Q: What is Phoenix Children’s Care Network?
A: Phoenix Children’s Care Network represents a partnership among community pediatricians and pediatric specialists, Phoenix Children’s Hospital and Phoenix Children’s Medical Group focused on the delivery of high-quality, coordinated, cost-effective pediatric care. PCCN is a pediatric-dedicated clinically integrated organization that positions its participating providers for success in the value-based contracting environment by facilitating improved communication among participants and utilizing evidence-based clinical care guidelines developed by physicians. Participating providers and hospitals realize financial incentives for the delivery of high-quality, cost-effective care.
Q: What’s the difference between an Accountable Care Organization (ACO) and a Clinically Integrated Organization (CIO)?
A: It’s easy to get lost these days in what seems to be a ladle full of alphabet soup: ACA, ACO, CIO, MSO, PHO, and the list goes on.
Let’s focus on two of those: ACO and CIO. The most significant difference is ACOs focus their care on Medicare patients. According to the Centers for Medicare and Medicaid Services, an ACO is a group of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal is to ensure patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.
A CIO (clinically integrated organization) is an FTC-recognized model of physician group (joint) contracting based upon development of a robust quality improvement program with real accountability among otherwise independent physicians. It integrates and rewards physician members around a common commitment to quality measures based on scientific evidence and cost improvement. And while an ACO’s contracting capability is limited to a sole product – Medicare – CIOs operate in the Medicare, Medicaid and commercial environments and can offer robust clinical services for children and adults.
Q: Why a pediatric–focused Clinically Integrated Organization?
A: As you are well aware, the national health care landscape is undergoing significant change, driven by market dynamics and the Patient Protection and Affordable Care Act, which was signed into law in 2010.
A significant element of this change is the transition to a value-based reimbursement structure, where physicians and hospitals are paid based on quality outcomes rather than the current fee-for-service model. In addition, under the new law the insured population is likely to expand.
Those considerations point to a need for provider-organized networks to coordinate delivery and management of care. Additionally, local market conditions support the rationale for developing a CIO just like Phoenix Children’s Care Network, where participating providers and hospitals benefit from improved quality of care, resulting in optimized reimbursement and shared savings.
Other organizations in the marketplace are developing adult-focused CIO’s and ACO’s. We believe our focus exclusively on children and adolescents best positions our providers to positively affect the quality and cost of pediatric health care.
Q: Would community physicians be required to refer exclusively to Phoenix Children’s Hospital?
A: Referrals within PCCN are encouraged and it may well be mutually beneficial to do so. It is consistent with the intent our network to provide the highest possible care to children; however, physicians will always retain the responsibility and right to direct their referrals in a manner that best serves the interest of the child.
Q: Is there network-based business support for practices that align with Phoenix Children’s Care Network?
A: A variety clinical, strategic, financial, and operational benefits are available to PCCN members.
Q: How do I join Phoenix Children’s Care Network
A: Reach out to us at firstname.lastname@example.org. A PCCN representative is happy to answer your questions about provider membership.