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FAQs for Physicians

What is Accountable Care?

Accountable Care describes a shift in how care is provided and paid for, with providers being increasingly accountable for the quality and cost of care, as well as the overall health of their patients.

Will the way I am paid for providing care change as healthcare reform proceeds?

One of the most fundamental shifts already underway is the trend toward “value-based” arrangements in which providers receive a financial incentive for achieving quality and/or cost targets. There may also be a fee structure, but it is highly likely that over time the portion of any provider’s revenue from fee-for-service arrangements will shrink.

What are the main benefits of joining an accountable care provider network?

This is a highly effective way for physicians to participate in a clinically integrated network and achieve the triple aim of better patient outcomes, lower cost and an enhanced patient experience. In addition, joining a network will offer physicians the chance to take advantage of new value-based contracts that are developed with payors and/or employers.

What is a Value-Based contract?

A value-based contract is a contract that aligns providers’ financial incentives with the value they deliver. Contracts could reward improved quality, reduced cost, or a combination of both. Value-based contracts may still include fee-for-service payments supplemented by additional incentive payments.

What is “Gain-Sharing”?

Gain-sharing is the basic term that relates to how physicians who are part of a value-based contract will receive incentives for improving care and/or lowering costs.

What is Clinical Integration?

Clinical integration occurs when a network of physicians work in collaboration with a hospital on initiatives to improve the quality and efficiency of patient care. The network is developed and managed by physicians, and supported by a performance management infrastructure. Clinical integration provides a legal basis for collective negotiation by independent physicians for reimbursement on the basis of improved clinical outcomes and efficiency.

What is a Medical Home?

The medical home is a care model in which a team of providers and care managers care for a patient, seamlessly and efficiently, while managing costs. In a medical home, a primary care physician assists patients who need specialty care, maintains electronic records of all patient/provider interactions, communicates with all of a patient’s clinical caregivers, and tracks the patient’s progress.

Why do I need to act on this now?

Led by the implementation of major elements of the Affordable Care Act (ACA), the pace of change in healthcare is accelerating, especially in the upstate New York region. Networks are forming now, and by joining now, you will have the opportunity to participate in decisions regarding organizational structure, best practices, value-based contracts and more. By carefully selecting networks, you can retain and possibly even grow your base or patients and/or referrals. Waiting may put you at a disadvantage if size limitations are imposed on any of the networks you think are right for you.

What are the benefits of choosing Accountable Health Partners?

AHP provides several important benefits:

  • Resources – A comprehensive range of over 1,000 specialists.
  • Facilities – The region’s leading hospitals and facilities including Strong Memorial, Golisano Children’s Hospital, Highland Hospital, Thompson Health, Jones Memorial Hospital, Wyoming County Community Hospital, Noyes Memorial Hospital, Arnot Ogden Medical Center and St. James Mercy Hospital.
  • Input – The opportunity to shape a new organization and contribute to decisions regarding organizational structure, best practices, value-based contracts and more.

How will the Accountable Care Network be Structured?

AHP will be jointly owned by hospitals and physicians, each with 50% ownership.

How will I be represented in decision-making?

The AHP governance model was designed to ensure that all key member constituencies have a voice in major decision-making. The Board has two classes: physicians and hospitals. Within the physician class, there are two sub-groups: URMFG (University of Rochester Medical Faculty Group) physicians and non-URMFG physicians (i.e., independent practitioners and employees of community hospitals). The affirmative vote of each sub-group will be required for board action. This voting structure ensures that all key decisions are made by consensus of all sub-groups.

Do I need to have an electronic medical record (EMR) system to participate?

The ability to gather, share and analyze data across your patient population is fundamental to the success under virtually any value-based scenario. If you have not yet implemented an EMR, AHP can provide support to help you decide which is right for your practice. If you already have one, we can assist with compatibility with the rest of the network.

If I do not have an EMR, will AHP help support my transition to one?

Yes, AHP can assist you.

What is the Membership Fee?

The capital contribution fee for physicians is $550. This is a one-time investment.

What will my capital contribution fund?

It will support the capitalization of the infrastructure and operating expenses necessary to develop a clinically integrated network. Infrastructure includes major investments centered on the development of information management capabilities to support quality and cost performance measurement and improvement. For operations, the fee will contribute to general overhead and staffing.

What does it means to be a Founding Member?

A founding member is a physician or hospital that joins before October 1, 2013. Founding members will have several advantages, including input into organizational structure of AHP, participation in the design of our first value-based contracts, and development of clinical protocols, quality measures and cost metrics. Founding members will also be eligible for a full or partial refund of their capital contributions if they decide to leave the network.

Do all physicians in a practice have to join AHP?

Yes, all physicians in a practice will need to be members of AHP.

Will I be limited to referring within AHP?

No, you are not limited to referring within AHP, but in some cases, patients may have a financial incentive from their insurance product for staying within AHP for their care.

Can I leave the network if I am dissatisfied?

Yes, you can leave the network at any time, for any reason.