Clinical integration is collaborative, coordinated care among health care providers. The focus is on improved quality, increased efficiency and reduced costs. A clinically integrated network may include physicians, acute and post-acute facilities, and other types of healthcare providers, such as pharmacies. Clinically integrated networks develop clinical protocols, measure performance against the protocols, build care management systems to engage patients, implement technology to support these initiatives, and reward providers for high quality care. As a result, communities should become healthier, patients should be more engaged, and health care should be better coordinated.
As health insurance costs continue to rise, health plans are reducing payments for volume and are instead rewarding value. Payment models are moving from fee-for-service payments to value based contracts that provide incentives for quality and efficiency. Clinically integrated networks provide the infrastructure for value based contracting through technology and systems designed to reduce variation in care, manage chronic disease and coordinate care across the continuum.
St. Luke’s Care Network expects to receive incentive payments earned through value based contracts with payors and purchasers. After covering certain expenses, St. Luke’s Care Network plans to distribute incentive payments to physicians and other participating providers based on quality and efficiency.
Among other benefits, participating physicians will have access to:
- Clinical protocols that are developed by their local colleagues
- Care management resources that engage high risk patients with chronic illnesses
- New payment models with financial incentives for quality outcomes
- Participation in a preferred network
Among other requirements, participating physicians will:
- Participate in quality and cost improvement programs that include sharing data with St. Luke’s Care Network
- Comply with certain eligibility criteria
- Support care management programs developed by St. Luke’s Care Network
- Abide by policies, procedures and performance standards adopted by St. Luke’s Care Network
- Obtain and maintain participating provider status with contracted purchasers
- Pay an initial participation fee and annual dues
- As requested, actively participate in the St. Luke’s Care Network committees
St. Luke’s Care Network will be the “in-network” network for the 15,000 members of the St. Luke’s University Health Network employee health plan. Providing care to the SLUHN employees will demonstrate St. Luke’s Care’s Network effectiveness in improving outcomes and reducing costs. St. Luke’s Care Network will not negotiate third-party payor contracts on behalf of its network of participating providers until it has determined that those negotiations are pursuant to a program of clinical integration or substantial financial risk sharing.
Participation requires physicians to support St. Luke’s Care Network quality goals, utilize clinical protocols, and meet standards of performance that are developed by St. Luke’s Care Network clinical committees.