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, home health practitioners, and other health care providers. 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 become healthier, patients are more engaged, and health care is better coordinated.
Payment models continue to move from fee-for-service payments to value-based contracts that share savings and 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 quality and efficiency, and the SLCN incentive distribution policy.
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; and
- 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;
- 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;
- As requested, actively participate in the St. Luke’s Care Network committees.
A goal of St. Luke’s Care Network’s program of clinical integration is to ensure that patients of participating providers have the benefit of the program’s quality initiatives through their continuum of care. Accordingly, for members of plans contracted with St. Luke’s Care Network, participating providers shall endeavor to utilize the resources of, and refer patients being treated pursuant to and within the scope of such contracts, to other St. Luke’s Care Network participating providers, in accordance with St. Luke’s Care Network policies.
St. Luke’s University Health Network (SLUHN) has invested funds in the infrastructure and operation of St. Luke’s Care Network. St. Luke’s Hospital of Bethlehem is the sole member of St. Luke’s Care Network. Physicians and other healthcare providers participate in St. Luke’s Care Network through participation agreements. As requested, participating physicians are expected to contribute to SLCN through service such as membership on committees, developing clinical protocols, and recommending best practices that improve St. Luke’s Care Network’s success.
In-network referrals assure that patients receive the consistent care that is included in physician developed clinical protocols. Also, in-network referrals support sharing of patient data, leading to more coordinated and efficient care.