Clinically Integrating for Atlanta s Kids. The Children s Care Network
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1 Clinically Integrating for Atlanta s Kids The Children s Care Network
2 How is the healthcare market changing? 1 Pediatric physician consolidation slower than adults 2 Growing outpatient environment Increasing demand for price and quality transparency 4 Expansion of adult health systems into pediatric market 3 2
3 The future will emphasize value over volume. 100% Value Based Accountability Revenue Generated Through Incentive Model Fee for Service 0% Time 3
4 So, what can an independent practice do to keep up with these changes? Keep providing the high quality, unique care of specially trained pediatric providers. Build the infrastructure to keep track of and demonstrate your performance. Find new ways to maintain a sustainable business model. Our community deserves the better outcomes pediatricians working alongside a pediatric hospital System can provide. 4
5 Across the country, clinical integration is being leveraged to deal with market changes. Increasing financial opportunity and alignment P4P P4P PCMH PCMH CLINICAL CLINICAL INTEGRATION INTEGRATION SHARED SHARED SAVINGS SAVINGS BUNDLED BUNDLED PAYMENTS PAYMENTS SHARED SHARED RISK RISK CAPITATION CAPITATION FULL RISK FULL RISK PROVIDER- Provider- SPONSORED SPONSORED PLANS PLANS
6 If we work together, we can advance pediatrics in our communities. The Children s Care Network is a physician-led nonprofit created to: improve quality increase efficiency demonstrate performance and value identify sustainable business models to protect the private practice model into the future 6
7 How would the network work? Example: Asthma Primary Care - PCP manages more of the care - PCP uses protocol before referring - Utilization is monitored - Easier access to subspecialists Billy has asthma. SPECIALIST Specialists - Knows PCP has followed protocols - Better able to focus on more serious cases - Reduced wait times for firsttime patients Schools - Trained on care protocols - Have dedicated rescue inhalers, spacing chambers, and individualized asthma plans 7
8 Developmental milestones for a CCN practice : Baby steps Year 5+ Each stage identifies checkpoints for practices Year 1 Sit-up Commit to CCN Establish a communication channel Education on measures Link to technology Gather baseline data Year 1-2 Crawl Create quality infrastructure (CI Champ, Q Coor, PA) Acceptance of Core Measures Coding education Benchmark data Set priorities Start to implement process changes in practice Year 2-5 Walk Take action Implement project plans Active participation from all staff Collect data / analyze results Evaluate data for care opportunities Identify barriers Establish ongoing processes Re-evaluation Submit best practices Run Identify areas of need from data Easy acceptance of new programs Periodic assessments Population buckets Peer interaction
9 How does the contracting work? All Members are required to participate in Incentive-Only contracts Upon achievement of clinical integration and delegated authority for base contracting Members have choice to optout of base contracts for certain payors if opt-in Contract under CCN singlesignature authority If opt-out Two-year exclusion from those base contracts 9
10 SPECIALIST PEDIATRICIAN The Children s Care Network Board of Directors PRIVATE PRACTICE 1. Helena Bentley, M.D. 2. Angela Hall, M.D. 3. Norman Chip Harbaugh Jr., M.D. 4. Robert Licata, M.D. 5. Anu Sheth, M.D. 6. Roy Benaroch, M.D. 7. Melinda Willingham, M.D. 8. Robert Wiskind, M.D. (chair) Medical: 1. Lonnie King, M.D. 2. Billy Meyers, M.D. Surgical: 3. Michael Busch, M.D. (vice chair) 4. Hal Scherz, M.D. EMPLOYED BY A SYSTEM (Children s or other organization) 1. Gary Frank, M.D. 2. Vivian Lennon, M.D. 3. Yasmin Tyler-Hill, M.D. 4. Vacant board seat Children s 1. Robert Campbell, M.D. 2. James Fortenberry, M.D. 3. Lucky Jain, M.D. 4. Mark Wulkan, M.D. Representatives Patrick Frias, M.D. Donna Hyland Daniel Salinas, M.D.
11 What are the membership criteria? Pediatric primary care physicians and pediatric specialist physicians are eligible to join. All members of a practice must join. Must be member of Children s Professional Staff. Must be board-certified or board-eligible. Must agree to submit practice data, but are not required to have an EMR system in their practice. Do
12 What do I have to do as a network member? Participate in quality initiatives. Adhere to performance goals. Share certain, defined patient data. Pay fair market value dues for services provided by the network. $200 per physician; enrollment closes June 30. Participate in certain network contracts. 12
13 So, why should I join? Improve coordination across the care continuum. A free-standing pediatric system of care benefits everyone especially our patients. Become an early-adopter of value-based care. Inaction doesn t mitigate risk from the changing healthcare market. Independent pediatricians govern the destiny of the network. We can share in the rewards of moving to a value-based system. 13
14 Where can I find more information? Visit Contact The Children s Care Network to request an in-person visit from a network representative or to receive an enrollment packet: or cin@choa.org. 14
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