How one clinical network runs its physician incentive program

by Roy Edroso on Mar 30, 2017

On Feb. 6, Part B News covered some insurer-based physician incentive programs your practice might get into. To get a more in-depth idea about how such programs work, we talked to Chad Johnson about the program at Phoenix Children’s Care Network, where he is the senior vice president and executive director.

PCCN’s CIO (clinically integrated organization) currently integrates more than 1,000 pediatric providers in greater Phoenix and is “negotiating incentive metrics into our contracts as we move toward risk,” says Johnson. Currently providers take no downside risk. “Risk will be held at a network level through accumulated reserves that are funded from incentive payment withholds,” he adds.

When providers join the network, PCCN asks them “to be meaningful members in our quality programs and share clinical data with the network as it pertains to population health management,” says Johnson. To make that data shareable, PCCN aggregates data from all the CIO’s member practices via a centralized population health tool.

From these network-wide data sets, PCCN identifies key patient populations “that stand out as needing additional resources to manage their health care needs,” Johnson says. Triggers might include frequently showing up in the ER or being admitted to the hospital in much higher rates than expected, for which PCCN might suggest care coordination activities such as enhanced appointments checks or medication tracking. 

For these needful populations, PCCN sets up key quality indicators (such as well child visits, immunizations, chronic illness monitoring, service utilization thresholds and seasonal epidemiology) to measure improvement and collaborates with individual insurance companies to create contractual incentives for providers to meet improvement targets. When those targets are met or exceeded as shown by the record, providers in the network share those incentive payments.

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