Clinically Integrated Network FAQs
The Health Partners Clinical Integration Program develops active and ongoing clinical initiatives focused on delivering quality, performance, efficiency, and value to the patient.
Providers and hospitals must partner more closely than ever before to ensure that the community receives the highest quality and value. As we move from yesterday's fee-for-service reimbursement models to today's performance- and value-based pay models, clinically integrated networks enable health care providers to join together to enhance the health of our community. These networks bring value to patients, payors, and physicians by improving transitions of care, coordinating chronic disease management, and managing the health of a population.
A clinically integrated network helps providers align with the health system to coordinate care across caregivers, focus on quality and performance, and participate in incentive-based compensation programs in addition to the base compensation they already receive. The network develops new payment systems and methods that focus on achieving quality, efficiency, cost-management measures, and enhancing value.
The principal purpose is to enhance the quality and efficiency of patient care services provided by participating providers, who work together to develop clinical performance standards and protocols for the network. These will form the basis for Mount Carmel Health Partners to negotiate contracts with payors for performance incentive programs.
For providers, the network offers the opportunity to:
- Become available as a preferred network provider to members
- Use care management resources provided by Mount Carmel Health Partners
- Identify and measure best practices
- Improve outcomes for patients
- Receive financial rewards for value-based outcomes and achievements
What is the difference between a Clinically Integrated network and an Accountable Care Organization (ACO)?
According to the Centers for Medicare and Medicaid Services (CMS), an ACO is accountable specifically for Medicare beneficiaries. It is an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries enrolled in traditional fee-for-service programs who are assigned to the ACO. Similarly, a clinically integrated network is an alignment model, coordinating care across affiliated caregivers and developing contracts with payors to improve quality while controlling growth in total cost of care, including value-based contracting initiatives with commercial payors and Medicare.
Are Clinical Integration participating providers required to refer enrolled patients to other network participants?
In-network referrals allow for the efficient accumulation and reporting of data, promote coordination and continuity of care, and ensure adherence to evidence-based medicine.
The Health Partners Patient Registry is an electronic health care tool that collects and analyzes clinical data from the claims acquired from the physician’s practice management system or billing company, outside laboratories, prescription histories, and data from Mount Carmel Health System. (This tool does NOT collect financial information such as charge amounts or reimbursement amounts.)
It supplies the clinically integrated network with information to be used in providing better and more comprehensive patient care through improved data sharing and managing to a common set of care guidelines. In addition to assisting providers with closing any gaps in care, data can also be used in payor discussions relative to pay for quality opportunities. The Health Partners Patient Registry supports our mission of assisting primary care physicians, physician specialists, and health care systems in working together, using proven protocols and measures, to improve patient care.
Participating providers or groups must sign the Mount Carmel Health Partners Clinical Integration Legal Addendum to their Physician Services Agreement. The Addendum contains the complete set of requirements, but some key items are:
- Agree to use the Health Partners Patient Registry
- Participate in required educational programs
- Ensure the practice has high-speed Internet access
- Maintain an active email address for communications
- Agree to active participation, which may include committee involvement
- Comply with quality, safety and efficiency improvement programs
- Abide by established Clinical Integration policies and procedures
The Health Partners Clinical Integration Program is non-exclusive; providers are not restricted from participating in other clinical integration programs. Also note that all Health Partners pay-for-performance projects are available to only those member physicians in the Clinical Integration Program.