What is clinical integration?
Clinical integration is an effort among physicians, often in collaboration with a hospital or health system, to develop active and ongoing clinical initiatives focused on delivering quality, performance, efficiency and value to the patient.
What’s driving the movement toward clinical integration?
In the years ahead, physicians and hospitals must partner more closely than ever before to ensure that the community receives the highest quality and value. As we move from today’s fee-for-service reimbursement models to new performance- and value-based pay models, Clinically Integrated Networks enable healthcare providers to join together to enhance the health of our community. These networks bring value to patients, payors and physicians by improving transitions of care, coordinating chronic disease management and managing the health of a population.
What does a Clinically Integrated Network do?
A Clinically Integrated Network helps physicians align with the hospital to coordinate care across caregivers, focus on quality and performance and prepare for new, incentive-based compensation programs in addition to the base compensation they already receive. The network is poised to access new payment systems and methods that focus on achieving quality, efficiency and cost-management measures.
What is the purpose of The Christ Hospital Clinically Integrated Network?
The principal purpose is to enhance the quality and efficiency of patient care services provided by the participating providers to the community. The Christ Hospital Clinically Integrated Network and participating providers will work together to develop clinical performance standards and protocols for the network. These will form the basis for the network to negotiate contracts with payors for performance standards.
How is it structured?
The Christ Hospital Clinically Integrated Network is a wholly owned subsidiary of The Christ Hospital Health Network and is managed by its own Board of Directors, with physician and hospital members. Many physicians collaborated on establishing the network’s structure, and a Population Health Committee continues to guide the network’s development. Physicians willing to participate in a meaningful way have the opportunity to be involved in the organizational committees that drive the network.
What are the benefits of joining?
For physicians, the network offers the opportunity to:
- Identify and measure best practices
- Improve outcomes for patients
- Receive financial rewards for positive clinical outcomes and cost-management achievements.
The goal of The Christ Hospital Clinically Integrated Network is to provide an exemplary patient experience and improve the health of individuals in our community with a continuum of care that is focused on quality, performance, efficiency and value. This will be the platform that will determine financial incentives for physicians.
Who can join?
To ensure the best value for patients and payors, the network is open to physicians who want to be accountable and raise the quality of care. These physicians, who will agree to meet specific quality performance goals, may be:
- Independent community physicians who seek clinical and quality alignment
- Physicians employed by The Christ Hospital Health Network
- Physicians who contract with the hospital to provide services in specialties such as emergency medicine, radiology, anesthesiology and pathology
Eligibility and participation criteria were developed to remove as many barriers as possible. Physicians are not required to be members of The Christ Hospital Medical Staff when they join, but will need to apply for privileges to participate in the network.
Is there a fee to join?
There is no fee to become a member. However, reasonable costs of credentialing applications, operations and reserves may apply prior to any distributions as recommended by the Physician Advisory Committee and approved by the Boards of the network and the hospital
Do physicians join as individuals, or do all the physicians in a practice need to join?
For independent physicians, a delegated representative from a group practice may sign the participation agreement and code of conduct on behalf of the practice to enroll all providers. However, each individual physician in the group will need to complete a short application packet. Physicians employed by The Christ Hospital will be enrolled with other members of their practice groups.
How is it legal for a Clinically Integrated Network to negotiate with health plans and employers?
Participation in an effective Clinically Integrated Network enables physicians to contract collectively with insurers and employers without violating antitrust laws, which forbid collective negotiations by economically separate entities. The federal government has said it will not prosecute provider networks that are genuinely clinically integrated and do not exercise market power.
In a series of advisory opinions, the Federal Trade Commission said it will not pursue action against clinical integration arrangements if they meet a three-part test:
- The network’s program of clinical integration is likely to achieve “real” integration of providers.
- The initiatives of the program are designed to achieve likely improvements in healthcare cost, quality and efficiency.
- Joint contracting with health plans is “reasonably necessary” to achieve the efficiencies of the clinical integration program.
With whom will the network contract?
The Christ Hospital Clinically Integrated Network will contract with:
- Commercial payors who offer their customers focused and narrow networks
- Self-funded organizations, like The Christ Hospital, that can manage their enrollees within focused networks
- Governmental programs like Medicare Accountable Care Organizations and bundled payment programs that depend on focused networks, which require the capability to measure and report outcomes
What types of contracts will the network pursue on behalf of member physicians?
Contracts negotiated with payors will likely include performance programs that base physician payments, in part, on the achievement of clinical performance measures.
Does the network have any contracts yet?
Employees (and their dependents) of The Christ Hospital have been enrolled as of January 2014 to demonstrate the network’s ability to improve quality outcomes and cost-effectiveness.
Will members be required to refer enrolled patients to other network members?
In most cases, yes. In-network referrals allow for the efficient accumulation and reporting of data, promote coordination and continuity of care, and ensure adherence to evidence-based medicine. The network participation agreement says that network physicians will admit enrolled patients to The Christ Hospital and refer them to other network physicians, except as dictated by law.
What clinical initiatives will be included? What type of data will be monitored?
Network leaders and the Population Health Committee are currently finalizing details on clinical initiatives and data. Collected data will likely be similar to that being measured for Medicare’s Physician Quality Reporting System and Comprehensive Primary Care Initiative, the Patient-Centered Medical Home program and Meaningful Use.
How will members submit data to the network?
Members will submit clinical and claims data on a timely basis to a secure, web-based platform that is HIPAA compliant and password-protected. The web-based platform enables physicians to conveniently and easily submit data from any device with internet access. With providers reporting meaningful processes, results and outcomes in real time, the network will be able to qualify for payment models of all payors, particularly those using new payment methods and systems.
What is the difference between a Clinically Integrated Network and an Accountable Care Organization (ACO)?
According to the Centers for Medicare and Medicaid Services, an ACO is accountable specifically for Medicare beneficiaries. It is an organization of healthcare providers that agrees to be accountable for the quality, cost and overall care of Medicare beneficiaries enrolled in the traditional fee-for-service program who are assigned to the ACO. Similarly, a Clinically Integrated Network is an alignment model, coordinating care across affiliated caregivers and developing contracts with payors to improve quality while controlling growth in total cost of care, including value-based contracting initiatives with commercial payors and Medicare.
What are the next steps to become a member of The Christ Hospital Clinically Integrated Network?
Physicians can find more information at TheChristHospital.com/CIN. To speak with a network leader, please call:
Manager of the Clinically Integrated Network