Clinically Integrated Network

BayCare Physician Partners

Creating a Clinically Integrated Networkin the Tampa Bay area

– New model of care for patients and physicians

– 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)

Clinically Integrated NetworkIntegrating the components of our care delivery system into a single entity to increase coordination and decrease fragmentation

BayCare Physician Partners

Hospitals

Physicians

Insurers

Insurers

Clinically Integrated Network

– Flexible, collaborative approach to improved quality and cost containment

– Focus on prevention, early detection and disease management

– New reimbursement structure connected to established goals and Quality outcomes

Definition

New organization that brings physicians and health system resources together into a more clinically and financially aligned model of care

FTC/DOJ Road Map to Clinical Integration

“Indicia” of Clinical Integration

1. The use of common information technology to ensure exchange of all relevant patient data

2. The development and adoption of clinical protocols

3. Care review based on the implementation of protocols

4. Mechanisms to ensure adherence to protocols

Federal guidelines provide a clear road map to clinical integration

Source: Improving Health Care: A Dose of Competition A Report by the Federal Trade Commission and the Department of Justice July 2004; Chapter 2; Section 4.b.3

FTC/DOJ Road Map to Clinical IntegrationFederal guidelines provide a clear road map to clinical integration

FTC / DOJ checklist What do the physicians plan to do together from a clinical standpoint?

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 can they effectively participate in multiple entities and continue to contract outside the group? Why or why not?

OverviewMay 1, 2011

– BayCare’s Board of Trustees unanimously approved strategic business plan to create a clinically integrated network

Collaboration– Plan designed by independent, physician-steering

committee with 20 medical doctors throughout BayCare

Goals– Deliver high-quality health care, at a lower cost– Better prepare for changes coming to the nation’s

health care model

Business Model

– Patient at the center of everything

– 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

– Single consolidated performance incentive structure to accommodate range of payment models

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.

Membership Requirements

– Licensure

– Medical Staff

– Prescribing

– Board Certification

– Insurance Requirements

– Legal

– Conflict of Interest

– Performance

– Infrastructure

– Data Management

– Patient Care Standards

– Communication

– Network Contract and Resources

– Training and Meetings

– Quality Assurance

– Compliance

Physician Eligibility Requirements Physician Participation Requirements

BayCare Physician Partners

1. Physician-led Board and Committees identify measures and initiatives

2. Network negotiates value-based payment structure

3. Physicians in network report and monitor results

4. Payments received and distributed to physicians based on performance

Quality and Performance

What’s In It For Physicians? Care coordination process should result in better patient follow-up

Greater access and working relationship between PCPs and specialty consultants

Greater support, access and integration of medical information technology

Better health care decision making via improved data and processes

Information transparency will allow physicians to compare practice measures with colleagues

Opportunity to demonstrate value and link reimbursement for better performance without regard to employment status

Allows Network members to proactively transition to a value-based system based on Network established measures

Physicians Lead the Way

• New organization led by 21-member Board with reserve powers• 17 members will be physicians

throughout Hillsborough, Pinellas and Pasco

• More private practice physicians than BayCare-employed

• Includes physician-led subcommittees• Credentialing• Clinical performance• Contracting• Nominating

Clinically Integrated Network Governance

Committee Structure

Initial and ongoing

membership criteria

Set clinical performance

criteria and review member

performance

Look at 3rd-party agreements and

risk pool allocations

Assist development of

board memberships

Network Board

CredentialingClinical

Performance Committee

ContractingNominating Committee

Executive Committee

Funds Flow

Continue CurrentFee-For-Service

Claims & PaymentStructure

Annual QualityBonus PayoutBased On Set

Goals and Performance

Measures

Insurers

New ReimbursementBased On Negotiated

Contracts

Health Information Exchange

Hospitals Practice

Overview

Contracting Approach

• Practice maintains control of billing and collects

• Practice makes claims information available to the network

• The network negotiates a “bonus pool” with the payers (not a withhold)

• The network is responsible for managing/distributing bonus payment

• Payouts are distributed annually after performance is reported

BayCare Physician Partners

Physicians

PatientsInsurersHospitals

Physician PatientsInsurersHospitals

GIVE

GET

FinancialSupport

Resources

Commitment,Participation,Leadership

PerformanceIncentivePayments

Trust,Proactive

Involvement

Efficiency,Partnership,

Mission

IncreasedEfficiency,

Coordination

Transparency,Efficiency,

Quality

BetterHealthCare

The Network Is NOT…

• A “bargaining” organization for physicians to increase negotiating power

• A replacement or extension of the hospital medical staff

• The beginning of a BayCare insurance company

• A practice management (or billing service) for private practice

BayCare Physician Partners

2011 2012 2013

Develop Plan

CreateNetwork

RecruitPhysicians

ContractWith

Payers

DeliverCare With

New Contracts

Timeline