MPP Membership Levels April 2018

McLaren Health Care

As previously reported in a September 2017 newsflash, the MPP Board of Directors’ approved three membership levels starting in 2018. These levels were created to provide the greatest opportunity for value-based payments to those that are most engaged and further along in their progress toward value-based care delivery. The membership criteria and level of commitment required increases with each higher level.

  • Non-clinical Integration (Non-CI) Membership Level:
    • Meets all basic MPP membership criteria.
    • Participation in fee-for-service contracts.
    • Ineligible for financial distribution through the MPP Clinical Integration (CI) program.
  • Clinical Integration (CI) Membership Level:
    • Level A plus meets additional value-based expectations of MPP membership criteria.
    • Participation in value-based contracts.
    • Includes shared savings contracts with no downside risk.
    • Eligible for financial distribution through the MPP CI program.
  • High Performance Network (HPN) Membership Level:
    • Levels A and B plus meets MHPN membership criteria
    • Opportunity to participate in MSSP Shared Savings Plan ACO contracts.
    • May include shared savings contracts with downside risk in the future.
    • Eligible for financial distribution through the MPP CI program.

Physicians applying for levels B or C are required to submit quality data to MPP or be subject to a probationary period of up to 1 year during which the member would be ineligible for the Clinical Integration or MSSP financial distributions.

All current members are classified as follows:

  • Level B Clinical Integration Members (non- ACO participants)
  • Level C High Performance Members (ACO participants).

Current members in Levels B or C must meet or demonstrate progress toward meeting the specific membership criteria for their respective levels.
Failure to meet the necessary membership criteria will result in reassignment to Level A, which includes loss of eligibility for financial distributions.
A physician that does not maintain requirements of participation will be placed on an action plan developed in conjunction with MPP Medical Leadership.

  • Compliance with the plan will result in satisfaction of the action plan and resumption of the associated level’s benefits.
  • Failure to comply with the action plan will lead to suspension and potential removal from MPP membership.
    • Suspension will include the following:
      • Loss of eligibility of financial distributions
      • Loss of voting rights (if applicable)
      • Suspension from committee membership (if applicable)
      • Payor contract participation may be affected

Physicians are also subject to a change in their membership level or suspension under the following situations:

  • Quality:
    • Physicians not meeting Clinical Integrations performance standards (Top Ten Composite score for PCP’s and Clinical Integration Scorecard performance for Specialists) will be placed on a performance improvement action plan as follows:
    • Phase 1 includes meeting with the Regional Quality Performance Specialist and Regional Medical Director to develop a specific improvement plan for the next 90 days.
      • If scores reach target the action plan is resolved.
      • If scores do not reach the target, the action plan moves to Phase 2.
    • Phase 2 includes meeting with MPP Medical Leadership (CMO, Senior Medical Director, or Associate Medical Director) and creation of a second improvement plan for 90 days.
      • If scores reach target the action plan is placed into a monitor phase.
      • If scores do not reach target the action plan may result in suspension
  • Licensing:
    • Any action taken against your licensing or privileging.
  • Professionalism:
    • Sanctions or disciplinary actions by State Medical Boards
    • Professional conduct unbecoming a physician or provider

Please visit the MPP website at www.mclarenpp.org for access to the following documents:

2018 MPP Membership Criteria
2018 MHPN Membership Criteria
2018 MPP Membership Levels

For more information please contact Dr. Michael Ziccardi, Chief Medical Officer, at michael.ziccardi@mclaren.org or at (248) 484-4923.