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