Clinically Integrated Network Integrating the components of our care delivery system into a single entity to increase coordination and decrease fragmentation Hospitals BayCare Physician Partners Physicians Insurers Insurers
Clinically Integrated Network Definition New organizationthat brings physicians and health system resources together into a more clinically and financially aligned model of care Flexible, collaborative approach to improved quality and cost containment Focus on prevention, early detection and disease management New reimbursement structure connected to established goals and Quality outcomes
FTC/DOJ Road Map to Clinical Integration Federal guidelines provide a clear road map to clinical integration “Indicia” of Clinical Integration The use of common information technology to ensure exchange of all relevant patient data The development and adoption of clinical protocols Care review based on the implementation of protocols Mechanisms to ensure adherence to protocols Source: Improving Health Care: A Dose of Competition A Report by the Federal Trade Commission and the Department of Justice July 2004; Chapter 2; Section 4.b.3
FTC/DOJ Road Map to Clinical Integration Federal guidelines provide a clear road map to clinical integration FTC / DOJ checklist
What do the physicians plan to do together from a clinical standpoint?
How do the physicians expect to accomplish these goals?
What basis is there to think that the individual physicians will actually attempt to accomplish these goals?
What results can reasonably be expected from undertaking these goals?
How does joint contracting with payers contribute to accomplishing the program's clinical goals?
To accomplish the group's goals, is it necessary (or desirable) for physicians to affiliate exclusively with one IPA or can they effectively participate in multiple entities and continue to contract outside the group? Why or why not?
Overview May 1, 2011
BayCare’s Board of Trustees unanimously approved strategic business plan to create a clinically integrated network
Plan designed by independent, physician-steering committee with 20 medical doctors throughout BayCare
Deliver high-quality health care, at a lower cost
Better prepare for changes coming to the nation’s health care model
Business Model Primary objective: Improve the quality and efficiency of health care received by patients living in the Network’s service area and achieve market leading quality and value.
Patient at the center of everything
Coordination and collaboration across continuum of care
Establish standards of care that must be met for members to remain in Network
Multiple EMR platforms for performance reporting and connectivity
Single consolidated performance incentive structure to accommodate range of payment models
BayCare Physician Partners Quality and Performance Physician-led Board and Committees identify measures and initiatives Network negotiates value-based payment structure Physicians in network report and monitor results Payments received and distributed to physicians based on performance
Committee Structure Initial and ongoing membership criteria Set clinical performance criteria and review member performance Look at 3rd-party agreements and risk pool allocations Assist development of board memberships
Funds Flow Overview Insurers New ReimbursementBased On NegotiatedContracts Annual QualityBonus PayoutBased On Set Goals and Performance Measures Continue CurrentFee-For-ServiceClaims & PaymentStructure Health Information Exchange Hospitals Practice