Independent pediatricians face a range of challenges in today’s healthcare environment, causing fragmentation of care. Accountable care organizations, minute clinics and adult practitioners are expanding into pediatrics, and the marketplace is consolidating. Children’s Healthcare of Atlanta has responded to these pressures by working with independent pediatricians and specialists to form The Children’s Care Network (TCCN), a physician-led clinically integrated network.
What is a clinically integrated network?
A clinically integrated network is a collaboration between a hospital system and independent providers to improve patient outcomes at a community level. Children’s and community providers created a clinically integrated network to help strengthen freestanding pediatrics.
The Children’s Care Network (TCCN) was created through a partnership of community physicians—both primary care and specialists—and Children’s to strengthen pediatrics in Georgia and ensure better health outcomes for patients. At the core of TCCN is a commitment to the belief that children should receive the highest level of care from pediatricians and pediatric hospitals. Preserving the quality of care provided to our patients and families is the driving force behind the creation of this network.
Physicians and practices also benefit from a collaborative system that offers group purchasing power, cost savings and technical resources.
Why was TCCN created?
For an independent pediatric community to remain strong, Children’s and independent practices need to remain viable. Children’s and many of its community-based colleagues want to avoid care fragmentation for our kids. Physicians who focus on kids, in collaboration with a hospital system that focuses only on kids, produce better pediatric outcomes. TCCN assesses the needs of the community for providers and patients and works to meet those needs through the creation of programs and service offerings.
The Children’s Care Network provides resources to enhance quality of care, improve outcomes, and reduce costs in the inpatient and outpatient settings. As a member, you may negotiate with payers jointly with other independent network members.
Network benefits include:
- Technical resources: Information technology to facilitate efficient data sharing, identify care gaps and drive toward improved patient outcomes.
- Negotiating for performance value: Collaborative structure that is necessary to succeed in the marketplace as payers move to value-based payment mechanisms.
- Business support: Access to services and discounted purchasing arrangements that may help lower your operating expenses, as well as educational programs to aid practice sophistication.
- Nationally recognized pediatric expertise: Access to Children’s nationally recognized resources and expertise in addition to education on important clinical topics regarding the implementation of quality improvement methodologies.
How can my practice join TCCN?
Enrollment is currently open. The initial membership term for TCCN is one year, with annual automatic renewal of membership. The clinical integration process takes approximately 18 months.
To join TCCN, you must:
- Be a credentialed member of the Children’s professional staff.
- Be board certified or board eligible.
- Participate fully in the quality program by following evidence-based protocols to improve quality, expand patient access and reduce cost.
- Contribute your practice’s pre-adjudicated claims data.
- Pay annual membership dues that are determined through a fair market value assessment of the services the network provides.
Membership requirements and information about dues are detailed in the membership and participation agreement. Email firstname.lastname@example.org or call 404-785-0101 to request a copy. Members have the option to terminate without cause upon a 90-day notice.
Yes. Small practices face particular challenges in addressing the demands of the changing healthcare market. Retail clinics are taking on more of the mainstays of the traditional pediatric medical home, such as back-to-school checkups and minor injuries. Adult systems are cherry-picking some parts of pediatrics, making it harder for primary care pediatricians to provide the full spectrum of care that they know is best for their patients. In addition, we expect the market to move away from fee-for-service reimbursement to payment methods that are based on demonstration of value.
TCCN helps small practices demonstrate their value to payers and helps handle administrative burdens, such as contract negotiations, while identifying and supporting opportunities to keep care in the medical home. The network also seeks to lower overhead expenses through access to other value-added services like group malpractice coverage, group health insurance and vaccine group purchasing.
Care and referral protocols used across the network help pediatricians manage the care of their own patients and make appropriate referrals to specialists. As a result, specialists can focus their efforts on kids who truly need advanced services and treatment.
You do not need an electronic medical record (EMR) to participate initially. The network’s population health management system and initial quality measures are designed to use billing codes that come from your practice management system. Our system is compliant with all Health Insurance Portability and Accountability Act (HIPAA) regulations. It is built to interface with a number of EMRs or be accessed in a stand-alone manner.
We understand the importance of not placing additional burdens on your busy staff. TCCN implements primary care quality measures structured around activities that you are already doing in your office, such as the Healthcare Effectiveness Data Information Set (HEDIS) measures for well checks and immunizations.
Members are given reports and information about their performance and have the ability to make improvements. Your practice will be compared with other practices across your specialty and against the measure benchmarks.
Our quality improvement team works with all practices on clinical improvement activities through collegial consultation. If a physician or practice is found to be seriously deficient and does not make the appropriate improvements, the physician or practice may be placed on probation or terminated from the network. If termination becomes necessary, practices are given sufficient notice to prepare to transition out of the network contracts and assume their own contract negotiations.
In general, TCCN is not exclusive. However, if your primary practice is internal medicine, general practice, primary care or family medicine, you will not be permitted to contract through other clinically integrated or accountable care-type organizations with payers for whom you have delegated your contracting authority to TCCN.
Yes. Clinical integration means that everyone is working toward the same goal of improving patient outcomes and reducing costs. Referrals within the network are never required.
We do not collect financial data on any practice. Our network’s population health management tool is built to analyze patient data in a secure manner that complies with all HIPAA regulations. The network only uses the data you provide for the purposes stated in your Membership and Participation Agreement, unless otherwise approved by the physician-led board of directors.
Members are given reports and information about their performance so they can make improvements as needed. The network addresses noncompliance through a process of collegial consultation and remediation. If sufficient improvements are not made, the member may be placed on probation or terminated from the network. The practice will be given sufficient notice during the remediation process to prepare to transition out-of-network contracts and assume its own contract negotiations.
Initially, you will maintain the base contracts you currently have through your practice. The network’s pay-for-performance contracts exist on top of your payer contracts and specify what incentives or shared savings your practice will receive as a result of reaching performance or quality goals.When you join TCCN, you can choose if you want the network to negotiate base agreements on your behalf on a payer-by-payer basis.