Physician led. Evidence based. Quality focused. Patient centered.
Economies of scale have never been more important in the delivery of medicine. Demands upon infrastructure, administrative time, staff training, and the cost of care are high—and increased demands are looming. Recent years have seen smaller groups struggle to achieve the economies necessary to continue. That is why Physicians Insurance recently announced the creation of a clinically integrated network called Physician Care Alliance.
Physician Care Alliance (PCA) is a unique collaborative effort on the part of Physicians Insurance, Premera Blue Cross, and The Polyclinic. The leadership and experience of these key groups have developed the governance of the PCA network. They contributed to the formation of the legal entity and its bylaws, articles of incorporation, investor funding, board and committee administration, participating provider group negotiations, contracting, and more. PCA leverages expertise developed by The Polyclinic’s established and successful Physicians Care Network, a separate corporate entity, which has been in existence for nearly 20 years, managing risk through Medicare Advantage products. While clinically integrated networks have gained popularity in recent years, The Polyclinic’s early and enduring success with its initial network is pivotal for PCA. It goes without saying that physician leadership is at the core of PCA.
“With PCA, we have the benefit of The Polyclinic’s 20-year experience with integration,” says Dr. Mary Anderson, Chief Clinical Integration and Quality Officer of PCA. Many CINs in recent years experienced growing pains as the concept caught on and more entities were formed, Dr. Anderson noted, but ”while the PCA entity is relatively new, its infrastructure is not.”
In addition to experienced physician leadership and two decades of infrastructure, the PCA provides independent practices across Washington with:
- A low-cost option for population heath management tools, data, and analytics. When used correctly, a population health-management system can pay for itself by helping clinics manage quality improvement and care-cost reduction. This system is adaptable, and will help practices demonstrate quality and value while supporting current reporting needs. Its use can help clinics stratify risk, identify care gaps, track population health around complex and chronic conditions, trend quality measures, aggregate disparate data for analysis, and assist staff with outreach.
- Health-plan reporting and analytics, including training and administrative services to streamline data compilation, extraction, and submission.
- Access to shared savings contracts. PCA launched with a shared savings contract with Premera and has signed similar contracts with Aetna and Cigna. Discussions are underway with several other health plans. The focus is on sustainable shared-savings agreements, reducing the total cost of care delivered to plan beneficiaries and aligning health-plan quality incentives with PCA’s Quality Program.
- Operational support, including network management, contracting, patient advocacy, care management, pharmacy analytics, and risk-adjusted coding.
- Evidence-based medicine and practice transformation and care-coordination services, such as committee protocols, quality programs, cost-saving initiatives, and clinical metrics.
As another important offering to participants, PCA offers support such as staff training for increased efficiencies and care improvements. Staff training is an area where smaller clinicsoften ask for help. PCA members will have access to staff training and ongoing support for:
- Patient-centered care, including assessment, resource coordination, pre-visit planning, shared decision making, and patient outreach/engagement activities
- Care-management programs, supporting clinics in providing wellness coaching, transitional care, home-visit programs, extended care, and preventative and chronic care
- Embedded workflow training and tools, including prevention, acute, and chronic care
With six provider organizations having joinedsince its inception in 2016, PCA has grown to encompass over 280 primary-care physicians across five counties. The ideal provider organizations for joining are those willing to participate in population-health activities and cost-efficiency work. In addition, the groups need to be using a Certified Electronic Health Record Technology (CEHRT) EMR.
Physician Care Alliance was initiated by Physicians Insurance as part of our continual commitment to providing services and support to our insureds. If your independent clinic is feeling the market pressure, learn more about how joining this CIN might help you refocus on providing quality care, rather than on survival.