Through clinical integration, independent and hospital-employed providers and practices can join together in an organization that allows them to: (1) identify and adopt clinical protocols for the treatment of particular disease states, (2) develop systems to monitor compliance with the adopted clinical protocols and (3) enter into provider-directed "pay-for-performance" and other contractual arrangements with health plans to financially recognize providers’ efforts to improve health care quality and efficiency. In summary, a clinically integrated network is a group of providers organizing themselves to improve cost and quality by operating under a shared set of clinical guidelines and measures. Access a brief 2-minute video by University Hospitals at https://www.youtube.com/watch?v=7da4t9cXFl0 to learn what it means to be clinically integrated.

Providers have multiple and overlapping motivations for joining together in a clinically integrated network, including: (1) to enhance the quality of the care provided to all patients, (2) to collectively build and obtain access to information technology and clinical resources necessary for population health management and (3) to build a network of providers to market to payers and employers on the basis of quality and efficiency.

The objective of the clinically integrated network is to deliver high-value care which meets the Triple Aim for all children, specifically better care, smarter spending and healthier children. CMHN believes value-based payment contracts and clinical integration between community and health system providers are necessary to align incentives and create an integrated and coordinated care management approach.

Healthcare delivery in the United States is in the midst of a transformation as the payment model shifts from a fee-for-service to fee-for-value model. This shift necessitates an integrated approach to care management and care delivery that is scalable and distributed in a geographic presence. CMHN's clinically integrated network allows providers across the continuum to achieve these goals and position themselves for success in a new era of healthcare delivery. Additional benefits of CMHN membership include:

• Opportunity to define and implement performance improvement initiatives to provide demonstrated value to patients and the market
• Shared infrastructure for population health management and financial risk management solutions and services
• Enhances value to patients, payers and the community by creating a regional network of pediatric providers that improves care and reduces practice variation
• Allows participation in new value-based payment models by creating an integrated approach to care management and care coordination
• Provides a mechanism for providers to share in savings when the value of care improves
• Provides a vehicle to partner with other pediatric practices and adult health systems while still remaining independent
• Support for practice transformation following the tenets of the Patient Centered Medical Home

In support of these goals, CMHN contracts with commercial payers and employers through single-signature authority on behalf of those CMHN providers who meet certain requirements outlined in the agreement and included in the responses below.

• (a) better value and the highest level of care from an integrated network of Kansas City’s healthcare providers that are dedicated to keeping patients healthy (b) an improved care experience based on more effective coordination and collaboration across sites and systems of care (c) better value for their health care dollars.

Providers nationwide are implementing clinical integration programs because of the value proposition:

Clinical integration allows providers to: (a) demonstrate their quality to current and future patients, (b) participate in establishing the clinical and efficiency measures against which they will be evaluated, and reduce their exposure to arbitrary measures imposed by health plans that are often not applicable to pediatrics, (c) enhance revenue through patient outreach and better management of chronic, high risk and/or high cost patients, and (d) collectively build the necessary population health management infrastructure.

Clinical integration gives hospitals the ability to: (a) demonstrate their quality to current and future patients, (b) enlist provider support for quality and efficiency initiatives, (c) develop a better, more collaborative relationship with independent providers, (d) shift toward and improve performance on pay-for-performance and value-based agreements and (e) position themselves as quality and health/wellness leaders in their service areas.

Clinical integration provides patients with: (a) better value for their health care dollars, (b) more effective case management, care coordination and outreach from a trusted source; their provider and practice support staff and (c) more reliable information to support their choice of providers, hospitals and other clinical services.

Clinical integration gives employers: (a) the ability to more effectively manage the health care costs of employees and their dependents through the purchase of more efficient health care services, (b) increased employee productivity and reduced absenteeism, through better management of chronic diseases and high risk patients and (c) more reliable information to support conversion to consumer-driven health insurance products.

To enable the network to deliver high-value care, provider members of CMHN's clinically integrated network function as partners in the management of CMHN's clinical integration program. Through CMHN's operating board and committees, the providers in the clinically integrated network are responsible for determining the clinical guidelines, quality measures, methods of practice, and performance requirements.

CMHN is led by an Operating Board and committee structure comprised of the network providers and supported by professional management services. The Operating Board is responsible for the development and implementation of the CMHN goals and objectives and is ultimately responsible for the approval of work completed by the CMHN Committees. The majority of the Operating Board consists of representatives of independent network physicians.

The Clinical Quality and Clinical Practice Standards Committee has a physician representative from each practice and a chair elected by the committee members. The chair of this committee is also a member of the Operating Board. This committee reviews and selects clinical focus areas for target improvement and develops clinical practice standards, best practices, and/or resources that are shared and applied by network providers. In addition, the committee has established standards for measurement and monitoring of performance that support the goals of the network.

The Network Business Operations Committee also has a member representative from each practice. This person is often the practice manager or another administrative or operational representative from your practice. The elected chair of this committee is a member of the Operating Board. This committee is responsible for payer contracting, operationalizing strategic priorities, and advancing performance improvement activity.

CMHN requires the active participation of the entire network, which is key to the success of the program.

The clinical focus of CMHN is determined by the network’s providers via the Operating Board and committee structure, which as noted above, has strong representation by providers. Often, clinically integrated networks seek to improve chronic disease management, care coordination, transitions of care, community/practice-based case management and communication among primary care providers, specialists, post-acute care entities (e.g. home care), community agencies, behavioral health providers, and others across the care continuum.

Yes, although the degree to which change is required will vary based on the degree to which providers have already implemented the components of the CMHN. Participation in the quality and care management initiatives of CMHN will require significant time and attention from the providers and their office staff. Providers must adhere to agreed-upon guidelines and performance measures with the goal of improving quality and reducing cost. CMHN will pursue new value-based payment models that allow CMHN providers to share in savings when the value of care improves.

An Electronic Medical Record (EMR) is important technology necessary to support the network's health care quality initiatives, improve care coordination, facilitate clinical information exchange and strive toward the objective of delivering high-value and integrated care. EMRs also provide reliable access to complete patient information and real-time clinical decision support. Furthermore, EMRs are essential tools to support the patient centered medical home care model and are necessary to deliver better experiences and better outcomes for patients.

All CMHN practices are required to have an EMR or have a specific plan to acquire and implement an EMR in the future.

A practice does not have to have NCQA recognition to join the CMHN. Importantly, the Medical Home Model encompasses much more than the NCQA recognition alone. The Agency for Healthcare Research and Quality (AHRQ) defines a medical home "not simply as a place but as a model of the organization of primary care that delivers the core functions of primary health care."

As outlined above in the definition and objectives of clinical integration, becoming clinically integrated requires controlling costs and improving the quality of health care services for all patients. Clinical integration requires data for all patients and across all payers.

Members of CMHN are required to share clinical and billing data sourced from your practice management system and/or EMR. The data collection process is facilitated by CMHN using an efficient, secure and automated technology.

After a practice terminates with Children’s Mercy Health Network, CMHN and our population health management vendor will contact and work with the practice to uninstall any applicable data feed technology. No data will be collected or loaded into CMHN’s population health management solution for services rendered after the practice’s termination date. Data associated with services rendered prior to the date of termination must be retained for CMHN's clinical integration program to support ongoing maintenance of the network’s quality and efficiency measures.

No. The Children’s Mercy Health Network’s clinical integration program is a non-exclusive organization, making no limitations on a provider’s ability to admit patients to non-Children’s Mercy sites of care or a provider’s ability to maintain contracts with health plans on an individual basis. The only exception would be any agreement limitations that prevent a provider/entity from participating in a similar value based agreement with the same payer and same group of patients. In those cases, the provider/entity would choose to participate in the CMICS agreement or the similarly defined non-CMICS agreement with that payer.

Each CMHN provider pays an annual per physician fee that is used to maintain the professionally managed infrastructure necessary to achieve CMHN goals and objectives. The annual fee is based on a fair market evaluation completed by an independent valuation expert. The membership fee will be reviewed annually or as needed. Any other assessments will be approved by the Operating Board.

PCN’s innovative care and payment delivery model has aligned incentives for providers serving patients enrolled in Medicaid and the Children’s Health Insurance Plan (CHIP). CMHN expands the PCN concept to all patients. Medicaid/CHIP agreements continue to be managed by PCN; CMHN focuses exclusively on commercially-insured and employer-based populations.

Physician leadership, provider participation and professional management are keys to the success of CMHN. CMHN practices participate in the development of a common set of clinical practice guidelines, quality goals and performance measures that are the basis of CMHN commercial contracts. Participation in this process is essential to the development of CMHN's clinical and operation processes and goals.

No. Providers who join CMHN will only be asked to delegate their contracting for agreements entered into by the network. Membership in CMHN is non-exclusive, meaning members are not prohibited from pursuing other payer contracting arrangements either independently or via another organization. The intent is for CMHN to focus exclusively on value-based agreements with payers and employers.

Providers who join CMHN are asked to delegate their contracting for agreements initiated by the network; existing practice agreements are not impacted. Initial CMHN contracts are intended to supplement and enhance your existing contracts. In other words, the practice would retain existing contracts with the specific payer and the CMHN agreement would "wrap around" that agreement with additional compensation opportunities. A member practice may have an established value-based agreement with a payer that prevents participation in a CMHN agreement with the same payer. If another value based agreement prevents participation, the member would decide whether to remain in their existing agreement or transition to the CMHN agreement upon renewal.

CMHN is a non-exclusive arrangement. This means members are not prohibited from pursuing other payer contracting arrangements either independently or through another organization. CMHN members can cancel their CMHN contract at any time without cause by giving at least ninety (90) days prior written notice. Cancelling your CMHN contract will end your participation with any and all CMHN payer agreements, population health management tools and patient centered medical home assistance.