What is a Clinically Integrated Network?
At a high level, the concept of clinical integration (CI) is a physician-led and patient-centered approach to healthcare management and coordination. Essentially, it is a group of physicians committed to providing high-quality, cost effective patient care that is measurable and leads to better results. It effectively brings together physicians, hospitals and health systems through shared data, technology and performance benchmarks to achieve healthcare’s “triple aim”: improving the quality of care, reducing healthcare costs and enhancing the patient experience. A clinically integrated network (CIN) like ColigoCare places the patient at the center of care and strives to deliver the right care, at the right time and by the right provider.
The transition to value-based payment models has put increased pressure and onus on healthcare providers to engage physicians more closely in restructuring the delivery of care. That’s why forward-thinking providers and healthcare organizations across the country are teaming up to develop CI programs that will help enhance quality; create greater value for patients, providers, payers and communities; and ensure a smooth transition to value-based care.
CI offers physicians an opportunity to take a leadership role in shaping the future of healthcare. By bringing together different specialties under common incentive and governance structures, CI creates – and rewards – collaboration between groups of physicians who may not work together today.
Are physicians involved in the development and leadership of the Clinically Integrated Network?
Yes. A Physician Operations Committee has been developed and is comprised of physician leaders from Valley Health System, as well as numerous independent community practices, to create a new, independent physician network called ColigoCare. Physicians have also led and participated in several workgroups and have developed key components of the program. Ultimately, ColigoCare will be governed by a physician-led Board of Managers whose purpose will be to ensure streamlined operations for all participating practices and strategically grow the network.
Why should I join ColigoCare?
Joining ColigoCare gives you the opportunity to:
Share best practices with your network colleagues;
Play a leading role in shaping the network’s overall Clinical Quality Program;
Gain access to your patient quality data and reports from Valley Health System population health software to help you continuously improve upon the quality care you deliver;
Leverage the stability, support and resources of a large physician-centric network, while remaining independent if you choose;
Have access to a team of centralized care managers to facilitate transitions in care for all patients within the CIN contracts, while maintaining control of your patient’s overall care;
Collectively negotiate with commercial health plans and self-funded employers for value-based payments;
For primary care physicians, be a part of the Valley Health System medical benefits network for employees, with similar terms as those of employed physicians;
Thrive in value-based reimbursement models focused on effectively and efficiently improving care (i.e., MACRA); and
Receive assistance with electronic health record interfaces in conjunction with population health software.
What is the difference between a CIN and an Accountable Care Organization (ACO)?
An Accountable Care Organization (ACO) most often implies a group of providers participating in CMS’ Medicare Shared Savings Program (MSSP), in which case the providers are responsible for improving quality and lowering total costs of care for a specific Medicare population over a defined period of time. A CIN, including ColigoCare, involves a network of independent providers who collectively commit to quality and cost improvement across a broad patient population and can jointly negotiate with commercial payers and self-funded employers for value-based incentives.
If I currently participate in an Accountable Care Organization (ACO), can I participate in a CIN?
Yes, by federal law, an ACO provider can participate in multiple CINs. However, primary care providers can participate in only one ACO per payer, yet can still participate in multiple CINs.
Am I allowed to participate in more than one CIN?
Yes, by federal law, a provider can participate in multiple CINs.
If I join ColigoCare and have an existing commercial contract, do I need to terminate it?
No, you do not need to terminate your existing contract upon joining ColigoCare. In fact, the shared savings derived from being a member of ColigoCare will be on top of any previously negotiated rates.
What will providers need to do in order to participate in ColigoCare?
To participate in ColigoCare, providers will be asked to do the following:
Have a proven track record of delivering high quality care;
Share a commitment to enhancing the patient experience, improving quality and reducing costs;
Be willing to become an active participant in the CIN’s initiatives and to promote and adhere to the CIN’s care models and continuous quality improvement strategies;
Develop and share best practices in collaboration with peer providers;
Be able to meet the CIN’s credentialing requirements;
Utilize a certified electronic health record (EHR), within the CIN’s established timeframe;
Be willing to electronically share clinical and demographic data with the CIN;
Be willing to participate in CIN payer contracting to the extent reasonably required by the CIN; and
Complete and submit the Network Participation Agreement.
Is there a fee to join?
There is no fee to join ColigoCare. The primary investment is your time and effort to help continuously improve the program and work to achieve the network’s clinical quality and performance standards.
What initiatives will the ColigoCare clinical quality program include and how are they determined?
The clinical quality program will include quality, cost, efficiency and practice transformation measures for primary care, ambulatory medical specialties and hospital-based specialties. ColigoCare physician leaders will be responsible for measure selection through active collaboration with their peers. In addition, physicians will establish operational procedures to define how the CIN participants can work together for ultimate success.
What role does an Electronic Health Record (EHR) system play in a CIN?
Because shared data is the foundation for a clinical quality program, an ambulatory EHR will be a prerequisite for participation in ColigoCare. While a common EHR across all participating provider practices can certainly accelerate and strengthen a Clinically Integrated Network, most (if not all) successful networks nationwide do not depend on a single ambulatory EHR platform. Valley Health System may sponsor a limited offering for an EHR subsidy in the circumstance that a provider or practice does not have a certified EHR system.
There has been a lot of buzz around MACRA. Will ColigoCare be able to report to CMS on my or my practice’s behalf?
Because CINs are mainly involved in commercial-based contracts, and not Medicare contracts, ColigoCare will not be able to report to CMS on your behalf; however, your participation in the CIN will set you up for improved performance in MACRA in several ways. ColigoCare’s clinical quality measures will have overlap with the measures included in MACRA’s Merit-Based Incentive Payment System (MIPS) track. With the CIN’s focus on consistent performance improvement on the clinical quality measures, you will simultaneously improve your position in the MACRA environment. In addition, the CIN will provide support for implementing best practices, such as improved coding and documentation, workflows and clinical protocols which may augment your practice’s capabilities.
Do I have the option to terminate my agreement at any time?
Physicians must provide a 60-day written notice if they plan to discontinue their affiliation with ColigoCare.
How does a Clinically Integrated Network protect against antitrust laws?
A CIN is protected from antitrust through the Federal Trade Commission’s (FTC) definition of Clinical Integration. As defined by the FTC, a “qualified clinically integrated arrangement” is:
… an arrangement to provide provider services in which: 1) all providers who participate in the arrangement participate in active, ongoing programs of the arrangement to evaluate and modify the practice patterns of, and create a high degree of interdependence and cooperation among these providers, in order to control costs and ensure the quality of services provided through the arrangement; and 2) any agreement concerning price or other terms or conditions of dealing entered into by or within the arrangement is reasonably necessary to obtain significant efficiencies through the joint arrangement.
The FTC has also indicated on numerous occasions that Clinical Integration programs may include:
… 1) establishing mechanisms to monitor and control utilization of health care services that are designed to control costs and assure quality of care; 2) selectively choosing network providers who are likely to further these efficiency objectives; and 3) the significant investment of capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies.