Our Network

Frequently Asked Questions (FAQs) about the TCIH ACO

TCIH membership includes a number of benefits including:

  • Access to commercial and other contracts not otherwise available.
  • Participation in a clinically integrated network of physicians that seeks to improve the health of its community in measurable terms by being part of the solution to spiraling healthcare costs.
  • Obtaining tools to measure your practice’s patient care performance relative to your peers.
  • Rewards with additional reimbursement for practices that achieve and demonstrate the value, not only the volume, of care provided.
While the TCIH Board of Directors has the responsibility to establish specific criteria for participating members, the board has not yet established specific criteria. However, at a minimum, participating members must satisfy certain standard credentialing requirements including, without limitation, NCQA requirements and standards, as is typical of existing managed care contracts. Participating members must also have a desire to clinically integrate his or her practice with Martin Health System hospitals and facilities and other providers participating in TCIH. This clinical integration is necessary to satisfy TCIH’s ultimate goal and objective which is to provide outstanding medical care to our communities at the lowest possible cost.
A contract will be required to participate in TCIH. The distinction between TCIH and existing payer contracting networks with which you may be familiar is two-fold. First, the TCIH network is physician-led and governed. Not all participating providers will desire or be expected to serve on the Board of Directors or on various committees. However, the providers that do participate will be able to ensure the network operates in the best interests of all providers and patients. Second, as a clinically integrated network, providers will have access to patient information that will help improve the quality of a patient’s care across all specialties and facilities. In the future, all TCIH physicians will be aligned by the same incentives around quality and costs. Over time, the benefits of referring to physicians with whom you are clinically integrated will be obvious and in the best interest of patient care.
Yes. Please contact Candice Tettamanti at 772-781-2754 for more information.

Qualifications to enter the TCIH network and maintain participation are:

  • Board certified, or become board certified within a specified time in practice, depending on your specialty and TCIH credentialing criteria. The TCIH Board of Managers will consider board-eligible (or equivalent) physicians on a case by case basis.
  • Meet TCIH’s minimum credentialing requirements.
  • Comply with TCIH policy and procedures. (These will be forthcoming.)
  • Maintain good standing including paid membership dues.
  • As TCIH matures, requirements to meet minimum performance on TCIH network endorsed quality and utilization metrics may be used in credentialing and membership decisions.
TCIH does not require that you have privileges at a Martin Health facility.
If you are a physician employed by Martin Health, you will become a member of TCIH. No one is required to join TCIH. If you don’t join you can still continue with your privileges at Martin Health hospitals and with your individual relationships with payers. However, not being a member will limit your ability to improve the environment in which you’ll want to work. Being part of a clinically integrated network with common goals provides you with the ability to have an impact on improving health care in our community.
It depends upon the payer program. In most cases, specialists can belong to more than one organization. In some cases, like the Medicare Shared Savings Program, physicians providing primary care services can belong to only one. TCIH plans to participate in, as well as construct, various clinically integrated networks. If you participate in another program, we encourage you to discuss this with us.
Shared savings contracts with elements of clinical integration necessitate a fully integrated network and as such will contract on behalf of all member providers. In addition to realizing the goals of clinical integration, this evolution will allow TCIH to react to contract opportunities much more quickly and efficiently. Typically, if you have a contract with a payer and you belong to TCIH, TCIH’s shared savings contract with the payer will apply to you. Shared savings contracts do not change the underlying fee for service contracts that you may have with a payer. You bill and collect as you usually would as regardless of your participation in TCIH.
All Part B Quality Gates are submitted via the ACO.
CMS provides the Medicare beneficiary a letter advising they are in a shared-savings program.
Ready to join an ACO? TCIH is accepting both primary care and specialty physician members. Call us today for more information at 772.781.2754.

Why Join an ACO Such as TCIH

Why are Integrated Healthcare Networks so Important?

Two trends that are transforming the health care delivery system include:

  • 1

    The purchaser of healthcare is evolving from groups to individuals. Employers are shifting a majority of the health care insurance cost to their employees through high-deductible health plans. As a result, cost has become an even greater factor in health care decision-making with consumers shopping for lower-cost care settings that are more accessible. There is a growing demand for integrated care across a continuum rather than episodic care.

  • 2

    Payment models are shifting from fee-for-service to value-based reimbursement. CMS estimates that by 2018 approximately 90 percent of their payments will be value-based and contingent upon quality and efficiency factors. Furthermore, the Medicare Access and CHIP Reauthorization Act (MACRA), with its merit-based incentive payment systems (MIPS) and advanced alternative payment models, is creating a new interdependence between hospitals and physician groups, and shifting the emphasis in physician compensation to incentive results over productivity. While the destination for payment transformation is now clear, the path to success in these models is not. There is no single way to win; these models require health systems and physicians to work collaboratively.  The rapid increase of value-based payment models will place an imperative to integrate in a formal way to be able to contract in the new insurance marketplace.

What are the healthcare network’s objectives?

Treasure Coast Integrated Healthcare will adopt mechanisms designed to drive consumer involvement and engagement as active participants in their own healthcare. This transformation is guided by the goals of a framework developed by the Institute for Healthcare Improvement (IHI) that describes an approach to optimizing health system performance.

 

The three objectives to assure patient-centered care include:

  • Improving the patient experience of care
  • Improving the health of populations
  • Reducing the per capita cost of health care

How will the integrated health network work?

In order to succeed, this network must manage the health of its population while providing individualized care to patients and meet their unique needs. The network will partner with physicians throughout our community to achieve this goal by facilitating the collection, organization and analysis of evidence- based quality metrics that aim to ensure patients receive optimal preventive and curative care.

The capacity to manage per capita reimbursement will require building a sustainable business model with improved health care service utilization and an integrated panel of providers. We will need an information technology infrastructure that can effectively measure and help manage utilization risk and per capita cost, while capturing patient outcomes and aligning incentives with physicians, providers and payers across the continuum of care.

Another critical success factor in succeeding in a value-based environment is forging innovative partnerships with health insurers. Through this collaboration, Treasure Coast Integrated Healthcare will serve as the contracting organization to participate in shared savings programs, ACOs, bundling programs and other value-based care models. These programs offer tremendous opportunities to develop the capabilities to manage the health of a population while providing revenue sharing opportunities for physician members.