BayCare Physician Partners

  • 2,880 views
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
2,880
On Slideshare
0
From Embeds
0
Number of Embeds
1

Actions

Shares
Downloads
59
Comments
0
Likes
1

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide
  • See possible further refinement on relationship between ACO and insurers
  • What do the physicians plan to do together from a clinical standpoint? What specific activities will (and should) be undertaken? How does this differ from what each physician already does individually? What ends are these collective activities designed to achieve?How do the physicians expect actually to accomplish these goals? What infrastructure and investment is needed? What specific mechanisms will be put in place to make the program work? What specific measures will there be to determine whether the program is in fact working?What basis is there to think that the individual physicians will actually attempt to accomplish these goals? How are individual incentives being changed and re-aligned? What specific mechanisms will be used to change and re-align the individual incentives?What results can reasonably be expected from undertaking these goals? Is there any evidence to support these expectations, in terms of empirical support from the literature or actual experience? To what extent is the potential for success related to the group's size and range of specialties?How does joint contracting with payors contribute to accomplishing the program's clinical goals? Is joint pricing reasonably necessary to accomplish the goals? In what ways?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?
  • Hospitals and physicians would continue to be paid directly for services they deliver (traditional claims and payments).Funds come into the network from pre-negotiated contracts developed with Insurers.Incentive Compensation Attained Through Predetermined Goals and Performance Measures

Transcript

  • 1. Clinically Integrated Network
  • 2. BayCare Physician Partners
    Creating a
    Clinically Integrated Network
    in the Tampa Bay area
    • New model of care for patients and physicians
    • 3. Physician-led collaboration
    • 4. Create a more clinically and financially aligned business partnership with physicians
    • 5. Flexibility to adopt to new reimbursement models driven by government reform
    • 6. Structured as limited liability company (LLC)
  • 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
  • 7. 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
  • 8. 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
  • 9. 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?
    • 10. How do the physicians expect to accomplish these goals?
    • 11. What basis is there to think that the individual physicians will actually attempt to accomplish these goals?
    • 12. What results can reasonably be expected from undertaking these goals?
    • 13. How does joint contracting with payers contribute to accomplishing the program's clinical goals?
    • 14. 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
    Collaboration
    • Plan designed by independent, physician-steering committee with 20 medical doctors throughout BayCare
    Goals
    • Deliver high-quality health care, at a lower cost
    • 15. 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
    • 16. Coordination and collaboration across continuum of care
    • 17. Establish standards of care that must be met for members to remain in Network
    • 18. Multiple EMR platforms for performance reporting and connectivity
    • 19. Single consolidated performance incentive structure to accommodate range of payment models
  • Membership Requirements
    Physician Eligibility Requirements
    Physician Participation Requirements
  • 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
  • 35. What’s In It For Physicians?
    • Care coordination process should result in better patient follow-up
    • 36. Greater access and working relationship between PCPs and specialty consultants
    • 37. Greater support, access and integration of medical information technology
    • 38. Better health care decision making via improved data and processes
    • 39. Information transparency will allow physicians to compare practice measures with colleagues
    • 40. Opportunity to demonstrate value and link reimbursement for better performance without regard to employment status
    • 41. Allows Network members to proactively transition to a value-based system based on Network established measures
  • Physicians Lead the Way
    Clinically Integrated Network Governance
    • New organization led by 21-member Board with reserve powers
    • 42. 17 members will be physicians throughout Hillsborough, Pinellas and Pasco
    • 43. More private practice physicians than BayCare-employed
    • 44. Includes physician-led subcommittees
    • 45. Credentialing
    • 46. Clinical performance
    • 47. Contracting
    • 48. Nominating
  • 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
  • 49. 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
  • 50. Contracting Approach
    • Practice maintains control of billing and collects
    • 51. Practice makes claims information available to the network
    • 52. The network negotiates a “bonus pool” with the payers (not a withhold)
    • 53. The network is responsible for managing/distributing bonus payment
    • 54. Payouts are distributed annually after performance is reported
  • BayCare Physician Partners
    Hospitals
    Physicians
    Insurers
    Patients
    FinancialSupportResources
    Commitment,Participation,Leadership
    PerformanceIncentivePayments
    Trust,ProactiveInvolvement
    GIVE
    Efficiency,Partnership,Mission
    IncreasedEfficiency,Coordination
    Transparency,Efficiency,Quality
    BetterHealthCare
    GET
    Physician
    Patients
    Insurers
    Hospitals
  • 55. The Network Is NOT…
    • A “bargaining” organization for physicians to increase negotiating power
    • 56. A replacement or extension of the hospital medical staff
    • 57. The beginning of a BayCare insurance company
    • 58. A practice management (or billing service) for private practice
  • BayCare Physician Partners
    Timeline
    2011
    2012
    2013
    DeliverCare WithNew Contracts
    ContractWithPayers
    RecruitPhysicians
    Develop Plan
    CreateNetwork