Q&A: How Clinical Integration Creates Framework for Value-Based Payment Contract

Wednesday, August 8th, 2012
This post was written by Jessica Fornarotto

Advocate Physician Partners is proud of its infrastructure of success in shared savings, built on a foundation of clinical integration.

“To describe how valuable our clinical integration program is at Advocate Physician Partners, two areas need to be highlighted,” says Dr. Carrie Nelson, medical director for special projects with Advocate Physician Partners (APP).

Dr. Carrie Nelson, Medical Director for Special Projects

Prior to her presentation on Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners, Dr. Nelson discussed in depth APP’s clinical integration program that helped to set the framework for their value-based payment contract with Blue Cross Blue Shield of Illinois (BCBSIL). This payor-provider agreement has reduced inpatient admissions and ER visits, and has bent the cost curve after its first year of implementation. APP’s clinical integration program is described in detail in
Case Study in Clinical Integration: The Advocate Physician Partners Experience.

HIN: How has APP’s clinical integration of more than 4,000 physicians and 10 hospitals over the last few years helped to lay the groundwork for your value-based payment contract?

(Dr. Carrie Nelson): We feel very fortunate that we have a strong clinical integration program in place. It has created a strong foundation for the work that we’re doing with shared savings. There are two major areas that demonstrate how valuable that foundation has been to us.

First, it is a culture of delivering that value that we have established here over the last eight years or so since we’ve been deeply involved in this clinical integration program. That has been a tremendous spirit to build upon with movement toward shared savings and value-based contracting. Physicians in our network have a strong understanding of the importance of delivering that value and achieving quality metrics and not just a fee-for-service volume-based approach to care.

The second would be the framework that it has laid for us in how we can continue to incentivize the physicians to achieve the goals associated with shared savings. We have been able to build a number of our key priorities into the clinical integration program, such as decreasing ER utilization, length of stay, and admissions for ambulatory care-sensitive conditions. Many of those things have rolled into our clinical integration program and have helped physicians to be energized to help achieve these shared goals.

We feel very fortunate that we had this program in place in many cases before it was truly rewarded. It has also provided this cultural basis and framework for building upon the successes that we’ve already seen. The last thing to remember is this: all that needs to be accomplished in shared savings can be overwhelming. Clinical integration and the measurements that we’ve been involved in for many years are some of those things.

It’s nice to be able to focus on some alternative areas to show our infrastructure of success in shared savings, instead of having to focus explicitly on just the measures that are brought along.

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