectations.
16:17:10	 From  Francine Jetton : whoever just got a call, please mute your phone.  Thanks!
16:19:15	 From  Francine Jetton : PLEASE mute your phones!
16:23:20	 From  Sarah Candler : How do you balance improving access with decrasing cost?
16:23:27	 From  Sarah Candler : *decreasing
16:24:37	 From  Mark Liebow : Given that hospitals have more capital than most practices but they will likely lose revenue in a well-run ACO, how do you get them to play?
16:24:52	 From  RPowell : We are currently in an Medicare Shared Savings Plan, and CCP+ model and finding that there is tension between being on the path to value-based reimbursement, but still very much reimbursed FFS.  
16:24:55	 From  slane : within an organization, how do you reward the primary care providers who help with downstream costs?
16:24:57	 From  Sarah Candler : Do you think Urgent Care is better than having a primary team who knows the patients well? During flu season, I think yes. For complex patients, it's trickier--but who triages that and decides that?
16:25:12	 From  dianne goede : Is there an approximate amount of Medicare patients a practice needs to have to make attempting a CPC + model beneficial to the practice?
16:25:13	 From  Mark via phone : Can an ACO continue to earn shared savings after the first 2-3 years when you have already done the easy things to improve efficiency? What is the longer term business model for ACOs?
16:33:02	 From  Sarah Candler : Are y'all getting alert fatigue with reminders for these measures? Or does someone else on the team manage those for you?
16:34:36	 From  Mark via phone : In VA, the RN on my team can handle some of these but there is certainly alert fatigue and opportunity costs of focusing on the metric of the month... perhaps a necessary evil of measuring and rewarding quality. Ideas on alternatives?
16:37:04	 From  Sarah Candler : Are those transitions visits with MDs or RNs?
16:44:10	 From  JSB : Please disregard if you already covered this, but how did your system manage the sharing of shared savings between primary care and various other specialties? Was there a palpable sense for clinicians that better care and HCC coding would result in more resources for primary care?
16:45:27	 From  Sarah Candler : Thanks, Scott! I really feel like the VA has led some of this, but we're now really having alert fatigue. I think maybe more physician extenders could help some of this, but I'm not sure yet how anyone would incentivize these huge changes in primary care (hiring new people) to specialists and others in the system so we don't drown.
16:45:30	 From  Francine Jetton : if someone raises their hand, we can unmute you