Clinical Integration

Q: What is the MSHP Clinical Integration Program?

A: The MSHP Clinical Integration (“CI”) Program is an ongoing collaboration among physicians and other providers in the Mount Sinai Health Partners (“MSHP”) network that seeks to align incentives with outcomes, quality and efficiency. Our CI Network (“CIN”) is a physician-led, physician-driven interdependent care delivery system that combines the latest in evidence-based best practices with innovative data and analytics technologies.

In order to maximize the effectiveness of this effort by achieving better quality, more efficient and less costly care, MSHP will negotiate with health plans on behalf of participating physicians and other providers to seek contracts that recognize the value of this important work — including, for example, shared-savings arrangements, pay-for-performance bonus programs, and quality-enhanced fee schedules.

Q: What clinical initiatives will the MSHP Clinical Integration Program include?

A: The MSHP Board, committees and staff will seek to adapt and improve the Clinical Integration Program based on physician feedback and ongoing analysis of provider quality and cost data. Current components of this continuously developing and evolving program include initiatives that are designed to facilitate and improve:

• Chronic disease management
• Care episode management
• Quality reporting
• Communication among primary care physicians and specialists
• Community case management
• Quality-based credentialing

The Clinical Integration Program’s overarching goals are to enhance the quality and efficiency of the services that participating providers deliver to patients. We will measure compliance with the program’s initiatives through various sources, including: claims processing and adjudication systems, practice management and scheduling systems, disease registries, pharmacy benefit systems, and hospital, physician, and ambulatory EMR systems.

Q: Are physicians involved in the development of the MSHP Clinical Integration Program and the leadership of this endeavor?

A: Yes. Physician leaders from the medical staffs of the 7 Mount Sinai Health System hospitals, along with health system leadership, have worked to create the MSHP Clinical Integration Program. MSHP is governed by a board composed predominantly of doctors, and operates for the explicit purpose of developing and implementing a Clinical Integration Program. The MSHP CIN welcomes your active participation. For further details, please contact us at 877-234-6667 or email us at MSHP@mountsinai.org.

Q: Does joining the MSHP Clinical Integration Program mean that I will participate in all contracts negotiated by the MSHP?

A: Physicians who join the MSHP CIN must participate in all contracts negotiated by MSHP on behalf of the CIN. However, physicians can opt out of participation in the MSHP CIN in its entirety with 90 days' written notice. Because this MSHP CIN contract participation requirement may alter some existing contractual relationships between a participating physician and certain health plans, please do not hesitate to contact MSHP with any questions.

Q: Does this mean that Clinical Integration will guarantee better contracts for doctors?

A: No. True Clinical Integration will only get you a “seat at the table.” The objective of clinical integration is to improve the quality of care that providers deliver to patients through a concerted, efficient, and streamlined approach. A clinically integrated foundation will allow the MSHP CIN to approach health plans on behalf of all clinically integrated providers in a legal and appropriate manner.

The potential for success as a CIN in obtaining better managed care contracts will depend on clinical quality and cost-effectiveness, commitment to improvement, and an ability to hold each other accountable for results. Simply put, payers must believe that our Clinical Integration Program drives high quality, cost-efficient care and that the CIP’s success in these areas will be enhanced through payor contracts that reward provider performance

Q: What happens if I don't want to remain in the MSHP CI Program after I sign up?

A: Under your Participation Agreement with MSHP, you may leave MSHP at any time and for any reason by providing 90 days prior written notice.

Q: Is the MSHP Clinical Integration Program the same thing as the Mount Sinai Care ACO?

A: No. Though Mount Sinai possesses significant care coordination experience — in part due to its participation in CMS' Medicare Shared Savings Program ACO (Mount Sinai Care, LLC) — the MSHP CIN is separate from the Mount Sinai Care ACO. The focus of the MSHP CIN is commercial health plans and employers, while Mount Sinai Care’s ACO’s role is to coordinate care for a CMS-assigned population of Medicare beneficiaries.

Q: What is the benefit to physicians in participating in a Clinical Integration program as part of the Mount Sinai Health Partners IPA, LLC ("MSHP")?

A: Participating in clinical integration with an IPA such as Mount Sinai Health Partners can provide distinct advantages to physicians. We believe (1) that MSHP's quality and efficiency objectives are aligned with those of participating physicians; and (2) that MSHP can prove to be a powerful ally and advocate on those physicians' behalf:

• MSHP has been dedicated to developing a Clinical Integration model that is both physician friendly and sophisticated;
• MSHP's commitment to clinical, quality and other initiatives reflects the values and priorities of its physician leadership (the Chair of the Board, the President of the MSHP, and a majority of the MSHP Board are all physicians);
• Because MSHP counts hospitals, ASCs and other providers in addition to physicians among its members, it can develop meaningful clinical integration initiatives that span the entire continuum of care, thus enhancing the value to all participants;
• MSHP has deployed significant resources in order to develop a sophisticated infra-structure that includes inpatient and outpatient quality measures and other tools that will enhance all of its Clinical Integration Initiatives;
• MSHP is not owned by investors or individuals; its sole purpose is to enhance CIN and it is dedicated to seeking to ensure that benefits of the Clinical Integration initiatives are returned to the physicians and other providers of the care; and
• The name Mount Sinai is synonymous with excellence in care delivery, world-renowned research, and innovative discovery at its several hospitals and at Icahn School of Medicine at Mount Sinai.

Q: What will physicians need to do in order to participate in the Clinical Integration Program?

A: Physicians who wish to participate in the MSHP Clinical Integration Program will be asked to do the following:

• First, because participation in the MSHP Clinical Integration Program is completely voluntary, physicians will need to choose to participate in the Clinical Integration Program by signing a Clinical Integration Program Participation Addendum.
• Second, physicians will be required to collaborate with their physician colleagues and the health system in the development and adoption of the Clinical Integration Program — a collection of clinical initiatives that will enhance the quality, service, and cost-effectiveness of patient care.
• Third, physicians will need to hold themselves and each other accountable for compliance with the initiatives of the Clinical Integration Program, including its disciplinary and remediation efforts, should physicians not meet the benchmarks set by the Clinical Integration Program.

Q: What are the characteristics of effective Clinical Integration initiatives?

A: An effective Clinical Integration program contains initiatives that: (1) provide measurable results, which (2) are used to evaluate physician performance for every physician in the network and (3) result in concrete remediation of that performance. Such a program should foster interdependence among providers and enable them to achieve higher quality and greater cost-effectiveness than they likely could accomplish on their own.

Q: Will participation in the MSHP Clinical Integration Program require physicians to change the way they practice medicine?

A: Participation in the quality and care management initiatives of the MSHP Clinical Integration Program will require significant time and attention from physicians and their office staff. MSHP will, in turn, seek contracts that better align rewards with physicians’ clinical integration efforts and outcomes.

Q: Is it lawful for a network of clinically-integrated physicians to collectively negotiate with health plans?

A: Antitrust enforcement agencies like the U.S. Department of Justice and the Federal Trade Commission view Clinically Integrated physician networks as an vehicle to further enhance efficiency and quality of care that can, in turn, provide greater value to patients and employers (who pay for health insurance). However, the DOJ and FTC will continue to prosecute those networks that fail to implement true Clinical Integration and seek to use the approach to attempt to obtain greater reimbursement without integrating or adding value.

Q: How can I receive more information regarding the details of the Clinical Integration Program?

A: In the coming months, the physician leaders developing the Clinical Integration Program will hold meetings at your hospital site for interested physicians to obtain detailed information regarding participation in the Clinical Integration Program, the clinical quality initiatives of the Clinical Integration Program, and their pay-for performance and incentive opportunities. In addition, you may request more information by calling MSHP at 877-234-6667 or emailing MSHP@mountsinai.org .