Q: What will physicians need to do in order to participate in the Mission Health Care Network (Mission HCN)?

A: Physicians will be asked to do the following: 

• First, because membership is completely voluntary, physicians will need to indicate their participation by signing a participation agreement.
• Second, participating physicians will be required to collaborate with their physician colleagues and the health system in the development and adoption of clinical initiatives that will enhance the quality, service, and cost-effectiveness of patient care.
• Third, physicians will need to hold themselves and each other accountable for compliance with the initiatives of Mission HCN including its disciplinary and remediation efforts should physicians not meet the standards of quality patient care set by the quality committee.

Q: Are there eligibility criteria that a physician will be required to meet in order to participate?

A: Yes. Mission HCN’s Board of Physician Managers developed the following eligibility criteria for physician participants:

• Be board certified, unless waived based on demonstrated clinical quality excellence as determined by the network development committee
• Have high-speed internet access in any outpatient office and regularly accesses electronic communications from Mission HCN
• Bill payers electronically for both inpatient and outpatient activities
• Agree to participate in, and to have office staff participate in, education necessary to participate in Mission HCN’s clinical integration program and to comply with regulatory requirements
• Agree to follow clinical guidelines approved by the Board and to be monitored on measures approved for such guidelines
• Provide 24/7 on-call coverage by a physician of the same or similar specialty, and if such covering physician is not a participating physician, she/he will be asked to follow rules of the Mission HCN clinically integrated network program for Mission HCN enrollees
• Serve on committees of Mission HCN, as reasonably requested.

Q: Will the participation agreement be with an individual physician or the group?

A: The agreement is with the physician group, but also signed by individual physicians. The group will internally determine the best way for its members to participate in the Mission HCN contracts, fulfill associated committee and leadership opportunities, and distribute any performance bonuses.

Q: Can a physician or physician group participate in more than one clinically integrated network?

A: Yes. Participants in Mission HCN may also participate in more than one clinically integrated network. It should be noted that certain payer arrangements such as shared savings programs require the Tax ID used for participation and billing to be linked to only one network. For example, the Tax ID used by primary care physicians for Medicare billing can only participate in one Medicare Shared Savings Program (accountable care organization/ACO), and similar restrictions may apply to commercial health plan ACOs. Participating in Mission HCN does not restrict the physician’s ability to refer to whatever physician or hospital or other provider that is best for a specific patient’s care, nor does it affect patient freedom of choice over time, physicians may find that they prefer to participate in one clinically integrated network, based on its ability to achieve results for patient care and the ease of use of the technology available.

Q: Will an electronic medical record (EMR) be required to participate in the clinical integration network?

A: No. While a common EMR across all participating physician practices can certainly accelerate and strengthen a clinically integrated network, most successful models of clinical integration nationwide do not depend on an ambulatory EMR for data on physician performance. Mission HCN will begin its efforts to measure, analyze, and evaluate physician performance through claims data, existing hospital data, disease registries, and chart audits. In any case, it is NOT expected that all physicians in Mission HCN will have the same EMR.

Q: Will clinical integration require me to negotiate all my contracts through the Mission Health Care Network?

A: No. While Mission HCN will seek to create opportunities that may not be available through your individual or group contracts, it will not replace all payer contracting. The CIN will likely seek to create a few select shared savings opportunities with a limited number of payers, and these will not replace your current contracting arrangements. Mission HCN will seek to add new payor relationships to your practice.

Q: Do member physicians have to participate in all contracts for which Mission HCN has contracted?

A: Yes. Successful networks have found that their ability to drive quality and efficiency improvements is greatly improved if members participate in all contracts. Initially, these contracts will only constitute a small percentage of a physician’s overall contracts. The physician-led Board of Managers will approve all payer agreements for the network.

Q: Will clinical integration require me to place my fees at risk in some sort of withhold or capitation model?

A: No. It does not require the use of withholds or capitation, although clinical integration utilizes many of the same quality improvement and medical management techniques that would allow for effective management of capitation. It is expected that the platform will essentially be a fee-for- service model, with Mission HCN taking the risk of implementing the infrastructure necessary to run the operations.

Q: Does clinical integration guarantee better contracts for doctors?

A: No. Clinical integration allows a network of otherwise independent physicians to approach payers together as a group to contract for new approaches to care delivery such as shared savings programs. The success of a clinically integrated network in obtaining such arrangements with payers will depend on the payer’s willingness to contract for improved quality through financial incentives, and the physicians’ ability to achieve improved quality and efficiency as consistent with the goals of the clinically integrated network.

Q: Is there an opportunity for physicians to be owners of the Clinically Integrated Network?

A: Yes. As requested by the Board of Managers, Mission HCN is initially being set up with Memorial as the sole owner (and source of start-up capital), but physicians can buy-in to the CIN in the future. The buy-in amount will be based on fair market value at the time of buy-in.

For more information, email us at missionhealth@memorial.org.