Frequently Asked Questions (FAQ)
Q: What is clinical integration?
A: It’s an effort among physicians to develop clinical initiatives that improve the quality and efficiency of healthcare services and help control costs.
Q: What are the defining elements of successful clinical integration?
A: Successful clinical integration provides measurable clinical improvements for patients and demonstrates improved physician performance.
Q: What does a clinically integrated network (CIN) look like?
A: Physicians who join together in a network to:
- Identify and adopt best practices for patient treatment and improvement of care processes
- Develop clinical guidelines, protocols, and measures
- Adopt data-sharing practices that measure adherence to agreed-upon guidelines and protocols
- Hold themselves and colleagues accountable for compliance with guidelines, protocols, and performance
- Enter into contractual arrangements with payers and health plans that financially recognize physicians’ efforts to improve care quality, efficiency, and cost-effectiveness
Q: What brought about CCPN being formed?
A: Three North Carolina primary-care associations – the North Carolina Academy of Family Physicians (NCAFP), the N.C. Pediatric Society (NCPEDS), and the N.C. Community Health Center Association (NCCHCA) – asked our state partners at Community Care of North Carolina (CCNC) to establish a CIN to help those associations’ independent physicians meet the demand for delivery and payment reform that’s rapidly emerging across all payers and health plans.
A key CCPN goal is to assist providers in preparing for Medicaid reform.
Q: How is CCPN structured?
A: CCPN is a North Carolina limited liability company (LLC) whose members are nonprofit healthcare organizations (CCNC and its member networks, like Community Care Plan of Eastern Carolina/CCPEC). CCPN is to be governed by a Board of Managers led by physicians who will have sole authority for developing and implementing clinical integration programs, and for negotiating and executing contracts with payers and health plans.
Q: What are the benefits of joining?
A: Collaboration among physicians and other providers is essential to improving quality, efficiency, and value; these advances will be essential for success under the impending new approaches to physician reimbursement. CCPN will provide a platform for collaboration, plus programs and tools that enhance care-quality and generate cost-savings.
CCPN also gives physicians the tools they need to demonstrate their value to payers, and offers physicians, both independent and otherwise, the opportunity to:
- Improve patient outcomes
- Become part of a preferred network
- Gain access to CCNC care-management, and also to other CCNC population-health resources
- Develop clinical improvement programs to be designed, implemented, and measured by participating physicians
- Secure the data and analytics needed to drive and document performance
- Receive financial rewards for value-based outcomes and achievements
- Develop services and supports needed by physician-members
Q: What do participating physicians need to do?
A: Responsibilities include:
- Collaborating with colleagues in developing and adopting clinical improvements and integration programs, including guidelines, protocols, and measures
- Adopting data sharing practices that enable adherence to agreed-upon guidelines and protocols
- Holding themselves and colleagues accountable for compliance with guidelines and protocols
Q: Who can join?
A: CCPN members can include:
- Independent primary care physicians (PCPs)
- PCPs employed by hospitals and health systems, and also those employed by Federally Qualified Health Centers (FQHCs), rural health clinics (RHCs), and public health departments
- Family nurse practitioners and physician assistants
All providers must be enrolled, or be willing to enroll, in North Carolina’s Medicaid Program. Though CCPN is being organized by the primary-care physician community, specialists and others may participate through Independent Physician Associations (IPAs), specialty societies, networks, or other organizations meeting criteria determined by participating providers.
Q: What’s the cost to join?
A: There are two fee options:
- For practices with fewer than 15 physicians: a one-time enrollment fee of $75 per provider
- For providers in practices or IPAs with more than 15 physicians: a one-time enrollment fee of $50 per provider
Q: Do I have to accept reimbursement plans that are to be offered to members?
A: No. Each member has the opportunity to opt-out of any reimbursement plan that’s offered.
Q: Will CCPN negotiate reimbursement rates on behalf of an individual provider or entity?
A: No. CCPN will only negotiate reimbursement plans on behalf of its members and those who have signed its participation agreement and agree to comply with its operating agreement.
Q: What if I want to leave CCPN?
A: You may terminate your participation agreement at any time, with proper notice.
Q: Can independent specialty practices join the CIN?
A: Yes. Initial enrollment will focus on PCPs. Those physicians, along with CCPN members, will help identify community specialists to recruit and enroll. Some specialty groups that have voiced an interest in joining include behavioral health providers and OB-GYN providers.
Q: Are mid-level providers eligible to be enrolled in the CIN?