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Clinically Integrated Network<br />
BayCare Physician Partners<br />Creating a <br />Clinically Integrated Network<br />in the Tampa Bay area<br /><ul><li>New...
Physician-led collaboration
Create a more clinically and financially aligned business partnership with physicians
Flexibility to adopt to new reimbursement models driven by government reform
Structured as limited liability company (LLC)</li></li></ul><li>Clinically Integrated Network<br />Integrating the compone...
Clinically Integrated Network<br />Definition<br />New organizationthat brings physicians and health system resources toge...
FTC/DOJ Road Map to Clinical Integration<br />Federal guidelines provide a clear road map to clinical integration<br />“In...
FTC/DOJ Road Map to Clinical Integration<br />Federal guidelines provide a clear road map to clinical integration<br />FTC...
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 ca...
Better prepare for changes coming to the nation’s health care model</li></li></ul><li>Business Model<br />Primary objectiv...
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
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BayCare Physician Partners

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  • 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&apos;s size and range of specialties?How does joint contracting with payors contribute to accomplishing the program&apos;s clinical goals? Is joint pricing reasonably necessary to accomplish the goals? In what ways?To accomplish the group&apos;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 of "BayCare Physician Partners"

    1. 1. Clinically Integrated Network<br />
    2. 2. BayCare Physician Partners<br />Creating a <br />Clinically Integrated Network<br />in the Tampa Bay area<br /><ul><li>New model of care for patients and physicians
    3. 3. Physician-led collaboration
    4. 4. Create a more clinically and financially aligned business partnership with physicians
    5. 5. Flexibility to adopt to new reimbursement models driven by government reform
    6. 6. Structured as limited liability company (LLC)</li></li></ul><li>Clinically Integrated Network<br />Integrating the components of our care delivery system into a single entity to increase coordination and decrease fragmentation<br />Hospitals<br />BayCare Physician Partners<br />Physicians<br />Insurers<br />Insurers<br />
    7. 7. Clinically Integrated Network<br />Definition<br />New organizationthat brings physicians and health system resources together into a more clinically and financially aligned model of care<br />Flexible, collaborative approach to improved quality and cost containment<br />Focus on prevention, early detection and disease management<br />New reimbursement structure connected to established goals and Quality outcomes<br />
    8. 8. FTC/DOJ Road Map to Clinical Integration<br />Federal guidelines provide a clear road map to clinical integration<br />“Indicia” of Clinical Integration<br />The use of common information technology to ensure exchange of all relevant patient data <br />The development and adoption of clinical protocols<br />Care review based on the implementation of protocols<br />Mechanisms to ensure adherence to protocols<br />Source: Improving Health Care: A Dose of Competition A Report by the Federal <br />Trade Commission and the Department of Justice July 2004; Chapter 2; Section 4.b.3<br />
    9. 9. FTC/DOJ Road Map to Clinical Integration<br />Federal guidelines provide a clear road map to clinical integration<br />FTC / DOJ checklist<br /><ul><li>What do the physicians plan to do together from a clinical standpoint?
    10. 10. How do the physicians expect to accomplish these goals?
    11. 11. What basis is there to think that the individual physicians will actually attempt to accomplish these goals?
    12. 12. What results can reasonably be expected from undertaking these goals?
    13. 13. How does joint contracting with payers contribute to accomplishing the program's clinical goals?
    14. 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?</li></li></ul><li>Overview<br />May 1, 2011<br /><ul><li>BayCare’s Board of Trustees unanimously approved strategic business plan to create a clinically integrated network</li></ul>Collaboration<br /><ul><li>Plan designed by independent, physician-steering committee with 20 medical doctors throughout BayCare</li></ul>Goals<br /><ul><li>Deliver high-quality health care, at a lower cost
    15. 15. Better prepare for changes coming to the nation’s health care model</li></li></ul><li>Business Model<br />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.<br /><ul><li>Patient at the center of everything
    16. 16. Coordination and collaboration across continuum of care
    17. 17. Establish standards of care that must be met for members to remain in Network
    18. 18. Multiple EMR platforms for performance reporting and connectivity
    19. 19. Single consolidated performance incentive structure to accommodate range of payment models</li></li></ul><li>Membership Requirements<br />Physician Eligibility Requirements<br />Physician Participation Requirements<br /><ul><li>Performance
    20. 20. Infrastructure
    21. 21. Data Management
    22. 22. Patient Care Standards
    23. 23. Communication
    24. 24. Network Contract and Resources
    25. 25. Training and Meetings
    26. 26. Quality Assurance
    27. 27. Compliance
    28. 28. Licensure
    29. 29. Medical Staff
    30. 30. Prescribing
    31. 31. Board Certification
    32. 32. Insurance Requirements
    33. 33. Legal
    34. 34. Conflict of Interest</li></li></ul><li>BayCare Physician Partners<br />Quality and Performance<br />Physician-led Board and Committees identify measures and initiatives<br />Network negotiates value-based payment structure <br />Physicians in network report and monitor results<br />Payments received and distributed to physicians based on performance<br />
    35. 35. What’s In It For Physicians?<br /><ul><li>Care coordination process should result in better patient follow-up
    36. 36. Greater access and working relationship between PCPs and specialty consultants
    37. 37. Greater support, access and integration of medical information technology
    38. 38. Better health care decision making via improved data and processes
    39. 39. Information transparency will allow physicians to compare practice measures with colleagues
    40. 40. Opportunity to demonstrate value and link reimbursement for better performance without regard to employment status
    41. 41. Allows Network members to proactively transition to a value-based system based on Network established measures</li></li></ul><li>Physicians Lead the Way<br />Clinically Integrated Network Governance<br /><ul><li>New organization led by 21-member Board with reserve powers
    42. 42. 17 members will be physicians throughout Hillsborough, Pinellas and Pasco
    43. 43. More private practice physicians than BayCare-employed
    44. 44. Includes physician-led subcommittees
    45. 45. Credentialing
    46. 46. Clinical performance
    47. 47. Contracting
    48. 48. Nominating</li></li></ul><li>Committee Structure<br />Initial and ongoing membership criteria<br />Set clinical performance criteria and review member performance<br />Look at 3rd-party agreements and risk pool allocations<br />Assist development of board memberships<br />
    49. 49. Funds Flow<br />Overview<br />Insurers<br />New ReimbursementBased On NegotiatedContracts<br />Annual QualityBonus PayoutBased On Set Goals and Performance<br />Measures<br />Continue CurrentFee-For-ServiceClaims & PaymentStructure<br />Health Information Exchange<br />Hospitals<br />Practice<br />
    50. 50. Contracting Approach<br /><ul><li>Practice maintains control of billing and collects
    51. 51. Practice makes claims information available to the network
    52. 52. The network negotiates a “bonus pool” with the payers (not a withhold)
    53. 53. The network is responsible for managing/distributing bonus payment
    54. 54. Payouts are distributed annually after performance is reported</li></li></ul><li>BayCare Physician Partners<br />Hospitals<br />Physicians<br />Insurers<br />Patients<br />FinancialSupportResources<br />Commitment,Participation,Leadership<br />PerformanceIncentivePayments<br />Trust,ProactiveInvolvement<br />GIVE<br />Efficiency,Partnership,Mission<br />IncreasedEfficiency,Coordination<br />Transparency,Efficiency,Quality<br />BetterHealthCare<br />GET<br />Physician<br />Patients<br />Insurers<br />Hospitals<br />
    55. 55. The Network Is NOT…<br /><ul><li>A “bargaining” organization for physicians to increase negotiating power
    56. 56. A replacement or extension of the hospital medical staff
    57. 57. The beginning of a BayCare insurance company
    58. 58. A practice management (or billing service) for private practice</li></li></ul><li>BayCare Physician Partners<br />Timeline<br />2011<br />2012<br />2013<br />DeliverCare WithNew Contracts<br />ContractWithPayers<br />RecruitPhysicians<br />Develop Plan<br />CreateNetwork<br />
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