The Case for a Pediatric-focused Clinically Integrated Organization
The national health care landscape is undergoing change, driven by market dynamics and the Patient Protection and Affordable Care Act, which was signed into law in 2010, upheld by the United States Supreme Court in 2012, and will likely expand the insured population in the years to come.
One element of this change is the transition to a value-based reimbursement structure, where physicians and hospitals are paid based on quality outcomes rather than the current fee-for-service model. Growing competition in the marketplace is an additional factor that has influenced many health care organizations like Phoenix Children’s to examine its current relationships with community physicians and the current contracting environment.
Those considerations point to a need for a provider-organized network to coordinate delivery and management of care while simultaneously protecting the independence of community physicians. Additionally, local market conditions support the rationale for developing a clinically integrated organization, which would allow participating providers and hospitals to potentially benefit from improved quality of care that results in optimized reimbursement and shared savings.
More than 60 community physicians provided initial feedback and helped identify needs to address, obstacles to overcome and suggestions on how to best capitalize on this opportunity. To further that effort, the Hospital established the Physician Advisory Committee (PAC) to guide the formation of the organization. The group successfully laid the groundwork to establish PCCN, which includes the development of participating and operating agreements and defining the structure of the organization. Now formally established, PCCN is registered as a legal entity, governed by a Board of Managers, afforded the right to negotiate contracts on behalf of the participating physicians, and led by physicians.