As the U.S. healthcare system shifts from volume to value, provider leaders are finding that there are many different ways to advance, and that in particular, there are many different ways to participate in ACO (accountable care organization) arrangements; but that one irreducible critical success factor is physician engagement.
That certainly has been a core awareness at Shore Quality Partners CIN, a clinically integrated network based in Somers Point, New Jersey, just south of Atlantic City. Formed in March 2014, Shore Quality Partners is owned by Shore Medical Center, a freestanding community hospital, and encompasses about 240 primary care physicians and about 190 specialists, 65 of whom are employed by the hospital, with the rest in independent practices.
Shore Quality Partners was formed as a network of providers aligned to support quality improvement and cost efficiency. The CIN is governed by a board of directors and several physician committees, who are responsible for developing and implementing clinical integration initiatives and dealing with all matters affecting the organization. The CIN’s board consists of a total of 12 directors, of whom nine are physician directors (a mix of primary care and specialist physicians), and three hospital directors.
As articulated on its website, “Shore Quality Partners brings independent, contracted and employed physicians – whether primary care, specialist or hospital-based-physicians, together with Shore Medical Center to form a network of providers aligned to support quality improvement and cost efficiency. The Clinically Integrated Network (CIN) is governed by a Board of Directors and several physician committees, who are responsible for developing and implementing clinical integration initiatives and dealing with all matters affecting the organization. The CIN performs various functions and activities: developing and managing arrangements with payers for payment of bonuses, care management fees and other incentive compensation; developing and implementing care guidelines, policies, procedures and protocols; gathering and analyzing data; designing and implementing care management initiatives; aligning with additional providers; managing IT infrastructure implementation and operations; and measuring performance and distributing incentive funds based on performance.”
With regard to the CIN’s founding, the organization’s website also notes that, “In collaboration with its Physician Leadership Council, SMC [Shore Medical Center] identified the need to respond to the changing market while allowing community physicians to retain their practice independence and autonomy. Shore Quality Partners emerged as a dynamic model designed to engage and align interests among community providers and SMC. This effort brings together physicians and SMC to enhance collaboration and achieve clinical integration with the support of Shore Medical Center’s resources and infrastructure. By proactively seeking opportunities with interested payers, Shore Quality Partners positions its participants for success under new payment and care models.”
In terms of the data analytics and population health needs involved, Shore Quality Partners has been partnering with the Piscataway Township, N.J.-based HealthEC, in order to achieve success in leveraging data analytics to support its intensive clinical transformation work.
Since the outset, Cliff Frank has been Shore Quality Partners’ interim executive director. Frank spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland about his organization’s push into value-based healthcare. Below are excerpts from that interview.
Tell me about the origin of the impetus for formation of the clinically integrated network?
At the end of 2012 and in early 2013, we realized that we didn’t have enough money to employ our way to a big medical staff; it just costs too much to employ physicians and cover their overhead. So we knew we needed some other vehicle. And a lot of medical staff didn’t want to be salaried, and in any case, we didn’t have the money. Same canoe.
Are you an MSSP?
We are part of an MSSP [Medicare Shared Savings Program], Track One. We have a direct shared savings contract, commercial, with Horizon Blue Cross, and a separate one with MJ Health for Medicaid; and we have a pay-for-quality contract with a Medicare Advantage program, Clover, which up in northern New Jersey and active here. They’re owned by the same organization up in northern New Jersey.
What is the name of the MSSP?
Allegiance ACO, and they’re based in Trenton. They have about 5,000 patients over there, and we have about 75,000 patients over here.
And what is the size of your commercial ACO population altogether?
About another 30,000 lives.
When did you join Allegiance ACO? And when did your commercial contracts begin?
Commercial ACO started about April 2014. The Medicaid ACO with M Health started in January 2016. And the Medicare ACO started in January 2017.
So you’re in the second year with the MSSP?
Yes, that’s correct.
What are you hoping to achieve overall?