Value of Participating in the PHQC:

  • Ability to work with peers and interdisciplinary teams to improve care, efficiencies and communication between your practice and other care sites
  • Opportunity to participate in bonus or “shared savings” incentive payments
  • Opportunity for increased patient volumes through narrow network agreements with payers
  • Provision of monthly performance measurement reports
  • Less burden to report to payers (e.g. – for Medicare Shared Savings Program participants, PQRS/MIPS quality reporting is done by the PHQC)
  • Availability of Care Coordinators for patients with chronic disease and/or need for health coaching
  • Access to technology that will help improve how your practice cares for patients and how you can communicate with other providers – the PHQC utilizes Caradigm, a population health software tool that compiles data from multiple sources to improve our capability to track outcomes, minimize gaps in care, and more accurately identify those patients most in need of care coordination services
  • Assistance for primary care practices to achieve NCQA certification as a Patient-Centered Medical Home

 

  • Continuing medical education and professional development programs
  • Opportunity to participate in group purchasing programs
  • Ability to help influence health policy and processes within the hospital system, with payers, and at the state and national levels
  • Access to services of the Care Coordination Institute (CCI), including data warehousing and utilization of a data feed from the practice EMR to CCI to:
    • Eliminate the need for practices to send monthly data to the PHQC,
    • Provide more timely, accurate and comprehensive performance reports,
    • Report quality measures to CMS for practices that signed MSSP participation agreements,
    • Report to payers who need clinical data from practices for quality measures,
    • Provide data for care managers to help eliminate gaps in care and improve health status for patients with chronic disease, and
    • Enable the PHQC to more effectively evaluate proposed payer contracts.
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    Integrating Quality Initiatives Across the Continuum of Care

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    We provide coordination across the continuum of care.

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    We work as an integrated team, Palmetto Health and its physician partners, to achieve the best results for our patients.
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    Accelerating the Implementation of Advanced Clinical Technology

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    We make the patient the focus of all our efforts.

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    .We provide the highest value of care for our community.
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    Reducing Underuse, Overuse and Misuse of Clinical Resources

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    We invest the appropriate resources necessary for achieving quality outcomes and efficiency.

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    We operate in an ethic of trust, integrity, respect, stewardship, and open communication.

Frequently Asked Questions

What is the PHQC Network?

The PHQC is a physician-led clinically integrated network of providers, comprised of the Palmetto Health-USC Medical Group, private practices and contracted hospital-based providers (such as anesthesiology, pathology, radiology, emergency medicine), that work together to ensure coordination of care across the continuum and to achieve the greatest value for our patients – high quality outcomes in a cost-effective manner.

How does the PHQC function?

The network utilizes a collaborative model that empowers providers to create a healthcare delivery system that can operate in a value-driven environment. The model includes a Board of Managers who provide leadership and oversight for the network, as well as committees that focus on improving and standardizing care. The committees are made up of network providers and organizational administrative staff who represent communities served by the network.

Why choose the PHQC?

By putting management and decision-making in the hands of providers, the PHQC can ensure that clinical quality priorities remain at the forefront of care. Additionally, the network’s structure allows non-hospital employed providers to remain independent while participating in a large provider network. The network’s large geographic footprint also enhances its ability to manage populations for government payers and large businesses, whose patients or employees reside in multiple communities, resulting in greater access to care.

What resources are available through the PHQC?

The PHQC is supported by resources designed to help providers improve health outcomes, reduce healthcare costs, and enhance the patient experience. The network’s primary resources include the PHQC staff and the Care Coordination Institute (CCI).  The role of the PHQC staff is to engage payers and insurers in innovative payment models, while monitoring and measuring cost and quality, and CCI’s role is to provide training, education, and other resources to improve outcomes.  Other resources include the Patient-Centered Medical Home team and Care Management staff.

Will the PHQC purchase or run our practice or hospital?

No. The PHQC will not purchase or run your practice or hospital. The goal is to bring physicians, hospitals, and other healthcare providers together to improve health outcomes, reduce healthcare costs, and enhance the patient experience.

What do providers need to do to participate in the PHQC?

First, because participation in the PHQC is completely voluntary, providers need to sign a participation agreement to be included in the network. Second, participating providers will be required to collaborate with other PHQC participants in the development and adoption of clinical initiatives that will enhance the quality, service and cost-effectiveness of patient care. Lastly, providers will need to hold themselves and each other accountable for compliance with the initiatives of the PHQC. This includes clinical care models and quality and process monitoring, as well as disciplinary and remediation efforts (should providers not meet the standards of quality patient care set forth by the PHQC board and committees).

What criteria do providers need to meet before they can participate?

PHQC eligibility criteria includes but is not limited to:

  • License to practice in South Carolina
  • Must be eligible to participate in federal healthcare programs, including, without limitation, Medicare and Medicaid
  • Serve as member of the medical staff of one of the Palmetto Health hospitals (e.g., active or refer and follow/consulting )
  • Bill payers electronically for both inpatient and outpatient activities
  • Participate in care improvement initiatives developed by the network

Is the participation agreement with an individual physician or the practice?

The agreement is with the practice, but insurers and other payers may also require that it be signed by individual physicians. The practice will internally determine the best way for its members to participate in PHQC contracts, fulfill associated committee and leadership opportunities, and distribute performance bonuses. A practice must sign a participation agreement to be included in the network.

Are the terms of the participation agreement negotiable?

The agreement is not negotiable because it needs to be consistent across all hospitals, practices, and providers. If you have questions about the agreement, please contact Anna Kay, PHQC System Director, at Anna.Kay@PalmettoHealth.org.

Will I be required to negotiate all of my contracts through the PHQC?

No, while the PHQC will seek to create opportunities that may not be available through your individual or group contracts, it will not replace all payer contracting. The PHQC will seek to create select shared savings and value-based payment opportunities with payers, which will not replace your current contracting arrangements.

Does the PHQC guarantee better contract rates for providers?

No. The PHQC allows a network of otherwise independent physicians, hospitals, and providers to approach payers as a group to contract for new approaches to care delivery, such as shared savings programs. The success of the PHQC in obtaining such arrangements with payers will depend on the payer’s willingness to contract for improved quality through financial incentives, and the provider’s ability to achieve improved quality and efficiency as consistent with the goals of the PHQC.

INTERESTED IN JOINING THE NETWORK?

Talk with one of our team members directly.