- Q: What is a Clinically Integrated Network (CIN)?
A: A CIN is a group of hospitals and providers who collaboratively make a commitment to improve the quality and efficiency of care for the patients they serve by proactively managing care. West Florida Health Network is a CIN that will lead the development of a health system focused on population health to accomplish the transformation from volume-based to value-based reimbursement.
- Q: What are the benefits of joining a CIN?
A: Physicians can be part of a large network and still remain independent. Successful physician-led networks benefit from physician-driven clinical outcomes, enhanced positioning for health care reform, a culture of ongoing performance improvement, and being recognized for quality and efficiency. A network enables members to align incentives, interface with multiple managed care organizations, measure and display results, and create a business partnership between physicians and the hospital members (Tampa General and Florida Hospital).
Member physicians participate in decisions about which quality and cost initiatives to pursue, have access to a clinical performance management system (CPMS) to measure practice performance relative to peers, have access to a number of commercial contracts including the hospital member colleague health benefit insurance plans, have financial incentives to help transition to a value-based payment system, and work with patients and employers who value a network with demonstrated quality.
- Q: What are the expectations of a physician who joins West Florida Health Network?
A: Participating physicians agree to:
* Actively participate in clinical integration programs, initiatives and measures adopted by the CIN.
* Comply with all applicable terms of the Physician Participation Agreement and all policies, rules, legal compliance program, and regulations.
* Commit to standards of access to share claims data on patients covered by the CIN’s contracts, honor in-network referrals and participate in network activities.
* Maintain appropriate technological protocols, including e-mail communications and high-speed internet connectivity.
* Complete continuous quality improvement orientation and training.
* Cooperate in good faith to investigate any complaints made by patients served under the contracts and to resolve complaints in a reasonable time with appropriate action.
* Participate in the CIN’s quality assurance, utilization review and risk management programs and serve on committees as requested by the CIN from time to time.
* Participate in ongoing audits and quality assurance monitoring activities.
* Comply with clinical protocols, criteria and procedures developed by the CIN to assure consistency and quality of all professional services provided under the contracts.
* Ensure all services provided in connection with the CIN are rendered in a competent and professional manner, consistent with continuous quality improvement standards.
- Q: What are the goals of West Florida Health Network?
A: To transform care delivery through a physician-led CIN accountable for the full continuum of care.
To lead the market in high quality, cost efficient care through population health management strategies that include engaging patients in the ownership of their care.
To become the preferred partner for physicians in the community through the creation of a culture of cooperation, collaboration and mutual interdependence.
- Q: What does the CIN seek to accomplish?
A: The CIN seeks to achieve the ‘Triple Aim’ of healthcare: improving population health, improving the experience of care, and reducing per capita cost by:
– allowing providers to improve the quality of care, especially across episodes of care.
– enabling providers to perform well in pay-for-performance and other related initiatives.
– allowing providers to gain additional patient flow through facilitating intra-group referrals.
– enhancing the value of information technology solutions through interoperability.
– permitting providers to gain negotiating leverage for enhanced reimbursement.
– preserving the private practice of medicine.
- Q: What is the vision of West Florida Health Network?
A: To be the recognized model for high quality, affordable health care, delivered by a team of multi-disciplinary providers, redefining health and wellness in our communities.
- Q: Are there any fees to join West Florida Health Network? Or annual dues?
A: West Florida Health, Inc., will fund the start-up costs of the CIN. Physician members will pay dues as established by the Board of Managers. Dues are currently set at $500.00 per year.
- Q: Do I need to have an Electronic Medical Record (EMR) to join the network?
A: No, an EMR is not required. However, an electronic claims submission or billing system is required in order to feed data to the CPMS (clinical performance management system), the backbone of the CIN’s quality monitoring system.
- Q: What is the leadership structure of West Florida Health Network?
A: The Board of Managers is comprised of the following:
— 10 Class A physicians of whom 5 must be PCPs, no more than 2 can be employed by the Hospital Members and 8 must be independent;
–6 Class B physicians of which 3 are from Florida Hospital and 3 from Tampa General Hospital.
–3 ex officio without vote Managers include the president, treasurer and medical director.
Other than certain reserved and approved powers of the Hospital Members, all actions of the Board shall require the approval of a majority of both the Class A and Class B Managers.
- Q: When will West Florida Health Network enter into contracts with payers and employers?
A: Initially, West Florida Health Network will focus its contracting with the Hospital Member’s health benefit insurance plans, scheduled for an effective date of 1/1/2016. The Board will consider other initiatives as the CIN’s capabilities develop.
- Q: Do I have to give up my privileges at non-Hospital Member hospitals?
A: No, hospital privileges –at any hospital, are not required. You may choose to have privileges – or not, at any hospital(s) you choose.