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Clinical Integration (CI) is a structured collaboration among participating Palmetto Health Quality Collaborative physicians and Palmetto Health to achieve a patient-centered performance improvement program that integrates quality initiatives across the continuum of care, specifically the hospital and ambulatory care settings, in order to enhance quality, improve the patient experience, create efficiencies in care, and reduce increasing cost. Such a program serves to create a high degree of Physician Leadership Development interdependence and cooperation among network physicians as is necessary in today's healthcare landscape to manage escalating healthcare costs and promote national, regional and local patient safety initiatives.
The Quality Collaborative Clinical Integration Program is a business and clinical strategy involving physician joint contracting as an integral part of an innovative program to accelerate the implementation of advanced clinical technologies, facilitate the adoption of evidence-based medicine, reduce under-use, overuse, and misuse of clinical resources, and eliminate variations in care not related to diagnosis or acuity.
The Quality Collaborative Clinical Integration Program is administered by Quality Collaborative, a physician-led organization established as a subsidiary of Palmetto Health and organized as a Limited Liability Company (LLC) to engage in medical management, practice support, and joint contracting with health plans and governmental programs for the provision of evidenced based care and other quality initiatives under enhanced reimbursement programs.
The CI program brings together physicians who are direct employees of Palmetto Health, under contract with Palmetto Health, members of the faculty of the University of South Carolina School of Medicine, and community physicians, through various contractual arrangements with health plans to provide physician services in which:
- all the physicians participate in the health system in active and ongoing programs to evaluate and modify the practice patterns of themselves and their peers, while creating a high degree of interdependence and cooperation between each other to include performance evaluation, in order to control costs and ensure the quality of services provided;
- all contractual agreements concerning price or other terms entered into, by, or within the arrangement are reasonably necessary to obtain significant efficiencies through the joint arrangement in order to achieve health system-wide cost efficiency goals and meet overall quality and patient safety objectives.
The Quality Collaborative Board of Managers, its executives and physician members believe that clinical integration is imperative for achieving the best possible clinical outcomes, in the most efficient manner, by realigning the incentives inherent in the current health care reimbursement system. These goals can only be achieved when physicians are integrated around common performance standards and quality measures, and have the leadership, infrastructure, governance, organizational support, technology, and financial resources necessary to assist them in providing evidence-based medicine throughout the continuum of care, in both the inpatient and outpatient setting.
The Quality Collaborative believes that patients will greatly benefit from the end result of improved health outcomes, reduction in complications, and greater satisfaction with their overall care. Payers and employers will benefit from lower overall health care costs and improved efficiencies in the provision of healthcare.
- Clinical Initiative/Quality Metric Tracking, Database Development and System of Accountability - A database was developed and is currently being used to track more than 60 quality initiatives across the Quality Collaborative for which we are holding each other accountable. We now are importing data on a monthly basis for each physician on each initiative into a database where we can produce performance reports and analyze trends.
- Clinical Integration Projects - These large-scale projects are designed to truly transform the system of care as the Quality Collaborative and its physician participants lead the way toward a more accountable, patient-centered care era.
- Blood Utilization - The Palmetto Health Blood Management Team and the Quality Collaborative implemented blood management metrics and educational efforts to reduce the overuse or misuse of blood products at our hospitals. Through this effort, more than $500,000 in savings was attributed to improving the appropriate use of blood products in fiscal year 2012. In addition, Palmetto Health's overall use of blood continues to drop. The Quality Collaborative has been able to incorporate an evidence-based multidisciplinary approach to appropriately providing patients with transfusion. The implementation of this best practice has resulted in better outcomes and improved patient satisfaction.
- Employee Health Plan- Due to our outstanding performance, the Quality Collaborative is playing a greater role in providing care to Palmetto Health team members and their families in 2013. Effective Jan. 1, 2013, the Palmetto Care Plan (Palmetto Health's self-insured employee health plan) began utilizing Quality Collaborative physician participants as its preferred network of providers. This arrangement clearly demonstrates the enhanced value that Palmetto Health believes the Quality Collaborative participants will provide for their employees and their families. In addition, it is our hope that this will be the first of many such arrangements between the Quality Collaborative and large employers like Palmetto Health.
- Low Back Pain Initiative - For over two years, William Rambo, MD, FACS has led a team of surgeons and clinical leaders to begin to refine the process to effectively manage back pain. Through their work, they were able to create a new model of care focused on utilizing best practices and improving outcomes. From this work, the Palmetto Health Spine Center was developed and opened Monday, November 17, 2014. Conveniently located on the Palmetto Health Baptist Parkridge campus at 100 Palmetto Health Parkway, Suite 250, this program will serve as a virtual program that effectively manages acute back pain through appropriate medical modalities, non-surgical interventions, physical therapy and surgical care as indicated. This new service offers a range of treatment options, from non-invasive to invasive interventions, to bring effective pain relief while improving functionality, minimizing medications and managing costs. Some program highlights include: 1) Same-day/next-day appointments for quick access. 2) Patients are assessed by the physician and physical therapist on their first visit. This is done without the patient being charged for their physical therapy evaluation. 3) While it is up to the physical therapist's discretion to develop the treatment plan, a likely scenario may involve three PT visits in two weeks followed by a revaluation. 4) Spine injections are performed at the Parkridge Surgery Center. 5) If surgery is indicated, patients are connected with a nurse navigator to guide them through the pre-op and post-op process through class instruction and individual consultation. 6) Eleven spine surgeons within the PHQC are part of this care team. 7) Patients see a surgeon within three days of referral.
- BCBS Total Knee Replacements Bundled Payment Pilot - Frank Voss, MD, and Coleman Fowble, MD, both Quality Collaborative participants, have been selected as physician leaders to assist in the implementation of the Palmetto Health Quality Collaborative BlueCross BlueShield bundled payment agreement for total knee replacements. This bundled payment structure is the first of its kind for the Quality Collaborative and will assist in the development of a pre-op health optimization process, the standardization of inpatient rehabilitation processes, and the standardization of discharge procedures.
- Patient-Centered Medical Home Network - The Quality Collaborative assisted more than 16 physicians and mid-level providers in six practices to achieve Patient-Centered Medical Home accreditation. This designation has resulted in enhanced reimbursement for providers.
- PHORCE Project - Quality Collaborative surgeons have participated in the PHORCE project to streamline care in the OR and standardize the surgical supply chain to optimize cost efficiency in this high-cost area of the acute care system.
- Care Management Infrastructure - One of the critical components of the system of care the Quality Collaborative is putting into place is the care management infrastructure that will be required to better manage high-risk patients as they transition from the acute care setting into the community. This has been accomplished by formation of the ACTT and PACTT Teams, and the ACCES clinic where high-risk patients recently discharged from the hospital can be seen in follow-up within seven days of discharge to assure they are stable and not at risk for readmission.
- Physician Leadership Development - The Quality Collaborative held two CME forums to educate Board and Committee members on health care marketing and finance. Speakers included Erik Berkowitz, PhD; Mark Covaleski, CPA, PhD; Tony Keck, SC Department of Health and Human Services Director; Laura Long, BlueCross BlueShield Medical Director; and Chad Rubin, CMS RUC Committee Member.