What is Virginia Care Partners?
Virginia Care Partners (VCP) is a physician-led clinical integration network, the first of its kind in Central Virginia. VCP has more than 900 PCPs and specialists comprised of approximately 700 independent and 100 HCA-employed providers.
What is Virginia Care Partners’ mission?
As a high-performing network of PCPs and specialists in the Richmond metro area, VCP’s mission is to coordinate the delivery of care by collaborating across care settings to improve quality outcomes and optimize cost savings for patients, employers and payers. Supported by advanced technology and a clinical care support team, VCP focuses on:
- Balancing the objectives of cost, quality and network integrity
- Supporting the influence of independent medicine as the healthcare industry matures toward incentivizing performance
- Creating a virtual system of care that supports patients along the continuum (preventive/ambulatory/specialty/acute/post- acute)
- Creating financial value for physician participants
How is VCP achieving network mission?
- By using population health management tools and analytics to gather actionable clinical data enabling network physicians to review evidence-based clinical gaps and utilization of medical services, and identify care delivery opportunities.
- By offering direct practice support, clinical nurse consultants work with primary care providers to share insight into data and best practices to improve efficiencies and insure patients receive care at the right time to avoid unnecessary hospital visits and medical services.
- By collaborating across care settings through a physician-led governance structure and web based referral management platform to reduce fragmentation and improve care navigation and coordination to optimize the value of healthcare for employers and patients. .
What does clinically-integrated mean?
- The Federal Trade Commission describes it as “an active and ongoing program to evaluate and modify practice patterns” designed to “create a high degree of interdependence and cooperation” among network physicians to control costs and ensure quality.
- Network physicians agree to develop and maintain active and ongoing clinical initiatives based on key quality measures agreed-upon and monitored by the physician network.
- Clinical integration across the care continuum typically has the support of a health care system.
What does a clinically-integrated network do?
- Provides a safe harbor for groups of physicians to collectively negotiate value-based contracts.
- Establishes analytic and technology infrastructure to monitor and control utilization of health care services designed to control costs and assure quality of care.
- Has active participation from physicians who feel ownership of the CI Initiative and hold each other accountable to the network.
How do doctors benefit from participating in Virginia Care Partners?
- Optimized patient care through collaborative focus on quality and accountability for best practices.
- Increased transparency and insight into data obtained from payer claims; no additional reporting is required of network physicians for VCP contracts.
- Support in navigating change and remaining independent as healthcare industry moves away from fee-for-service to value-based care.
- Opportunity to demonstrate high performance and earn incentives and shared savings by meeting the quality and cost targets of network’s value-based contracts.
What contracts does VCP have?
VCP manages care for nearly 200,000 lives under commercial contracts with Anthem, Aetna, Optima, Cigna, United Healthcare and Medicare Advantage contract with Humana and 23,000 Medicare beneficiary lives as an ACO.
How does an ACO differ from a clinically integrated network?Accountable Care Organizations (ACOs) are usually associated with federal health care reform legislation and refer to organizations that agree to take on direct responsibility for the quality and cost outcomes of a Medicare patient population across the continuum of care. Qualification as a Medicare ACO is synonymous with participation in a Medicare shared-savings reimbursement agreement. CMS is far more prescriptive on the Medicare ACO structure and capabilities than the antitrust agencies have been for clinically integrated programs. While physicians can participate in more than one clinically integrated network, they can only participate in one ACO.
Does VCP negotiate professional fee schedules on behalf of individual practices with the network?
No. VCP negotiates quality performance contracts that are separate from a practice’s current fee schedule with payers.
How are physicians involved in VCP?
Network is governed by physicians:
- Board of Managers comprised of up to 16 physician and four HCA seats; two thirds of the seats must be held by independent physicians.
- Physician-run committees: Quality, Performance, Payer and Credentialing.
Medical Director position held by an independent network primary care provider.