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 durable medical equipment suppliers. 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, resulting in healthier communities, patient engagement and care.
As health insurance costs continue to rise, health purchasers are reducing payments for volume and are instead rewarding value. Payment models are moving from fee-for-service to value-based with shared-savings risk. 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.
As St. Luke’s Care Network (SLCN) receives shared savings payments from value based contracts with payors and purchasers, the incentive payments will be distributed to physicians and other participating providers based on the SLCN incentive distribution guidelines which focus 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:
- 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
Participating 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.
Shared claims and data supports care coordination across the continuum and provides the method to assess outcomes. In the absence of a shared electronic medical record, clinical information can be viewed via the EpicCare Link, and data can be submitted to SLCN via fax or to a secure website. Examples of EHR data that may be collected includes BMI and BP measurements.
Aggregate data will be used by the St. Luke’s Care Network leadership and clinical committees to measure the success of the clinical programs and to identify opportunities to improve care. Individual provider results will be reviewed if there is an opportunity to improve the overall performance of St. Luke’s Care Network. Periodically, participating physicians will receive individual or practice outcome reports.