Frontiers of Health Services Management - Summer 2014 - (Page 26)

care physicians and to work with those physicians who were part of UHaco network to order missing lab tests, assist in scheduling appointments, and follow up with members who needed further treatment. the formation of the UHaco network, UHaco clinical activities, and introduction of wellness incentives in the health plan design coincided with UH's expansion of the high-deductible health plan benefit and employer-funded health savings account contributions. all these efforts required education of the employees in the health plan, allowing our providers to gain a In compliance with Medicare Shared Savings consumer perspective. During the first year Program regulations, of UHaco's operation, we established the cMS issued the Medicare Shared Savings Program UH Coordinated Care regulations, and we conOrganization [which] sidered applying to particimaintained a governance pate as a Medicare aco. after deciding to apply structure [whose board was] made up largely of and include all employed physicians in our participaparticipating providers tion, we determined that and Medicare beneficiary we should form another separate organization to representatives. provide oversight and guidance to the Medicare aco. in compliance with Medicare Shared Savings Program regulations, we established the UH coordinated care organization (UHcco). this entity maintained a governance structure that included a board of directors made up largely of participating providers and Medicare beneficiary representatives. Kicking off the Medicare Shared Savings Program on July 1, 2012, UHcco, a direct subsidiary of UHaco, engaged its physician members as leaders in the initiative. We established three committees to address the primary areas of focus of UHcco: the Patient engagement committee, the Quality and care optimization committee, and the finance and operations committee. each committee is active in the governance of the Medicare aco and provides experienced feedback as initiatives are proposed and implemented, including, for instance, offering examples of how to integrate quality measures into practice management and the eMr. these practical discussions facilitate health system clinical integration and promote conversations between community primary care physicians and hospital-based specialists about how to most effectively organize care around their patients. Simultaneous with entry into the Medicare Shared Savings Program, University Hospitals cleveland Medical center, doing business as UH rainbow Babies and children's Hospital, was awarded a Health care innovations award by the innovation center for the Physician extension team program. this program includes a series of quality initiatives that could be implemented in pediatricians' offices to measurably improve the health and development of their patients, particularly Medicaid beneficiaries. to facilitate a network of pediatricians, many of whom were not employed, and to form independent arrangements with the Medicaid managed care plans, we formed our third aco, University Hospitals rainbow care connection (UHrcc), a wholly owned subsidiary of UHaco. the governance of the pediatric aco is provided by a board of directors consisting of community physicians, hospital administrators, and community representatives. (a more detailed study of the pediatric aco is provided later as a case example.) through UHrcc, the UHrcc network was formed, and its pediatrician participants were eligible for quality-based incentives 2 6 * f ro ntier s o f h ea lt h s e rvic e s m a na g e me nt 30 :4

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Summer 2014

Table of Contents

Frontiers of Health Services Management - Summer 2014