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HIStalk Practice Interviews Lerla Joseph, MD Board Chair, Central Virginia Coalition of Healthcare Providers

November 15, 2016 News No Comments

Lerla Joseph, MD is an internal medicine specialist and board chair of the Central Virginia Coalition of Healthcare Providers, a Medicare ACO created for solo physicians and small practices.


Tell me about yourself and the organization.
I have been a practicing internal medicine specialist for 36 years, and have been in private practice for 33 of those years. My practices are located in a medically underserved community in Richmond, and in the small town of Petersburg. I am very much interested in the availability of quality care for all persons and have advocated for more access to care my entire career. Central Virginia Coalition of Healthcare Providers (CVCHIP) was developed to ensure the triple aim of Medicare and to ensure the sustainability of the private practice of medicine. It is particularly interested in serving the small medical practice. We have 20 medical practices affiliated with CVCHIP, all of which are located in Virginia and North Carolina. We were approved as a Track 1 ACO in the Medicare Shared Savings Program in December 2015. We are primarily primary care practices, but have a few specialty practices as well.

CVCHIP implemented chronic care management technology last month. Why prompted the ACO to consider this type of software?
CVCHIP recognized early on that in order to achieve the quality metrics required by CMS, we need to engage in care coordination. Many of our patients suffer with two or more chronic diseases and are not accustomed to care management with emphasis on prevention and a holistic approach to care. Additionally, participating in the CCM program meets several of the MACRA measures that heretofore were PQRS and Meaningful Use. We believe earlier engagement in CCM rather than later will greatly benefit our patients and the quality and cost of care our providers give.

How do you envision this type of health IT impacting outcomes in the near future?
Our initial expectation is better patient engagement. We believe that having multiple touch points with the patients will give them a better understanding of their disease process, improve their lifestyle choices, and give them confidence in doing self-management. We also expect the providers to be better informed about the total patient including their support network, socioeconomic situation, and the patient’s ability to execute the recommendations for care we give. This should all translate into more collaborative care with decreased emergency department and hospital utilization.

What other types of healthcare IT is CVCHIP looking at right now (or will be looking at in the near future)?
We have in place a population health tool. Going forward, however, we will look at forecasting and data analytics tools.

When it comes to implementing new health IT, what are the biggest obstacles/pain points for CVCHIP physicians?
Cost is always a major concern for our practices when we look at implementing new IT solutions. At the same time, we want to be certain that the solution we select gives us data that is actionable and efficient – one that does not require additional human resources to utilize.

The MACRA final rule is still making headlines. How will MACRA affect CVCHP and its participants? What will 2017 and 2018 look like for the ACO in terms of reporting?
As an ACO, one of the selling features is our ability to do reporting for our participants. Many have not done PQRS or Meaningful Use reporting, and those that had found it confusing and cumbersome. With the ACO reporting GPRO, this removes some of the burden for the practices. What is disappointing is that the practices will still need to report Advancing Care Information because Track 1s are not Advanced APMs. We are gearing up for the 2017 reporting, and our population health tool will help with that.

Is CVCHIP doing anything to help its physicians with their population health management programs? Is the ACO leveraging relationships with local payers in this area?
We have started integrating participant EHRs into our population health tool. We have the ability to share claims data submitted by CMS to our participants. We have targeted quality metrics to keep them abreast of emergency department utilization and annual wellness visit utilization by practice. We have not engaged as yet with any of the local payers.

What do you consider to be the number-one challenge facing practices in ACOs right now? How have you seen your members overcome this?
CVCHIP is a physician-led and governed ACO. The challenge for our participants is time management in finding the balance between caring for their patients and devoting the time necessary to make CVCHIP all it can be. We are dedicated to preserving the private practice of medicine. This requires our input in decision -making and implementation of our strategies for success. It is called physician engagement and workflow management. I prefer to look at it as the time necessary to advocate for our patients and our practices. No one can do that better than we can. We are trying to overcome this by committee assignments for our participants, conference calls for quality reviews, and quarterly in-person governing meetings.

Do you have any final thoughts?
I truly believe physicians are the best advocates for their patients. This new era of health care delivery de-compartmentalizes the care delivery we have created over the last 40 years, placing the patient at the center of care. It is a shift for all of us. However, I believe that ultimately patients and physicians alike will be more satisfied and gratified with the change. Change is always daunting, but the providers of CVCHIP are ready to embrace the change for better care and healthier lives.


JennMr. H, Lorre, Dr. Jayne, Dr. Gregg

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