Stronger Together

From: Max Hamburger MD United Rheumatology LLC President
To: Current United Rheumatology Active Practice Members
We have been together for as long as a year- where have we gone? Why should you stay with us? Where are we going? Have we warranted your continued loyalty and participation?
You have been with United Rheumatology for some time as an active member, and I am emailing to open the conversation about your satisfaction with United Rheumatology. We need you to remain loyal and stay with us, and help make your organization strong. Loyalty does require some patience, particularly with a startup, which is what United Rheumatology has been, as you all knew.
At the outset, I want to firmly state our intention to fulfill our commitment we all made – to find the ways for independent rheumatologists to work together to fulfill the mission statement we all subscribed to- built the preeminent service organization supporting rheumatologists to provide the standard of care for their patients, strengthen our practices and practice autonomy, and the autonomy of the patient physician relationship.
Who is making this commitment to you? I am, as your President. Lynette Byrnes, VP of operations, and her committee of 8 Practice Administrators, joins me. Amanda Byrnes, Director of Member Services, joins us. Fran Hamburger, Vice President of Data Analytics and Logistics, joins in the commitment. The 23 physicians on our Medical Policy Committee make this commitment. Doug Tardio, former COO and President of Carecore, and Shelley Weiner MD, former Chief Medical Officer for Carecore, join in that commitment.
We have been- you and we together- pioneers. Independent practice rheumatologists have never forged a network that enabled working together on a national scale. We have come a long ways in one year, and we intend to accelerate the pace as well.
We have sought advice from the best consultants available to build the operating model and business plan for United Rheumatology, and worked hard to implement the services our members indicated were important.
We need to know now- have we satisfied you? Fulfilled the premise? Perhaps even exceeded expectations? Surely when most signed on, the lyophilized Cimzia opportunity was not a feature of our offerings, and so its implementation was a very positive surprise for us and the members so early in our history. We recently signed the first contract between any group of independent rheumatologists and a pharmaceutical manufacturer for the sale of EMR data. You will learn more about that shortly. There is much more to the value proposition, as many of you have learned. But beyond that- we need to know how we are doing, to ensure that we continue to grow toward our ultimate goals.
First, I want to address the actions of some of the major distributors, who are actively promulgating programs to lure our members away. I ask you to ask yourselves several questions when you are approached with deals that bind you for a year or more. If the distributor is offering you an opportunity they never brought to you before- ask- would they have done this if it were not for United Rheumatology? Is the distributor working on the behalf of the subspecialty, or are they working in their own interests? We all fully understand that the major distributors are going to do what they can to keep their business, and that is not a surprise. And those distributors who do not have any agreements with United do not view us as a positive. They worry about us, because the larger we get the greater our strength. They will therefore continue to use their size and financial might to make offers that are remarkable in appearance. If you let that derail your long term commitment to being an independent rheumatologist, you will have converted to being dependent on the distributors for your future success. I have talked to members of US Oncology after they sold to Mckesson. You should do so as well. Will Mckesson or Cardinal work with a national rheumatology network to extract and aggregate and commercialize data across the country? Not likely, because they have no such network. If United were not there, would Mckesson or Cardinal have offered the rebate opportunity that we first negotiated and they then copied? Well, if they would have then why did they wait until we did it first?
We have heard considerable skepticism from some that we cannot get rheumatologists to work together. People from industry have seen oncology, retinal specialists, urology and orthopedics work cooperatively, but they have seen us to be a group that does not work together. As evidence, they note there are no true rheumatology supergroups. We at United have chosen to pursue the model that maximizes the best of both worlds- keeping your practices independent, and yet working as a group to get best values. If you allow your attention to be diverted by a package deal of drug pricing and contract negotiations, for example, then you weaken our network, and you do yourselves no favor for your future. I implore you to keep your eye on the long term as well as the near term. Isn’t that what we try to teach our patients as well?
Some of you have said- we started this to be able to work with payers. So where are we as regards payers? We have told you that we need to grow large enough- we need to be 10% of US practicing rheumatologists. We are at 180- and we need another 60. At our current pace, we will hit that level this spring. We need guidelines – and the Medical Policy Committee has completed its work on osteoporosis and psoriatic arthritis, and will complete its work on rheumatoid arthritis, ankylosing spondylitis and the spondyloarthropathies, and knee osteoarthritis by April. The committee has commenced working on ultrasound guidelines, and will soon add gout to its list. So in sum, we will have the needed guidelines.
We need the ability to extract and aggregate data- and we have made significant strides and continue to do so. TSI is working with us at a high level of cooperation. Even ECW has now become a cooperative participant, offering substantial values in one of the key tools you and we will need for United Rheumatology members. If you use ECW, look for communications from United Rheumatology about this value.
We need expert help and guidance in working with payers, and we have gained that in the persons of Doug Tardio and Shelley Weiner MD, who have more than a decade experience in working with payers and in managing the utilization of costly resources.
We will seek in our meeting with payers to discuss our expertise, and start discussions on different types of alternative payment approaches. You are all aware that CMS has mandated a major shift toward these alternatives as part of MACRA and MIPS.
These are major accomplishments in a short time period. We are, after all, only a year old. No one was offering programs like the one United pioneered with UCB until United came into existence. Everyone in the rheumatology arena knows who United Rheumatology is, and regards our mission very favorably.
I am as impatient as anyone to get to where we all want to be- in the room with payers, having productive conversations. I am impatient about more direct United-manufacturer opportunities as well, and we are currently negotiating on three different such opportunities.
The value proposition has probably been of greatest value to smaller practices. Very large practices have been able to negotiate best pricing on drugs because of their size. Getting together as United has brought those values to every United member. Not even the largest practice would have seen the value we created with the Cimzia opportunity without United Rheumatology. We are working to ensure that the value proposition brings that value to every member this coming year.
What do we expect to accomplish in 2016? What have we learned, and what can we build upon?
We expect to continue to strengthen the infrastructure of staffing. We are interviewing for new staff to work on member services and on data aggregation. We will have staff sufficient to be fully responsive to you, to reach out to you regularly and ensure we are doing all we can to provide the services you need. Can we afford to do this? Yes. In year one, there were very substantial legal and consulting costs to defray. We have paid for those undertakings in full, and United is in a sound financial state. In year one, we explored a variety of approaches to increasing rheumatologist awareness of United Rheumatology, as member growth was a top priority. We evaluated the success of those approaches, and will carry forward with those approaches that were most effective. We will have a significant presence at the Washington ACR meeting, at the Congress of Clinical Rheumatology Meeting in May in Destin, and we will conduct as many as 40 dinner meetings around the country to introduce United Rheumatology to new members. We will conduct meetings with payers. Doug is already working with several United members to coordinate such meetings, and that schedule will ramp up over the course of the year. The payers do not know who we are, or what we do. We are building a presentation that will accomplish all that is needed to introduce us to payers, underscore who we are, our mission, and how we can work productively and effectively with the payers to help them efficiently bring best care to their members, our patients. We will continue work on additional data commercialization contracts with manufacturers and others. This will provide added value to participating United members.
We will strengthen the services we currently offer. United has a Revenue Cycle partner in American Rheumatology, and can accept clients from across the country.
United has a value agreement with TSI, termed a most favored nation agreement, for pricing. TSI is the only vendor who has taken the United Rheumatology Data Model and implemented it in their 2016 platform. I know that the topic of EMR is a sensitive one. No other vendor in the country currently providing services at a national scale on a fully integrated platform works with us as cooperatively as TSI. They are a small company as well, and there will be speedbumps for them as us. EMR technology is fraught with controversy from the political arena, and thus not being allowed to evolve naturally. We cannot change that, but we do know that from Dave Dickson, TSI President on down, the TSI staff is responsive to me, to United Rheumatology, and its members.
United has a value agreement with MDI – Medical Data Inc- and an exclusive contract with revMD for the software tool that enables us to extract data from most EMRs in a HIPAA compliant fashion. So United does not ask you to change your EMR platform.
As usual, my intention to send a short communication gives way to a lengthy one. Aside from asking that I shorten it up, what else can we do to be of service? The best way to answer is to come to the national meetings. United will be built the way you want it if you participate actively. In sum, if we have satisfied you fully, I am thrilled- and I ask you to tell your colleagues. If we have disappointed, tell us why and how, and we will work to correct any misunderstandings and shortfalls. What can we do more of? What can we do better? Tell us and we will do our best.
I appreciate your involvement, and ask that you rejoin us for a second year when that time comes. We are doing everything we can to capitalize on the size of our membership for the benefit of that membership, and here, size matters without a doubt. If we double in size in 2016, we will be able to extend the value as well.

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