NHealth Clinical Integration in Norman Frequently Asked Questions
- What is a clinical integration Network (CIN)?
A Clinical integration Network usually involves independent and employed physicians working in collaboration with a hospital or health system to develop active and ongoing clinical initiatives that seek to control costs and improve quality of the services provided. Clinical integration is an important part of the larger Population Health strategy of the health system.
- What are the characteristics of effective clinical integration?
An effective clinical integration program contains initiatives that: (1) provide measurable results used to evaluate provider performance, and (2) results in concrete improvement of that performance. Interdependence among providers is fostered. Coordinating care enables providers to achieve higher quality and more cost effective care than could be accomplished on their own.
- Why would physicians want to participate in a CIN?
NHealth’s mission is to support and strengthen the healthcare community through collaboration among patients, physicians, employers, payers, and community members. The CIN provides a platform for providers to coordinate care delivery, reduce inefficiencies, and measurably improve the health of our community. NHealth’s vision strives to create an organization that is differentiated from our competitors through superior service and clinical outcomes.
- What does a clinically integrated network look like?
Clinical integration involves both employed and independent physicians and the health system to work together. Identifying and adopting clinical protocols to treat particular disease states, developing systems to monitor the effectiveness of the adopted protocols, exchanging data to identify trends, holding each member of the CIN accountable for compliance with CIN processes, rewarding physicians for achieving quality care in a way that recognizes the physician’s efforts, and sharing savings from reducing the cost of care for a specific payer.
A New Organization
- Were physicians involved in the development and leadership of the CIN that Norman Regional Health System is facilitating?
Yes. The Norman Physician Hospital Organization (NPHO) Board, which is made of physicians (employed and independent) and health system representatives, have discussed the restructuring of the NPHO and the CIN for more than two years. There were several meetings devoted to asking each other questions, as well as gathering opinions from legal counsel. We were also fortunate to have a question and answer conference call with hospital and physician leadership of Kootenai Care Network from Coeur d’Alene, Idaho. Kootenai Care Network is the health system facilitated CIN made up of employed and independent physicians and Kootenai Health System. The information and experiences of the system in developing their CIN was instrumental in helping us understand the operational issues associated with creating a new CIN and provided valuable insight of how to create an effective physician-led organization.
- How will this organization be different from NPHO?
On the surface, NHealth will closely resemble NPHO. The new organization allows physicians the freedom to choose to participate or not. Those physicians that elect not be a part of the CIN will still be able to participate in certain payer agreements through a messenger model arrangement but they will not participate in certain quality incentive programs or any shared savings arrangements.
- What benefits will the health system provide in the development of clinical integration programs?
With NRHS as a partner, there are several advantages to the continuing development of clinical integration. In cases where the health system shares the same quality vision as the physicians, we see the development of clinical integration initiatives based on existing inpatient quality measures, contributing financial and personnel assistance that are tied to improving inpatient and outpatient community benefit and are not in violation of any federal referral guidelines, and demonstrating the legitimacy and value of clinical integration as a whole to payers, employers, and the community.
- What does the organization’s governance look like?
The current NPHO Board is comprised of eight physicians from the NPA and three health systems representatives; each side having one vote. NHealth will be physician-led and governed by an 11-member Board of Managers. The Board will be comprised of six non-NRHS employed physicians, three NRHS employed physicians, and two NRHS representatives. Our organization Operating Agreements require that there always be a non-NRHS employed physician majority, as well stipulating what decisions and actions the Board of Managers can take.
- Will there be an opportunity for physician leadership?
The success of NHealth will be a direct result of our physician leaders. Whether serving on the Board of Managers, chairing a committee, serving on a task force, or providing input on certain clinical initiatives, there will always be a need for actively involved physicians, independent and employed. We recognize that your time is valuable and we hope that we will have many interested physicians participate in CIN. NHealth will also compensate physicians for their time.
- What do physicians need to do to participate?
Because participation is voluntary, interested physicians will sign a new Participating Provider Agreement and will work with their physician colleagues and NHealth staff to develop initiatives to improve the quality of care, enhance the services provided, and reduce the overall cost of care. Physicians must be able to hold themselves and their colleagues accountable for compliance with CIN initiatives.
- Are there membership dues?
There are no membership dues, fees, or withholds.
- How are contractual arrangements negotiated and will I be required to see any patient covered under that agreement?
The network will have a contracting committee, led by physician members of the network, who will determine the parameters of any contractual relationship. You would be required to treat patients under these arrangements in the same manner that you currently experience under any other managed care relationship.
- What effect does that have on my current managed care agreements?
You are only asked to delegate contracting for agreements entered into by the network. Those agreements should not impact your current managed care contracts in any way.
- What can I expect during the first year of participation?
During the coming year, we will continue to build and improve upon the clinical integration strategies of NHealth and NRHS. Our primary objectives include:
- Further deployment of technology infrastructure including analytics and population health software, exchanging health information, and care coordination.
- Implementing new committee and subcommittee structure that promotes member engagement and continuous improvement without contributing to physician burnout.
- Supporting clinical outcomes improvement through developing and deploying new programs.
- Engaging payers and employers as appropriate.
- Advocacy efforts that further support our independent provider members.
- Developing cost containment strategies for members.
- Member engagement and education.
- Recruiting providers to the CIN and growing the organization.