What to Expect in the Participant Agreement

Benefits to Participation in MHCN.

  • Participants work together to improve patient care, decrease cost and demonstrate value to the market.
  • Potential to receive additional revenue in the form of shared savings distributions.
  • Does NOT require physicians to place any fees at risk in a withhold or capitation model.
  • Upon attainment of clinical integration within MHCN, Participants may collectively negotiate payer contracts.

Impact on Physician’s Medical Practice. Medical decision making always remains with the physicians to be exercised according to their best medical judgment. Physicians evaluate the care they provide in light of cost and quality targets established by payers and self-insured employers with which MHCN contracts; however, any decisions relative to the care rendered to a specific patient is made only by the physicians treating the patient, not by MHCN.

Payment. MHCN participants continue to receive payment on a fee-for-service basis under their own fee structure. In addition, if the Participants collectively reduce the cost of care while meeting quality goals, they are entitled to receive a bonus based on the shared savings realized by MHCN for programs in which they participate. MHCN will distribute the bonus among the Participants (i.e. the physician group practice) which then determines how any shared savings received from MHCN are distributed among physicians within the group.

Term and Termination. The initial term of the Participant Agreement ends on December 31, 2016. Thereafter, the agreement renews for additional 3 year terms, unless either party provides the other with notice of non-renewal at least 90 days prior to the end of the current term. Participants may terminate their participation in MHCN at any time by 120 days’ notice.

Exclusivity. MHCN is non-exclusive, and Participants are generally free to contract outside of MHCN (except if MHCN negotiates the rates, the MHCN contracts will supersede individual contracts with the same Payor and product). However, MHCN Participants may be prohibited by payors from participating in other ACOs for specific initiatives involving shared savings. For example, under the Medicare Shared Savings Program, Participants that provide primary care services may participate in only one ACO.

Cost of Participation. There are no monthly or annual fees for participation in MHCN. However, at such time as physicians desire to “buy-in” as owners/members of MHCN, physician owners would be required to make a capital contribution.

Action Steps. Physicians interested in participating in MHCN will generally be asked to do the following:

  • Fill out a “Participant Questionnaire” which provides MHCN with general background information about the physicians’ practice
  • Have their group execute a Participant Agreement with MHCN
  • Have each physician within the group sign an Addendum to the Participant Agreement, agreeing to comply with its terms.
Mission Health Care Network | 2525 de Sales Avenue | Chattanooga, TN 37404 | MissionHealth@memorial.org
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