Value of participating in the network:

  • 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 payors.
  • Provision of monthly performance scorecards.
  • Less burden to report to payors (e.g., for MSSP participants, MIPS quality reporting is done by the network).
  • Availability of care management 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 Prisma Health Midlands Network utilizes 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 patients most in need of care management 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 health organization, with payors, 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 your practice EMR to CCI.
    Benefits of these services include:
    – Eliminating the need for practices to submit monthly data to the network.
    – Providing more timely, accurate and comprehensive performance scorecards.
    – Reporting to payors who need clinical data from practices for quality measures.
    – Providing data for care managers to help eliminate gaps in care and improve health status for patients with chronic disease.
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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, Prisma 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 Prisma Health Midlands Network?

The Prisma Health Midlands Network is a physician-led, clinically integrated network of providers, including the Palmetto Health-USC Medical Group, private practices and contracted hospital-based providers (such as anesthesiology, pathology, radiology, emergency medicine), who work together to ensure coordination of care across the continuum and to achieve the greatest value for our patients – high-quality, cost-effective outcomes. As a patient-centered performance improvement organization, the network strives to:

  • Integrate quality initiatives across the network.
  • Accelerate the implementation of advanced clinical technologies.
  • Reduce underuse, overuse and misuse of clinical resources.

How does the network function?

The network utilizes a collaborative model that empowers providers to create a health care delivery system that can operate in a value-driven environment. The model includes a Board of Managers that provides 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 Prisma Health Midlands Network?

By putting management and decision-making in the hands of providers, the network 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 payors and large businesses whose patients or employees reside in multiple communities, resulting in greater access to care and choice of providers.

What resources are available through the network?

Network participants are provided with the tools and operational support necessary to meet the industry’s evolving needs and maximize success in an at-risk, value-based environment. The network is supported by resources to help providers improve health outcomes, reduce health care costs and enhance the patient experience. The network’s primary resources include the Prisma Health Midlands Network staff and the Care Coordination Institute® (CCI). The role of the network staff is to engage payors 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 network purchase or run our practice or hospital?

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

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

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

Why is data sharing required for participation in Prisma Health Midlands Network?

Sharing data on measures that are part of the network’s Clinical Integration Program is a requirement for network participation because it enables quality measure data aggregation across the network to:

  • Follow how our patients are being cared for across multiple settings.
  • Give credit to all providers connected to a patient when a quality measure is met.
  • Track data across the network for all our population health quality measures. Specialists can contribute to those measures being met even though the measures may not necessarily be assigned to their specialty (e.g., tobacco use, high blood pressure control, body mass index, depression screening). Thus, specialists can see results for all measures being tracked by the network and drill into patient detail for any measure that contains data for their patients.
  • Improve performance for the network as a whole and increase opportunities to earn shared savings and quality bonuses.

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

Prisma Health Midlands Network eligibility criteria include but are not limited to:

  • Have a current license to practice in South Carolina.
  • Be eligible to take part in federal health care programs, including – without limitation – Medicare and Medicaid.
  • Serve as a member of the medical staff of one Prisma Health hospital (e.g., active, courtesy, refer and follow, or consult) or meet other criteria requirements.
  • Bill payors electronically for both inpatient and outpatient activities.
  • Participate in care improvement initiatives developed by the network.
  • Agree to share data for measures that are part of the network’s Clinical Integration Program:
    – Population health measures: These types of measures are included in network contracts with payors. The data to determine how each provider is performing on these measures is collected through a direct electronic medical record
    (EMR) feed with CCI.
    – Network measures: These are additional measures that are important to improving quality within the network. Since data needed to calculate the measures may not be readily available within the data set that can be pulled from practice EMRs, data for these measures may come from acute care hospitals, registries or even practice billing systems.

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

The agreement is with the practice, but insurers and other payors also may require that it be signed by individual physicians. The practice will determine internally the best way for its members to participate in the Prisma Health Midlands Network, 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, executive director, network operations, at Anna.Kay@PrismaHealth.org.

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

No. While the Prisma Health Midlands Network will seek to create opportunities that may not be available through your individual or group contracts, it will not replace all payor contracting. The network will seek to create select shared savings and value-based payment opportunities with payors, which will not replace your current contracting arrangements.

Does the Prisma Health Midlands Network guarantee better contract rates for providers?

No. The Prisma Health Midlands Network allows a network of otherwise independent physicians, hospitals and providers to approach payors as a group to contract for new approaches to care delivery, such as shared savings programs. The success of the network in obtaining such arrangements with payors will depend on the payor’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 Prisma Health Midlands Network.

INTERESTED IN JOINING THE NETWORK?

Talk with one of our team members directly.