What is clinical integration?
Clinical integration (CI) is a platform that promotes care collaboration among a network of physicians with the ultimate goal of improving health care quality, increase continuity of care and reducing cost.
What is the overall goal of a clinical integration program?
The overall goal for entering into a clinically integrated network (CIN) is to enhance the value of the services that are provided to a patient. In turn, by providing valuable services to patients, the clinically integrated organization positions itself as a valuable partner to the payer organizations, the referral network, and the surrounding community. By being organized in achieving quality improvement initiatives, the clinically integrated organization is well positioned to achieve success with improved patient outcomes and efficiencies in care.
What is an Accountable Care Network (ACN)?
An ACN is an approach to address the Triple Aim (outcome, experience and cost). Accountable Care Networks are comprised of physicians, other providers, hospitals, and other care delivery groups. The purpose is to drive toward better patient outcomes, improve the patient and provider experience and share the financial risk to reduce costs.
Examples of local ACNs: University of Washington Accountable Care Network, Puget Sound High Value Network
What is Seattle Children's Care Network (SCCN)?
SCCN is a legal entity with a Board of Managers, several committees and sub-committees. This entity positions us to transform care and proactively respond to a changing marketplace moving toward value-based contracted care delivery.
This network serves as the platform to improve the health and wellness of children in our area. SCCN is comprised of Seattle Children’s Hospital, the Children’s University Medical Group and primary care pediatric providers from more than 20 practices across our region.
SCCN has a management team composed of clinical experts, data analysts, contract managers and operational managers that support the daily work of the SCCN.
To see the Board of Managers, look under the About SCCN tab on this website.
What role does Seattle Children’s Hospital (SCH) play in SCCN?
Besides the obvious role of providing hospital based services for pediatric care, SCH is financially and administratively supporting the infrastructure of SCCN. Currently there is no fee for a practice to join. Your obligation/accountability is to participate on committees as requested, to submit data, implement opportunities to improve performance as needed and provide feedback and ideas related to transformation of care in a value-based environment.
What are the current contracts in which SCCN is involved?
Boeing Employee Contract administered through the UW Medical ACN:
Effective January 2015 – December 2019
5,200 lives in the contract
Age = >18-21
Health Care Authority (HCA)/Public Employee Benefit Board (PEBB):
Effective January 2016 – December 2019
6,000 lives in the contract
Age = 0-21 years
What are the outcome measures? How often are they collected/reported?
Data are due (may fluctuate – these are approximate):
Q1 = May 9, 2016
Q2 = Aug 1, 2016
Q3 = Nov. 1, 2016
Q4 = Feb. 1, 2017
Boeing and PEBB Metrics:
- Diabetic A1C: % of patient aged 18-75 with most recent A1C > 9.0%
- Diabetic Blood Pressure: % of patients aged 18-75 with DM and most recent BP of < 140/90
- Hypertension Blood Pressure: % of patients aged 18-85 with diagnosis of hypertension and controlled BP < 140/90
- Coronary Artery Disease: % of patients > 18 years with diagnosis of CAD that have prescription for statin
- Behavioral Medicine/Mental Health: % of patients >18 with a diagnosis of major depression who had a PHQ-9 administered within 30 days of diagnosis
- Behavioral Medicine/Mental Health: % of patients >18 years with a diagnosis of major depression AND a PHQ-9 score of >9 who achieved remission at 6 months by evidence of PHQ-9 score of <5
- Weight Management/BMI Screening: % of patient 18-74 who had outpatient visit and documented BMI within year of measurement
- Weight Management/BMI Follow-up: % of patients >18 years with >30 BMI referred to weight management program AND 2 further attempted contacts to urge/confirm participation
- Cervical Cancer: % of patients aged 21-64 who received appropriate screening for cervical cancer (cervical cytology in past 3 years)
- Chlamydia Screening: % of female patients aged 16-24 who were identified as sexually active and had at least one test for chlamydia during measurement year
- Childhood Immunization: % of patients who turned 2 in the measurement year who received the recommended vaccine (aka Combo-10) on or before the second birthday
How are the measures being evaluated? What will success look like?
At this point, we do not have a firm idea of the desired performance; though we expect that will come into focus once Wellcentive is live.
Once the Wellcentive tool is live, collection of the priority measures will start, in addition to other measures that are not considered a first year priority (such as baseline data for common acute illnesses). The Quality and Care Transformation committee of SCCN will review the results and initial goals will be developed. These goals will be shared with all practices by SCCN’s clinical and data analytics team. Improvement plans will then be developed.
What is Wellcentive and how was it chosen as a Population Health tool?
It is a population health data aggregation software tool that interfaces with your office EMR, claims data and other data sources to:
- Facilitate quality measurement
- Care management based on risk stratification
- Total cost of care reporting
We considered several vendors (Valence, MedInsight, etc.) and chose Wellcentive based on its capacity to track care management and a proven track record of EMR integration.
What’s in it for me and my practice?
- Increasingly the market demands action directed at the triple aim. Participation in SCCN gives your practice an advantage in meeting these aims.
- Best practice recommendations
- Data about your practice
- Peer to peer collaboration and exchange
- MOC and CME
- Access to the science behind the measures
- Support for quality improvement and process improvement. You can focus on patient care and excellence to achieve the triple aim while being supported by data analysts, clinical experts, contract managers and performance improvement specialists.
What is on the horizon for SCCN?
Developing the capabilities to support:
- Patient centered care and appropriate certifications
- Refinement and automation of reports to meet regulatory and payer requests that tie to specific pediatric quality initiatives
- Training and education for optimal coding within practices to support value-based contract opportunities
- Communication tools for providers and their patients to better explain the changes in healthcare reform