Frequently Asked Questions
What is Clinical Integration?
- Coordination of patient care across conditions, providers, hospitals and care settings to achieve care that is safe, timely, effective, efficient and patient-focused
- To achieve clinical integration:
- Promote changes in provider culture
- Redesign payment methods and incentives
- Incorporate technical care support tools to aid providers
- Focus on chronic disease management
- Measure clinical outcomes
- Focus is on creating a clinical integrated delivery network focus on improving the health outcomes of patients within communities
Where Do We Begin in Clinically Integrating Care?
- Establish a burning platform for change
- Physicians must lead the care coordination initiatives
- Identify programs for care coordination and quality tracking
- Establish a system that rewards provides based on performance
How is the Organization Set Up?
- Physician-led organization
- Contracts with insurance companies
- Provides infrastructure and support to member physicians
- Creates market-responsive program
- Rewards physician performance
- Significant start investment from St. Tammany Parish Hospital
How Do I Get Paid?
- As the clinical integrated network begins to develop, the CI entity will negotiate value-based contracts with payers
- “Incentive-only” contracts vs. “Full” contracts, which include base FFS rates
- Group contract
- Shared savings vs. performance
- Base rates – Physicians continue to bill and collect from insurance company under group contract rates and terms
- Incentives paid to CI entity, then distributed per program measures, weighting and physician performance
What are the Benefits of Participating in a CI Organization?
- Positions you and your practice well as payment reform begins to occur
- Population health approach creates opportunity to impact community health status
- Providing better care to patients within you community
- Opportunity to join with others to prepare for coming “Value Based” market changes
- Minimizes insurance company intrusiveness
- Opportunities to take advantage of value-based incentive programs such a PQRS assistance
- Strong strategic commitment by Resolute Health and Guadalupe Regional Network