The Children’s Care Network
To meet the new demands of a changing healthcare market, a group of committed community physicians partnered with Children’s to create The Children’s Care Network, a physician-led, taxable nonprofit subsidiary corporation of Children’s Healthcare of Atlanta. The Children’s Care Network, Georgia’s only clinically integrated pediatric network, demonstrates performance and value by emphasizing data-driven approaches to quality improvements.
The Children’s Care Network provides independent pediatricians the resources they need to enhance quality of care, and an association with Children’s—the largest and most trusted pediatric healthcare system in the state. The network offers strategic benefits in several areas, including:
- Information technology to facilitate efficient data sharing and communications
- A collaborative structure necessary to succeed in the marketplace as payors move to value-based payment mechanisms
- Access to services and discounted purchasing arrangements that may help lower operating expenses
- Access to our nationally recognized resources and expertise
Once The Children’s Care Network demonstrates its clinical integration, its members may jointly negotiate with payors together with Children’s Healthcare of Atlanta and other independent network members. Having its own data will help the network and its members in issue resolution and demonstrate value to payors.
Additionally, patients will receive comprehensive, quality care provided by pediatric-trained physicians. Ultimately we seek to ensure our pediatric system of care will produce better health outcomes for kids.
Enrollment for The Children’s Care Network is currently open.The initial membership term for The Children’s Care Network is one year, with annual auto-renewal of membership. Members have the ability to terminate without cause upon a 90-day notice.
Dues and requirementsTo join The Children’s Care Network, you must be a credentialed member of the Children’s Professional Staff, be board-certified and agree to:
- Participate fully in the Quality Program by following physician-directed 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.
Frequently asked questions
A clinically integrated network is a collaboration between a hospital system and independent providers to improve patient outcomes at the community level. Community providers and Children’s Healthcare of Atlanta created The Children’s Care Network to form their own clinically integrated network as a response to continued challenges to free-standing pediatrics in our new healthcare environment. The network will support the use of protocols and evidence-based practices to support quality care.
Many other healthcare systems across the country have also implemented clinically integrated networks to support independent pediatricians as the best source of healthcare for kids. Children’s and community providers believe a clinically integrated network will help demonstrate our value to payers and potentially bring other benefits from optimized reimbursement and shared savings.
In general, The Children’s Care Network is not exclusive. However, if a physician’s primary practice is internal medicine, general practice, primary care or family medicine, the physician will not be able to contract through other clinically integrated or accountable care-type organizations with payers who are also contracting with The Children’s Care Network.
Yes. Clinical integration means that everyone is working toward the same goal of improving patient outcomes and reducing costs. While referral within the network is strongly encouraged, it is not mandatory. In fact, the adoption of protocols to improve common chronic conditions like diabetes and asthma can help kids avoid unnecessary hospital and specialist visits.
Do I need to have an electronic health record to participate in the network? If I have one, will the network tools be able to interface with mine?
Currently, you do not need an electronic health record to participate. The network’s population health management system and initial quality measures are designed to use billing codes that come from your practice management system. This system is compliant with all HIPAA regulations. It is built to interface with a number of electronic medical records, or it can be accessed in a stand-alone manner.
Small practices face particular challenges in addressing the demands of the changing healthcare market, while retail clinics are taking on more of the mainstays of the traditional pediatric medicine. Even 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.
Once clinically integrated, The Children’s Care Network will help small practices demonstrate their value to payers and help handle administrative burdens, such as contract negotiations. The network also plans to provide ways of lowering overhead expenses through access to other value-added services such as group purchasing arrangements.
By developing care and referral protocols used across the continuum of care, pediatricians will be better equipped to manage the care of their own patients and make appropriate referrals to specialists. As a result, this will enable specialists to focus their efforts on the kids who truly need advanced services and treatment.
Initially, members will maintain the base contracts they currently have through their practices. The network’s pay-for-performance contracts will exist on top of your payer contracts and will specify what incentives or shared savings practices you would receive as a result of reaching performance or quality goals.
Following the achievement of clinical integration, it will become possible for the network to negotiate base agreements on behalf of members. At that time, there will be an opportunity for you to determine whether you wish to have the network negotiate base agreements on your behalf on a payer by payer basis.
Ultimately, Children’s believes that the industry is moving to pay-for-performance as a standard, and this approach allows practices to manage that transition.
What happens to a member’s contracts if the practice is unable to meet the performance standards required by the network?
Members will be given reports and information about their performance so they can make improvements. In the event that a member fails to comply with network standards, the network will address such 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.
What kinds of protocols or quality standards will I have to adopt, and how will my daily practice activities be affected?
The Children’s Care Network will implement primary care quality measures structured around protocols your office already has, such as HEDIS measures for well checks and immunizations. The physicians on our board want to avoid placing an additional burden on your busy staff. Other core programs to be rolled out over time include: concussion, asthma, obesity and diabetes prevention and treatment.
Members will be given reports and information about their performance, and have the ability to make any needed improvements. Your practice will be compared across your specialty with the other practices as well as against the measure benchmarks. The medical director and the quality committee will work with all practices on clinical improvement activities through collegial consultation.
If a physician or practice is found to be seriously deficient, and sufficient improvements are not made, a member may be placed on probation or terminated from the network. The practice will be given ample notice during the remediation process to prepare to transition to out of network contracts and assume its own contract negotiations.
The network’s population health management tool is built to analyze patient data in a secure manner that complies with all HIPAA regulations. In addition, the network will only use the data provided by the practice for the stated purposes in the Membership and Participation Agreement, unless otherwise approved by the physician-led board of directors.
A copy of the membership agreement is available upon request by emailing firstname.lastname@example.org. No practice’s financial data will be collected through the data you provide.