As a physician organization, the CAIPA Board, committees and physicians, provide constructive inputs in the managed care decision-making process at the highest levels so that high-quality patient care can be achieved in the most cost-effective manner. Additionally, CAIPA is actively involved in the development and implementation of pay-for-performance programs which provide financial rewards for high performing physicians. The IPA board members and staff offer a number of educational and advocacy opportunities that can assist IPA practices.
In addition, the IPA network management group interfaces daily with health plan staff to resolve issues and provide education on policies and programs. The IPA also has set a strategic direction to develop a cache of Value-Added Service partners to deliver valuable products and services to IPA physician practices to help meet the demands of the future practice of medicine.
CAIPA’s Quality and Provider Outreach teams work with providers throughout the year on clinical documentation improvement, risk adjustment, quality gap closure, audit support, and claims reviews. CAIPA also has a successful track record of working with health plans and their vendors to improve both clinical and performance outcomes with chart review and collection.
CAIPA was established on a reputation for integrity and honesty, and our relationships with our members are built on trust earned through experience over time.
We strive to operate our business ethically and in full compliance with applicable federal and state regulations, including but not limited to The Health Insurance Portability & Accountability Act (HIPAA). We provide compliance education and guidance of compliance program implementation for our members to meet the Medicare and Medicaid compliance program requirements and fulfill the compliance-related terms with our business partners. CAIPA promotes open and clear lines of communication to report compliance and ethical concerns of fraud, waste and abuse or other violations of company policies, without retaliation or intimidation.
CAIPA places the overall interests of our providers first in all contract decisions.
The Contracting Department works closely with our business partners including health plans, hospitals, and laboratories. Carefully examining key contract elements, such as language, reimbursements, range of quality incentives, and matrix of responsibility to ensure the highest possible economic benefits for CAIPA providers.
CAIPA will work with our provider members to ensure that all necessary documents are in place and submitted for credentialing with our contracted payers.
We strictly adhere to compliance with the National Committee for Quality Assurance (NCQA) and health plan standards. We take every precaution, utilizing state-of-the-art technology to ensure our network is secure, reliable, and protected. Data is secured to ensure confidentiality, HIPAA compliance, and disaster recovery. The Credentialing Department maintains a proprietary physician database and can offer a quick turnaround time of 24 hours of processing time when required. It is also available for the provider’s convenience in completing credentialing applications quickly and securely, while we, at CAIPA, immediately access the information you are submitting or updating.
CAIPA Disease Management is dedicated to preventing and treating illnesses and enhancing the greater health of individuals, families, and communities of Asian Americans. Our core Diabetes Self-Management Education and Support (DSMES) Program is positioned to improve the health and well-being of patients with diabetes through improved self-care behaviors in a cost-effective manner.
CAIPA has a team of technical professionals to help our providers in health care technology implementation and adoption.
The IT Department combines the latest hardware and software to ensure efficiency and accuracy of data gathering and statistical reporting. IT provides ongoing training and technical support to all providers and their staff and providers who utilize our online applications.
CAIPA has always been focused on helping our provider members to optimize their revenue and improve workflow in an ever-changing healthcare environment. The Point of Care (PoC) platform is one of CAIPA’s latest innovations to assist our providers and their staff to help streamline the provider’s access to content, which results in better decisions, better care and better financial outcomes. The Point of Care platform provides patient-specific information, intelligently presented at the patient’s encounter, to enhance health and health care. The platform encompasses a variety of tools to enhance decision-making in the clinical workflow. PoC offers important benefits, including:
CAIPA helps administer providers’ health insurance programs. Solo practitioners can purchase health coverage for his/her family and staff through CAIPA. Practitioners, who have more than 2 insured families or staff, may also have their coverage administered by CAIPA.
The team develops strategic plans through various communications channels and collaborates with providers, partners and managed care plans in the healthcare community in accordance with CAIPA’s mission.
We are also responsible for creating, supporting and delivering marketing programs to support the growth and expansion of the CAIPA patient base and services through outreach events.
The CAIPA Quality Team strives to support CAIPA providers in delivering high-quality and efficient care. Through education, outreach and chart review, the Quality Team can help providers excel in performing the necessary preventative care and quality measures, which improve outcomes and reduce cost.
The Quality Team also performs functions in prospective and retrospective risk adjustment programs, which assist providers in capturing conditions or diagnoses that may have been missed. With outstanding patient care, unrivaled accessibility, and support from the Quality Team, CAIPA physicians consistently rank among the top quality providers with health plans.
The primary goal of CAIPA Network Management is to improve quality and clinical excellence for our providers and patients, and to allow providers to practice medicine with little or no administrative burden.
This is done through a number of functions performed daily by CAIPA staff, such as liaison between health plans and doctors to resolve claims issues, overpayments and recovery, audits, vouchers and demographic updates. CAIPA is also actively negotiating with the VBP’s health plans. CAIPA will simplify the resolution of these issues and eliminate barriers to providers through designated health plan representatives.
CAIPA employees provide resources for practice when our providers and their employees encounter difficulties accessing program resources. While most cases are handled by health plan representatives, it is sometimes appropriate to upgrade to CAIPA to attract health plan managers to focus on key issues that will affect IPA practices.
Our knowledgeable, professional and friendly staff is committed to supporting and educating our doctors about managed care policies. They are strategically assigned to physicians in our IPA network to ensure maximum communication and to assist physicians and office workers in the following areas of operation.
New provider orientation and office staff training
Provider Engagement consists of a team of Account Executives who work closely with CAIPA providers and their office staff to support and improve their practices’ financial and quality performances.
The Account Executives engage practices across many areas pertaining to provider performance and operational excellence, including financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, and operational improvements. These services are pivotal in delivering best practice strategies to our physicians for effective and efficient healthcare delivery.
Provider Relations at CAIPA is committed to our network physicians and their office staff.
Our knowledgeable and professional team works to support and keep our providers informed of current managed care policies. They ensure the greatest communication and work in a hands-on-manner to assist physicians and office staff in areas, such as:
The care coordination program is a safeguard that is designed to keep our patients healthy. Our program is staffed with physicians, physician assistants, nurse practitioners, nurses, social workers and medical assistants.
Within our program we have a transitional care management and chronic care management team that works closely with our community physicians to monitor patient traffic, zeroing in on admissions, discharges and ER visits with our chronic and high-risk patient population. This allows us to capture and prevent the progression of ambulatory sensitive and chronic conditions.
Care coordination is the keystone to our organization, allowing us to keep our patients healthy while fostering an intimate patient relationship and maintaining a keen eye to quality and utilization.
The home health assessment program is an added benefit for patients under our CAIPA umbrella, with the intention to close the gaps in care, but not replace the care provided by their primary care physician. We provide an annual medical assessment to qualified patients to monitor their health status. This service is furnished by licensed medical providers also known as Advanced Practice Providers (APP), such as Physician Assistants (PA) and Nurse Practitioners (NP).
The assessment encompasses a broad range of medical, social and psychological evaluations, which includes but not limited to the optimization of medical diagnoses, medication reconciliation, depression and anxiety screening, cognitive assessment, activities of daily living (ADLS) assessment, nutritional survey and social assessment.
Any unaddressed needs that are identified through our assessments are directed to the appropriate resources, such as case managers or the patient’s primary care physician. The overarching objective of the program is to identify missed gaps, monitor chronic illnesses and improve the accuracy of the patient’s diagnosis. Our service, in addition to our case management further assists our PCPs effort in maintaining and improving the health of our patients.
Changes within the healthcare landscape have created layers of administrative hurdles for our physicians. Our Individualized Physician Management Services is designed to unchain our doctors from all the administrative burdens, allowing our doctors to be doctors.
As large healthcare systems continue to jeopardize the existence of solo and small private practices, it is within our core DNA to maintain the independence of our physicians. We provide a spectrum of services such as, but not limited to, practice management, ancillary clinical support, human resources support, information technology support, billing and coding, and maintenance.
Creating an environment that is sleek, innovative and modern, in addition to our added services, allows us to remain competitive to attract healthcare professionals to care for the people in their community.