NCMGMA News Sponsor

 

Fcb-Rans-600x300

Twice monthly, NCMGMA News will feature a sponsor on our site. Our sponsors are a vital part of our organization, enabling us to provide the high level of products and services our members have come to enjoy from NCMGMA.

Our sponsor this period is First Citizens Bank.

Learn more about First Citizens by viewing their ad on NCMGMA News and on our website. You can also visit their website at here.

Understanding and Preventing Imposter Fraud Schemes

When cyber attackers pose as the CEO,
will your business be ready?

2019 Alliance sponsor feature article courtesy of First Citizens Bank

Imposter fraud — in which a criminal poses as an executive, vendor or other trusted entity in order to steal company funds — is a fast-growing threat to businesses. Last year, one form of imposter fraud, business email compromise (BEC), affected nearly 80 percent of businesses surveyed by the Association for Financial Professionals. In total, firms have been hit with more than $5 billion in costs from BEC schemes, according to FBI figures.

Companies of all sizes and in virtually all industries are potential targets for these sorts of attacks. Imposter fraud is very different from a fraudster stealing online banking credentials and using the data to make fraudulent payments. With this type of scheme, your organization’s authorized users make the payments, so they look like normal transactions to your bank. This typically means the fraud is not quickly identified, which makes it harder to recover the funds, particularly if they are sent by wire.
You can help protect your firm by learning how to recognize fraud attempts and taking steps to improve your security.

Understanding imposter fraud schemes

The first step in preventing BEC and similar schemes is to be able to recognize the common types of scams:

  • C-level scheme: A hacker poses as the company’s CEO, CFO or other executive and sends an email from a compromised account, usually to an employee in the finance department, with an urgent request to wire funds. The money is then sent to a bank account under the hacker’s control. Forty percent of BEC scams target CFOs, which is more than any other company role, according to security software provider Trend Micro.
  • Vendor impersonation fraud: Posing as a trusted vendor, a fraudster will send an invoice requesting payment. Sometimes, the criminal will have infiltrated the email account of an employee of the company in order to study the pattern of payment requests. The fake invoices will resemble legitimate ones, except for changes in the payment instructions — which allows payment from the company to go directly to the thief.
  • Data theft: Unlike imposter fraud focused on wire transfers, this scam relies on gathering employee data by sending emails to the human resources department requesting identifiable information of staff members. This data is then used to commit additional fraud attacks against the business.

Imposter fraud schemes such as BEC typically require time and research on the part of hackers. Once they have gained access to an employee’s email account, they must analyze patterns of fund transfers and identify who normally handles payments and which vendors businesses interact with. This level of familiarity with a company’s business practices and routines can make fraudulent messages particularly convincing.

Preventing imposter scams from harming your business

Implementing strong safeguards can help minimize your risk of falling victim. Consider these steps to help protect your company:

  • Verify all requests. Train employees to follow up on any request for fund transfers or changes in payment information through a channel other than the one used to make the original request. If an employee receives an email, they should follow up with a phone call to a previously known number — not the number provided in the email, since it could be fraudulent. Warn employees to be particularly wary of urgent payment requests.
  • Warn against oversharing. Encourage employees to exercise caution when sharing work-related or even personal information on social media and other websites. Hackers will often piece together information they find online to learn about employee roles and company happenings like business deals that might coincide with large payments. They can then use this data to make their outreach more convincing.
  • Use account controls. Access management features offered by banks allow you to define how transactions proceed and give you additional layers of protection. For example, you might require one employee to initiate a funds transfer and another to approve it. You can also add one-time access codes for extra security, and set up account alerts so that you’re notified of unusual activity or when transactions need your approval.
  • Protect your computers and network. Malware is often a key component of BEC scams, so use anti-malware software from a reputable provider that automatically updates to block new threats. Be sure to follow other security best practices as well, such as having a firewall in place to filter traffic to and from your network.
  • Review your insurance policy. Knowing what your insurance will cover should your business fall victim to fraud is a great way to prepare for an incident. Talk with your insurance agent to find out how and if your company will be protected. You may need to sign up for a specialized plan as some policies won’t cover fraud instances where an employee unknowingly transfers funds.
  • Alert your bank immediately. Be sure to instantly notify your bank should you spot instances of potential fraud. Informing your bank provides an additional layer of protection and security, and it can help you recover from fraud quickly and effectively.

Your banker can also help you explore steps to reduce your fraud risk. For more information, contact Andy Shene, Charlotte Metro Area Executive for First Citizens Bank, 704.338.3926. First Citizens Bank. Forever First®.

Connect, Discover and Collaborate at Regional Education Days Exhibit Hall

red19-hdr600a

red19-svbtn1Join us for Regional Education Days in Charlotte on September 26th and Durham on November 1st. Spend quality time with some of the healthcare industry’s leading product and service providers. With the smaller scale of the Regional Education Day format, you’re sure to get the personal attention you need to get all of your important questions answered.

Register for the session that best fits your location and schedule and sign up today!

Regional Education Day Exhibitors

Here’s your chance to get one-on-one time with some of the healthcare industry’s leading product and service providers. With the smaller scale of the Regional Education Day format, you’re sure to get the personal attention you need to get all of your important questions answered.

Curi – a Medical Mutual Co.
Emtiro Health
First Citizens Bank*
HitsTech
LabCorp
MagMutual
MSOC Health
NCHA Strategic Partners
zone Waste Solutions
Prince Parker & Associates
RingCentral, Inc.
SCS – An A/R Management Firm
Stanley Benefit Services
SunTrust Bank
UnitedHealthcare

*Exhibiting at the Charlotte Regional Education Day only*.

 

Agenda

 

Time Event
8:30 am – 9:00 am Registration
9:00 am – 10:15 am General Session I
Workplace Violence: Supervisors and Staff Response to an Active Shooter
Presented by Lt. Michael Huber, CMPD (CLT)
Presented by Captain Terry Hairston, Defend and Protect, Inc. (DUR)
Workplace violence can happen at any time. Now is the time to train yourself and your staff on how to respond to an active shooter. Join us as we cover safety knowledge, preventative measures, action plan development, and response training for your supervisors and staff. 
10:15 am – 10:45 am Break with Exhibitors
10:45 am – 11:30 am General Session II
Workplace Violence: Supervisors and Staff Response to an Active Shooter
Presented by Lt. Michael Huber,, CMPD (CLT)
Presented by Captain Terry Hairston, Defend and Protect, Inc. (DUR)
11:30 am – 11:45 am NCMGMA Annual Business Meeting
Presented by Jane Lutz, Charlotte Radiology
 11:45 am – 1:00 pm Lunch with Exhibitors
 12:45 pm Exhibitor Prize Giveaway
 1:00 pm – 2:00 pm Exhibitor Table Breakdown
 1:00 pm – 2:15 pm General Session III
Becoming a Master Communicator
Presented by Scott Carbonara, The Leadership Therapist
In this session, leaders will explore their biggest “pet peeves” or communication obstacles at work and learn 10 practical and immediately applicable tips that range from tactical to strategic communication. By the end of the session, participants will be able to understand and implement:

  • The big 3 I’s of why people communicate (Inform, Influence, Inspire)
  • The dos and don’ts of email etiquette
  • Maximizing verbal and cross-cultural communication
  • Increasing the “stickiness” and audience retention of communication
2:15 pm – 3:30 pm General Session IV
Digital Patient Acquisition
Presented by Stephen Fogg, Fogg Media
Physician practices are becoming more proactive in recruiting new patients. What is the ‘state of the art’ in acquiring new patients via search engine optimization, social media, paid search, and other means? How can practices increase patient engagement and mobilize them to tell their friends about a delightful experience? Healthcare marketing expert Stephen Fogg shares his experiences helping physician practices acquire new patients and the metrics he uses to track those results.

Attendee Registration

The cost to register is $125 for members, $150 for non-members and $50 for students. Additional staff can attend at a 10% discount per attendee. Follow the link below for online registration.

Questions

Follow the links above for more information and for registration. If you have any questions or need additional information, please contact the NCMGMA offices at info@ncmgm.org.

Call for Nominations to the NCMGMA Board of Directors Ends Friday 8/16

Call for Nominations to the North Carolina
Medical Group Management Association
Board of Directors

Western Region and Piedmont Region Director 
Positions Open

NCMGMA Members: Nominations are being solicited from our Active and Affiliate members to serve on the NCMGMA Board of Directors. In accordance with our bylaws, there will be two (2) open positions on the Board of Directors as an at-large member beginning November 1st, which are both three (3) year terms. Candidates will only be accepted from the Western and Piedmont regions to fill these vacancies.

NCMGMA regions are outlined in the map (PDF) found at the following link. 

Any member from one of these regions may nominate another member from the region or themselves, however, all nominees should complete a leadership profile for review by the Nominating Committee. The Nominating Committee will convene in August for the purpose of recommending a slate of candidates to the NCMGMA Board of Directors for approval by the membership at our next NCMGMA Business Meeting. This meeting is scheduled for Thursday, September 26th during the NCMGMA Regional Education Day in Charlotte at the Harris Conference Center.

Please click this link to view a copy of our bylaws (PDF). 

The NCMGMA Leadership Profile Form asks general questions and asks for a personal letter of commitment and an employer letter of recommendation. Both letters are required and can be submitted through the online Leadership Profile Form or emailed to info@ncmgm.org. Please click on the Leadership Profile Form below to begin.

Leadership Profile Form

Nominations are due NO LATER than 5:00 pm on August 16th.
Remember! Only candidates from the Western and Piedmont regions
will be reviewed and considered.

The Nominating Committee appreciates all nominations received. However, the Committee may only be able to respond to those candidates it elects to recommend.

Digital Patient Acquisition at Regional Education Days

red19-hdr600a

red19-svbtn1Join us in Charlotte on September 26th and Durham on November 1st as we bring in Stephen Fogg, the Healthcare Chief Marketing Office of Fogg Media, for our Regional Education Days. At 2:15 pm at both events, Stephen will present “Digital Patient Acquisition”, sharing how physician practices can acquire new patients and discussing the metrics he uses to track those results. By the end of the session, participants will learn how to become more proactive in recruiting new patients and increasing engagement.

Browse this email for complete Regional Education Day event information. Registration is open, so pick the session that best fits your location and schedule and sign up today!

Agenda

 

Time Event
8:30 am – 9:00 am Registration
9:00 am – 10:15 am General Session I
Workplace Violence: Supervisors and Staff Response to an Active Shooter
Presented by Lt. Michael Huber, CMPD (CLT)
Presented by Captain Terry Hairston, Defend and Protect, Inc. (DUR)
Workplace violence can happen at any time. Now is the time to train yourself and your staff on how to respond to an active shooter. Join us as we cover safety knowledge, preventative measures, action plan development, and response training for your supervisors and staff. 
10:15 am – 10:45 am Break with Exhibitors
10:45 am – 11:30 am General Session II
Workplace Violence: Supervisors and Staff Response to an Active Shooter
Presented by Lt. Michael Huber,, CMPD (CLT)
Presented by Captain Terry Hairston, Defend and Protect, Inc. (DUR)
11:30 am – 11:45 am NCMGMA Annual Business Meeting
Presented by Jane Lutz, Charlotte Radiology
 11:45 am – 1:00 pm Lunch with Exhibitors
 12:45 pm Exhibitor Prize Giveaway
 1:00 pm – 2:00 pm Exhibitor Table Breakdown
 1:00 pm – 2:15 pm General Session III
Becoming a Master Communicator
Presented by Scott Carbonara, The Leadership Therapist
In this session, leaders will explore their biggest “pet peeves” or communication obstacles at work and learn 10 practical and immediately applicable tips that range from tactical to strategic communication. By the end of the session, participants will be able to understand and implement:

  • The big 3 I’s of why people communicate (Inform, Influence, Inspire)
  • The dos and don’ts of email etiquette
  • Maximizing verbal and cross-cultural communication
  • Increasing the “stickiness” and audience retention of communication
2:15 pm – 3:30 pm General Session IV
Digital Patient Acquisition
Presented by Stephen Fogg, Fogg Media
Physician practices are becoming more proactive in recruiting new patients. What is the ‘state of the art’ in acquiring new patients via search engine optimization, social media, paid search, and other means? How can practices increase patient engagement and mobilize them to tell their friends about a delightful experience? Healthcare marketing expert Stephen Fogg shares his experiences helping physician practices acquire new patients and the metrics he uses to track those results.

Regional Education Day Exhibitors

Here’s your chance to get one-on-one time with some of the healthcare industry’s leading product and service providers. With the smaller scale of the Regional Education Day format, you’re sure to get the personal attention you need to get all of your important questions answered.

Curi – a Medical Mutual Co.
Emtiro Health
First Citizens Bank*
HitsTech
LabCorp
MagMutual
MSOC Health
NCHA Strategic Partners
zone Waste Solutions
Prince Parker & Associates
RingCentral, Inc.
SCS – An A/R Management Firm
Stanley Benefit Services
SunTrust Bank
UnitedHealthcare

*Exhibiting at the Charlotte Regional Education Day only.

Attendee Registration

The cost to register is $125 for members, $150 for non-members and $50 for students. Additional staff can attend at a 10% discount per attendee. Follow the link below for online registration.

Questions

Follow the links above for more information and for registration. If you have any questions or need additional information, please contact the NCMGMA offices at info@ncmgm.org.

Survival of the Fittest: Employers Step up Their Commitment to Healthcare

By Sara Parikh and Jean Hippert

2019 NCMGMA Alliance sponsor feature article courtesy of PNC Bank

Nearly 160 million Americans are covered by employer-sponsored healthcare plans,[1] with most employers covering a significant proportion of their employee healthcare premiums. Consequently, rising healthcare costs directly impact our nation’s employers. In order to understand how employers are responding, Willow Research and PNC Healthcare conducted a large-scale study of senior level executives at U.S. companies who offer healthcare benefits to their employees. Through qualitative and quantitative research with employers, we examined the contours of employer-sponsored healthcare plans today, what companies are struggling with, and how they are coping with exploding healthcare costs.  Read more

Provider Playbook Announcement from NC Medicaid Deputy Secretary

At DHHS, we know that well-informed Medicaid providers like you are essential to the success of managed care. We are committed to ensuring you have the tools and resources to transition your business models, and to help your Medicaid patients navigate enrolling in a health plan for the first time and learning how to make managed care work best to get the care they need. I would like to share several steps that DHHS is taking to give you the support you want and need:

  • New Provider Playbook. DHHS has launched an online “Provider Playbook” to ensure you have at your fingertips the latest information on managed care, including communications and materials provided to your patients. The Provider Playbook combines new resources, such as a beneficiary enrollment experience paper and managed care fact sheets with the existing training, forums and virtual office hours already in place to support providers.
  • New Provider Issues and Resolutions Overview. Raising issues as they are encountered allows for prompt research and implementation of improvements that have an immediate effect on the provider and beneficiary experience. It is also important to share the situations and their resolution broadly for other providers to anticipate potential needs in their own practices. Attached is the first Provider Issues and Resolutions Overview that describes the issue, its resolution and next steps. Naturally, there will be times when mitigating circumstances may affect the outcome. In those cases, the Overview includes a “Know” section that provides you with background information and additional considerations.
  • New Provider Calls Start August 13. The complex transition to managed care requires regularly scheduled and ongoing interaction between providers, stakeholders and DHHS to quickly identify, discuss and solve issues and concerns. For example, there are times when it is more effective to ask questions and get answers from Medicaid leadership and experts on specific topics rather than receive a written update. Starting Tuesday, August 13, Medicaid will hold calls with provider associations where association leadership will hear an update on the progress to launch Medicaid Managed Care, an overview of provider-related issues and how they are being addressed, and other information specific to the provider community. This will be an interactive call with time reserved for questions and answers. Calls will initially occur with provider associations. We will add open calls for all providers and other stakeholders in the weeks that follow. Look for details to arrive shortly.

This is an exciting time for NC Medicaid and the health care professionals who take care of about 1.6 million people who will be moving to Medicaid Managed Care. Thank you for your dedication to their health and well-being, and for your valuable partnership. We encourage you to explore the Provider Playbook, review the Medicaid Issues and Resolutions Overview, and join us for the first call on August 13.

— Dave

Dave Richard
Deputy Secretary
NC Medicaid
Division of Health Benefits
NC Department of Health and Human Services

Office: 919-855-4101
Mobile: 919-500-1596
dave.richard@dhhs.nc.gov

1985 Umstead Drive, Kirby Building
2501 Mail Service Center
Raleigh, NC 27699-2501

Bringing Behavioral Health Services to Primary Care: New Models

By Art Kelley, MD, Chief Medical Officer, Emtiro Health

2019 Alliance sponsor feature article provided courtesy of Emtiro Health

About 60% of Americans who could benefit from mental health care in any given year receive no care at all. And of those who do receive care, over half receive that care in the primary care system, not the mental health system. Ask any primary care clinician and they will tell you that their practice has become a de facto mental health clinic. These primary care practitioners are the ones writing the majority of prescriptions for antidepressants in the United States.

Many factors went into creating this scenario. Despite significant work by many, there remains a reluctance among patients to seek care in the mental health system. Furthermore, some people who could benefit from mental health care do not perceive a need for it. The inadequate size of the mental health workforce, particularly in rural areas, creates significant access issues for many patients. That access is further diminished by the fact that low reimbursement rates for mental health services have driven many providers to a cash-only practice model.

Many primary care clinicians are uncomfortable playing the role of mental health provider but, when faced with the obligation to serve and care for their patients, they reluctantly accept the role. Unfortunately, the lack of robust screening procedures for mental health disorders in primary care facilities and less than optimal treatment regimens often lead to undertreatment.

The good news is that coming changes to the healthcare landscape will require more integration of behavioral health services into primary care. The United States’ healthcare system is rapidly moving from a fee for service model to a value-based contracting model in which providers will be paid based on the quality of clinical outcomes and the lowering of costs. Practitioners will be required to more rigorously identify and treat mental health disorders. It will be particularly important to identify and treat these disorders in patients with chronic medical conditions because the medical costs for this sub-set of patients are particularly high. For example, a patient with diabetes and major depression has twice the medical costs than a diabetic patient without major depression. This need for integrated care will be even greater when advanced practices enter risk bearing contracts.

Fortunately, two integration models show promise in bringing improved behavioral health care to the primary care space: the Primary Care Behavioral Health Model (PCBH) and the Collaborative Care Model (CoCM).

Primary Care Behavioral Health Model (PCBH)

The PCBH model adds a non-physician behavioral health clinician to the primary care team to help manage and treat patients with behavioral health issues as well as diagnosable disorders. The work of this clinician cuts across the entire population in a practice. One may think of it as a horizontal service. Using 15-30-minute patient meetings, the clinician aims to have a high-volume workload, seeing most patients on the day of referral. The patient sessions are focused on problem solving and ideally occur following a “warm hand-off” from the primary care provider. This position requires a generalist who is comfortable seeing a wide range of behavioral health issues, can develop rapport quickly, and can tolerate ambiguity. He or she may provide brief psychotherapy at times, but efficiently identifies and refers patients who need a higher level of care. The PCBH clinician is also an educator, increasing the knowledge and skills of other team members who may then more confidently manage the care of behavioral health patients themselves. Studies of this model show high patient satisfaction as well as improvement in many behavioral health symptoms such as post-traumatic stress disorder (PTSD), depression, and anxiety.

Currently, the one drawback of this model is payment. Many of the patient encounters that occur under this model do not conform to traditional reimbursement codes making it difficult to fully fund the behavioral health position. Successful implementation has often relied on grant funding. However, when value-based contracting becomes more common there will be an opportunity for practices to negotiate a per member per month (PMPM) payment that includes this service.

Collaborative Care Model

As mentioned, patients with chronic physical conditions and a co-morbid mental disorder have higher medical costs than those without a mental health disorder. Those higher costs are primarily due to the care of their physical health conditions. Often times, depressed patients simply lack the energy to manage their diabetes, leading to increased emergency room visits, more hospitalizations, more ambulatory care visits, and higher A1Cs. Research has clearly established that treating depression in those with diabetes lowers their medical costs and improves quality of life. The same is true of other chronic physical conditions and co-morbid depression.

Whereas the PCBH model can be viewed as a horizontal model, the CoC model can be thought of as a vertical model. The CoCM model offers a way to deliver psychiatric services in a primary care practice to patients with specific mental health disorders, particularly those with depression, and have co-morbid chronic physical conditions. Research has demonstrated that the collaborative care model improves the quality of treatment for psychiatric illnesses and improves patients’ physical health (e.g. lower A1c, BP, lipid levels), consequently lowering medical costs.

This model adds two members to the primary care treatment team: a behavioral health care manager and a consulting psychiatrist. Using depression as an example, the following process is followed. First, using a robust depression screening process with the PHQ-9, those who appear to be suffering from depression are identified and the primary care clinician confirms the diagnosis. Those patients are then referred to the care manager who evaluates the depression further, places the patient in a registry, and begins to monitor the treatment progress. The treatment process is monitored with serial PHQ-9s and frequent contacts with the patient both face-to-face and telephonically (usually every two weeks for the first twelve weeks). The care manager has a weekly discussion with a consulting psychiatrist to review patient progress and identify those patients who are not progressing. Recommendations for treatment changes are made by the psychiatrist and communicated to the primary care provider.

Throughout this process the primary care physician remains responsible for all treatment. Because the psychiatrist functions as a caseload consultant, not a direct provider, his/her expertise can inform the care is of an entire population of depressed patients in a practice. Research shows that up to 60% of patients treated within this model achieve remission or at least a 50% improvement while other research has demonstrated that $6.00 in medical costs are saved for every $1.00 invested in this model.

In the past, funding for this model has been primarily through grants but recent reimbursement changes are beginning to create a funding stream for this work. Medicare now reimburses for collaborative care through a new set of the CPT codes. North Carolina Medicaid now reimburses the same codes and commercial insurance companies are also coming on board in some areas.

I doubt there is a single person reading this article who does not believe that mental health and physical health are inextricably entwined. Even the ancients understood this:

“A merry heart doeth good like a medicine, but a broken spirit drieth the bones.” – Proverbs 17:22 (written between 400 and 700 B.C. E.)

“To keep the body in good health is a duty…otherwise we shall not be able to keep the mind strong and clear.” – Buddha (400-600 B.C.E)

But here we are in the 21st century largely delivering care in silos, one for behavioral healthcare and one for physical healthcare. It’s time to bring this ancient wisdom to fruition. The models described in this article, if implemented more fully, can help our healthcare system provide integrated, whole-person care.