A clinically integrated network, or CIN, brings together a group of providers to cooperate actively in efforts to limit costs and deliver high quality care. That, in turn, allows the providers to contract jointly with payors and to share gains associated with their efforts.
We are a physician-led clinically integrated network that brings together primary care pediatricians and specialists across the Commonwealth of Virginia as part of a new legal entity that will stand with and support pediatric providers. This clinically integrated network is steered by a physician-led Board of Directors that recognize children as a unique population.
Population health is a lens to view health outcomes for a group of people, and the distribution of those health outcomes within a group. Looking at a population of children allows us to identify gaps in care, inequities in care, and opportunities to improve outcomes for the entire defined population. As an example, all children need and deserve well-child care and immunizations. Analyzing populations of children at various ages allows us to target those who need well-child visits and timely vaccinations and helps us to assure that all children in our care get what they need and deserve, not just the children who access care and keep their appointments.
Having the ability to look at data for an entire population allows us to plan for care in new ways. As an example, having a registry that identifies all children with chronic persistent asthma in a given population provides the opportunity to plan, deliver, and evaluate their annual influenza vaccinations in a systematic and timely way.
There are increasing pressures on pediatric providers trying to provide excellent care given the constantly evolving healthcare marketplace. For decades, the foundation of pediatric practice has been the family centered medical home. Pediatric providers create a partnership between the child and their family to provide access, coordination and integration of all the important community services needed to support the growth and development of our patients. There are growing challenges to the pediatric provider with emerging accountable care organizations, retail-based clinics and increasing fragmentation of the medical neighborhood. Concurrently, innovation in value-based payment models has primarily focused on adults with little emphasis on the needs of children. The mission of Fortify Children’s Health prioritizes the special needs of children and supports the pediatric providers that create the pediatric medical home to coordinate high quality care.
We hope to work together with a broad spectrum of organizations to transform the way we deliver children’s health care in Virginia. Meaningful impact for kids throughout the Commonwealth will require physicians, other health systems, payors, the Commonwealth, community organizations, and others to work together in designing new ways to improve the care of Virginia’s children.
CINs around the country follow guidance on this topic provided by the U.S. Department of Justice (DOJ) and the Federal Trade Commission (FTC), as well as their own legal counsel. The DOJ and FTC created a mechanism for joint contracting and gain sharing because they recognize the benefits of providers working together to improve quality and reduce costs.
No. This is a collaboration. Mergers and acquisitions are neither needed nor anticipated for this collaboration to be successful.
While there are examples of pediatric collaborations in other parts of the country, we are not aware of a pediatric collaboration whose specific purpose, scope, and composition is exactly the same as this one. Other examples include Nationwide Children’s Partners for Kids, the Phoenix Children’s Care Network, and the Arkansas Children’s Care Network.
As part of the Fortify network you would help provide a unified voice for pediatrics in Virginia. You would have access to clinical protocols and care management resources, access to data and IT systems, and the opportunity to earn financial incentives and shared savings, among other benefits.
Clinically integrated networks are emerging in Virginia and across the country, though most of those are focused on adults. Our vision is to create a single, pediatric CIN for Virginia that would be a “plug in” for other adult networks. That way, participants in the pediatric CIN could channel their time and energy into a single network that provides a unified voice for pediatrics, while avoiding the duplication of clinical and administrative activities resulting from participation in multiple CINs.
The CIN is physician-led, with physicians actively involved in the design of clinical elements and operations of the CIN. The governance structure includes a physician majority Board, representatives from employed and community practices, and a mix of primary care and specialist physicians. We also have a committee structure that includes a broader group of providers.
The Board of Managers and the FCH committees are majority physician. Every effort is made to create a transparent and inclusive process for member clinicians.
The network negotiates value-based contracts (such as shared savings) on behalf of participating providers, and those providers negotiate with payors for their own fee-for-service contracts. We envision that providers will continue to operate in a fee-for-service environment while testing value-based arrangements through the network until the CIN and the market shift more dramatically toward risk-based contracts.
Fortify will monitor and report on active participation at the Practice level where the integrated care team engages in Clinical Integration Program activities collaboratively to ensure high quality care is achieved. Fortify requires all Providers to be engaged in Clinical Integration Program activities to support the mission, vision and values of Fortify Children’s Health. The goal of these active participation requirements will be to support the improvement of quality, accessibility, efficiency, and cost-effectiveness of pediatric care. As an example, planning for QI, assembling data for an outreach plan, utilizing the FCH HealtheIntent platform during a clinical visit, discussing FCH mission and goals, reviewing metrics, all count as active participation.
A registry automatically stores and aggregates data about patients. Inclusion Rules define who is in the registry and are available in the Cerner Wiki and within each registry. Registry measures are pre-selected. Data points or calculations are gathered and organized automatically. Well child visit, immunizations, screenings, and lab data are examples of data points. Registry measures are most often seen in the registry as “Met” or “Not Met”
The data in registries are validated before release by a team of experts. Data are at least 95% accurate before the registry is released.
Pediatric primary care and pediatric specialist practices are eligible to join. All practice providers within a practice must join. All team members must have appropriate credentialing. Your practice will be required to submit practice data through your electronic medical record system and participate in all clinical care initiatives. For more information, please email firstname.lastname@example.org or call 1-833-FCH-1234.