Care Delivery Alliance
Care Delivery Alliance (CDA) is a physician hospital organization (PHO) based in Lake County, Florida, built on a strategy that supports an independent rather than employed physician alignment and engagement model. Within CDA, physician participants maintain their individual practices in accordance with best practices. CDA represents the 1st phase of an evolutionary transition to a clinically integrated network, which gives independent practitioners the added advantage of partnering with other physicians and ancillary health providers and the local health system to improve quality and access for their patients, while better managing the cost associated with delivering that care.
What is a PHO?
A PHO is a vehicle that enables hospitals and physicians to work cooperatively toward accomplishing several objectives. Primary purposes for forming a PHO are developing improved methods of healthcare delivery; overseeing integration of physicians and hospitals into health delivery networks; assisting in voluntary group formation; and collecting, analyzing and disseminating information. Secondary purposes include contracting with managed care organizations with joint risk sharing, developing standards of care, and building trust between hospitals and independent physicians. PHOs are legal entities generally formed by physicians and 1 or more hospitals.
What are the advantages of a PHO?
- Provides an organized approach for physicians and hospitals to work together on managed care issues, such as utilization management and quality improvement.
- Serves as a clearinghouse for certain administrative duties, thus reducing the burden on individual physicians and hospital members.
- Collaborates with managed care companies.
- Establishes reimbursement and risk-sharing approaches that align incentives among all physicians.
- Supports independent physicians and their practices as they face the new challenges of healthcare reform.
Why should I join Care Delivery Alliance?
Because CDA offers a comprehensive network of providers who are collaborating in managing patient care and focused on quality improvement, it can often develop more attractive agreements with managed care plans than individual providers can provide. As membership grows, the large provider network of physicians and hospitals can offer health plans and other payers a significant partner to work with on innovative patient care initiatives. CDA can provide significantly greater value to the health plans than individual physician practices. As a result, payers are willing to offer additional performance incentives for integrated groups of providers who are committed to collaborating to control costs, enhance quality and improve patient satisfaction.
CDA will also offer a growing menu of Practice Management Support Offerings, including various administrative and technology solutions that may be beyond the resources available to individual physicians.
Overall functions of CDA include:
- Maintain and administer a comprehensive provider network.
- Provide an ongoing managed care strategy.
- Create/implement a clinical integration strategy.
- Provide general support to community practice managers.
- Provide a general communications function for the physician community.
- Develop and implement community and employer outreach activities.
- Develop a portfolio of optional practice management services offerings.
What is a clinically integrated network?
With healthcare reform, the need for an organization dedicated to the interests of the physicians supporting Central Florida Health became evident. Both physicians and hospitals recognize the importance of developing some form of collaborative arrangement as the healthcare system moves toward fully integrated networks of service providers. Physician-hospital alignment and clinical integration that is designed to maximize efficiencies and minimize waste and duplication will become paramount in the near future. Failure to act now will jeopardize our ability to compete with other integrated health systems.
What is clinical integration?
The Federal Trade Commission and the Department of Justice Antitrust Division defined physician clinical integration in their 1996 Statements of Antitrust Enforcement in Health Care as "an active and ongoing program to evaluate and modify practice patterns by the network's physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality."
Broadly speaking, an FTC-accepted clinical integration program features (1) collaboration and interdependence among the participating physicians that (2) result in significant quality, utilization and cost improvements in the delivery of their services and that (3) make it "reasonably necessary" for the program's success of efficient operation for the participants to jointly negotiate prices.
What does a clinically integrated network entail?
Although there is no standardized model, the components most clinically integrated networks incorporate, based on FTC guidance, are:
- Requirements that physicians invest time and effort in the development, planning and ongoing operation of the clinical integration program.
- Inclusion of physicians, based on their interest in providing high-quality, efficient care and their willingness to participate in and abide by the policies of the CI program.
- Development by the physicians of practice guidelines sufficient to (1) improve quality and efficiency, (2) cover the majority of medical specialties and (3) cover diagnoses representing a high percentage of the total medical costs of the network's services.
- Dissemination of the guidelines to physicians, and agreement among the physicians to apply the guidelines to the clinical integration program's patients.
- Development by the participating physicians, and adoption by the group, of quality, efficiency, utilization, and cost goals or benchmarks reflecting improvement by network physicians over their current performance.
- Development and implementation of a formal process by which the group will obtain information regarding the physicians' compliance with the guidelines and a formal program through which physicians review and assess the aggregate group and individual physician performance in relation to the group's benchmarks.
- Development and implementation of a formal program by physicians for identifying, and providing support and corrective action for, individual participants who fail to apply the guidelines or otherwise fail to achieve the group's benchmarks.
- Development and implementation of a system of financial rewards, based on group and individual performance, to incentivize physicians to improve their performance.
- A process for ensuring that referrals remain within the network of clinically integrated providers to the maximum extent possible.
Conduct to avoid:
- Improper sharing of competitively sensitive information, regardless of shares or other indicia of market power. Significant competitive concerns can arise when PHO/CIN operations lead to price-fixing or other collusion among participants in their sale of competing services outside the network. For example, improper exchanges of prices or other competitively sensitive information among competing participants could facilitate collusion and reduce competition in the provision of services outside the PHO, leading to increased prices or reduced quality or availability of healthcare services.
- Refrain from, and implement appropriate firewalls or other safeguards against, conduct that may facilitate collusion among participants in the sale of competing services outside the network.
Medical staff members are currently being recruited to join Care Delivery Alliance. Signing up is easy; merely complete and sign the agreement and provide an annual fee of $500. You will then have access to all of the advantages of being a CDA member.
Download the Master Membership Agreement.
The following documents and links can serve as helpful resources during the transition from the fragmented quality reporting programs in Medicare to the Merit-Based Incentive Payment System (MIPS) or when learning to participate in the new alternative payment models (APMs) track.
- MACRA Checklist for Medical Practice Leaders from the Medical Group Management Association (MGMA)
- MACRA FAQs: Source MGMA
- Individual Quality Measures Available for MIPS Reporting in 2017
- Specialty Measure Sets for MIPS Reporting in 2017
- CMS Quality Payment Program Overview Fact Sheet
- List of Clinical Improvement Activities
- Advancing Care Information Fact Sheet with 2017-2018 Measures
To learn more about CDA, physician hospital organizations and clinical integration, or to pursue membership, please email: [email protected]