A. For the past several months, dozens of physicians from across the area have been working with representatives from Bethesda Health to develop the Bethesda Health Quality Alliance, a Clinically Integrated Network (CIN). The CIN is the newly formed physician-led provider network that will transform healthcare in our communities by collaborating with premier health care providers and engaging patients in their health choices to provide value.
A. A CIN is a group of hospitals and providers who collaborate and contract together to improve quality and control costs, i.e., achieve value. The Legal definition of acceptable Clinical Integration provided by the Federal Trade Commission (FTC) and U.S. Department of Justice, 1996, states: “Clinical Integration is an active and ongoing program to evaluate and modify practice patterns by the network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.
A. The CIN was created to engage physicians to lead our transformation to deliver higher quality and more cost effective care. The CIN will lead the development of a health system organized for population health to accomplish the transformation from volume-based reimbursement to value-based. This transformation in care delivery and financing will require significant physician engagement and leadership to assure patient-centered care with the goals of Triple Aim: improve the patient care experience, improve population health and reduce the per capita cost of care.
A. The Bethesda Health Quality Alliance will transform healthcare by collaborating with premier health care providers and engaging patients in their health choices. The CIN will:
A. Besides addressing some of the requirements of Health Reform, the CIN will address the need of payers and employers to stabilize premiums and decrease costs. In a collaborative and transparent effort between hospitals, physicians, payers (insurers/employers/government) and patients, the CIN seeks to accomplish, at a minimum, the following:
A. The CIN operates as a subsidiary of Bethesda Health, Inc. and has recently established its Board structure. The Board will consist of 5 physician representatives, 5 hospital representatives and one community lay person. The organization recently appointed its Board but left a position available for a Primary Care Physician interested in serving.
A. Physicians and hospitals will work together in a collaborative fashion to improve the health of the population as payment for care changes from volume-based to value- based incentives. Shared savings and other current or future alternative payment models are only sustainable when all components of the care delivery system work in a coordinated way. The CIN promotes physician participation in that transformation to improve the quality and the coordination of care that will increase efficiency and cost effectiveness. Through participation in the CIN you have the opportunity to influence collaboratively the selection of the quality initiatives and the measures by which success will be determined.
A. The CIN will primarily enter into agreements that have quality and utilization incentive goals. If you achieve the goals, you will receive incentive payments. The contracts you have with existing payers will remain in place. In the future, the CIN may also accept risk, either sharing in the savings if costs are reduced, or sharing in incentives from improvements in quality and efficiency with bundled payment and capitated contracts. A hospital-sponsored CIN has the additional ability to develop Hospital Quality and Efficiency Programs in house that do not depend upon payer involvement to generate savings and income.
A. One of the more well known is CINs is Advocate Physician Partners (APP), a network of physicians associated with the numerous Advocate Health hospitals in the Chicago area. The network has approximately 5,000 physicians. Each year they produce a report to the community showing how the network, by the use of quality improvement processes and incentives to the physicians, has improved the health of their patient population with results that are better than other populations in both Chicago and Illinois. Locally, Holy Cross Hospital and Memorial Health System in Broward County have successful full-service CIN programs that partner physicians with hospitals and post-acute care providers.
A. Yes, physicians and providers who align with hospitals to provide value based care can more effectively manage the total cost of care for a population. Already, employers and insurance companies (payers) are seeking full-service CIN partners who represent all or most of the continuum of care to create high quality provider networks to offer to employees and customers. Most payers place great emphasis on their relationships with hospitals and seek to deepen them by supporting clinical integration programs that yield value for their customers. Additionally, Bethesda Health is one of the top employers in Palm Beach County and will encourage its employees through its benefit plan to seek out care from CIN participating physicians. Moreover, a hospital supported CIN can align processes and incentives around inpatient quality and efficiency programs that can benefit physicians directly as well as the performance of the overall CIN.
A. Yes, participation the Medicare Shared Savings Program, in any track, has benefits over reporting quality to Medicare independently. Likewise, insurance plans tend to work closely with CINs on quality reporting in commercial shared savings programs which reduces the need for physicians and providers to report individually.
A. CINs that were not physician led have not been as successful as physician led and accountable networks, a major design principle for the CIN. Physicians must lead these improvements in clinical care in partnership with hospitals and other health care entities and providers that will be part of the overall solution. A landmark Rand corporation study concluded only about 55% of patients receive all of the expected care for a given chronic condition. Physicians, hospitals, and other providers must work together to improve the health of our patients.
A. If the following milestones are achieved, the Bethesda Health Quality Alliance will have positioned itself for success in the healthcare reform era:
A. Over time, it is expected all CIN members will share information through technology platforms that will give you access to data about your patient population you don’t already have. You will be asked to use evidence based protocols endorsed by your colleagues within the CIN for certain common diseases when possible and review your patients’ data as part of your practice pattern to ensure that your patients are receiving all of the care needed for their conditions. We believe that healthcare in the future will require much more teamwork and interdependent activities. In so doing, local and national measures of quality will improve in your practice.
A. CIN members will be required to contribute some patient information in the course of coordinating care with other CIN providers. Most of the data, such as diagnoses and laboratory information should come from other electronic systems including claims systems.
A. Initially, the CIN is not expected enter into risk contracts, but will evolve with incentive contracts as the informatics infrastructure and expertise develop within the CIN. One exception may be the Medicare Shared Savings Program Track 1+, or others if it is felt the CIN can perform well in the program and take advantage of the benefits of participation to its providers under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Most early pay for performance contracts will have only potential for gains and pay for performance shared savings arrangements.
A. At present, the CIN is seeking to participate in the Medicare Shared Savings Program (MSSP) Track One. One benefit of a hospital sponsored CIN is the fact that existing relationships with major commercial insurance providers pave the way for full-service commercial ACO contracts. The Bethesda Health Quality Alliance anticipates having a strong portfolio of shared savings agreements with various employers and other payers.
A. Eventually, the CIN will seek contracts with the value proposition that could include bundled payments, episodic payments, or capitation. Hospital Quality and Efficiency Programs (HQEP) can be structured around episodes, bundles or other mutually agreed upon measures of quality and efficiency. The initial focus of the CIN’s contracting will be contracts that have only upside potential to its members. Later as the CIN matures in its informatics and quality capability, more complex incentive contracts would be considered based on the needs of payer and employers.