Kettering Physician Partners is a Clinical Integration Network, which is the organizational and legal foundation for contracting with a variety of payers
and a variety of types of contracts on behalf of physicians and an integrated health system, such as Kettering Health Network.
Kettering Health Network is funding the initial start-up of Kettering Physician Partners in order to provide a platform for collaboration across all
specialties and care settings and enhance the quality, value, safety, and efficiency of our patient's care in the communities we serve.
Physician Hospital Alliance is an organization that was created to negotiate and implement managed care contracts that meet Physician Hospital Alliance
contracting criteria, expand cost saving services such as discount programs and group purchasing, and provide educational opportunities to members and
their staffs related to the local delivery of health care and group purchasing options.
As a messenger model, rather than Clinically Integrated organization, Physician Hospital Alliance is limited in its ability to negotiate on behalf of the
physician and hospital members of the organization and is limited instead to being the messenger of contract terms offered by an individual payer.
Physician Hospital Alliance will continue to provide its purchasing, discount, and educational services and will remain the Tier 1 provider for the
Kettering Health Network Employee Plan.
The Operating Agreement for Kettering Physician Partners stipulates that the physicians on the Board of Directors shall include no more than a total of
four (4) of the Class A Managers who are employed by Kettering Health Network. A number of Kettering Physician Network physicians are serving on the
initial Board of Directors.
An Accountable Care Organization is an organization of healthcare providers that agrees to be financially accountable for the quality, cost, and overall
care of Medicare or other insurance beneficiaries who are enrolled in the otherwise traditional fee-for-service program who are assigned to it. Typically
Accountable Care Organization contracts have the potential for either shared savings or full risk for the cost of care.
A Clinical Integration Network may include Accountable Care Organization contracts such as Medicare Shared Savings Plan contracts with partial or global
risk based on the total cost of care for the Medicare patients.
Kettering Health Network has decided to launch Kettering Physician Partners without participation in Accountable Care Organization contracts at this time.
Kettering Physician Partners plans initially to focus on Incentive-Only Contracts, Commercial Fee-for-Service Agreements, Medicare Advantage Contracts,
Managed Medicaid Contracts, and Bundled Payment Agreements for specific conditions such as joint replacements. In the future, Kettering Physician Partners
could be a platform that could progress into various forms of partial or global risk agreements, such as Medicare or Commercial Accountable Care
agreements, and full risk arrangements like fully capitated HMO agreements.
Incentive Only - This level of contract commitment allows Kettering Physician Network to participate in Quality Incentives contracted for on behalf of Kettering Physician Partners, such as incentives for value that have been committed by the Kettering Health Network Employee Plan. This level may also include care management agreements providing a payment per member, per month for care management activities.
Commercial Fee-for-Service Contracts - KPN will allow Kettering Physician Partners to replace their current practice's contracts based on recommendations from the Contracting committee and decisions by the Board of Directors. At the inception of Kettering Physician Partners, no Commercial Fee-for-Service Contracts are as of yet in place.
Medicare Advantage Contracts - Medicare Advantage Contracts are being negotiated that will provide for distribution of a portion of any savings over the expected acuity-adjusted cost of care back to Kettering Physician Partners. Providers are paid at Medicare fee-for-service rates until such time that the total cost of care can be calculated and compared to the historical average for the contracted patients. Kettering Physician Partners plans initially to contract only for potential 'upside' shared savings distributions (no risk of repayment if the total cost of care exceeds the expected). These contracts are also expected to provide a per member, per month care management fee payable to the primary care physician for each assigned patient. A portion of the care management fees as well as distribution of any shared savings is at risk based on attainment of performance targets for selected Healthcare Effectiveness Data and Information Set measures.
Bundled Payment Agreements (by invitation only) - Bundled payment, also known as episode-based payment, case rate, global payment or package pricing, is defined as the reimbursement of health care providers, such as physicians and hospitals, on the basis of expected costs for clinically-defined episodes of care. Typically the bundled payment is set in advance, but in the case of the CMS Bundled Payment Initiative being proposed for knee and hip replacements, fee-for-service payments will be made and then reconciled against historical or market-based cost expectations with the potential of additional payment and/or requirement for pay back if the total cost exceeds the target. Bundled payment contracts will be condition-specific and Kettering Physician Partners physicians will be invited to participate in specific Bundled Payment Contracts as appropriate for their specialty.
Managed Medicaid Contracts - The majority of Ohio Medicaid recipients are contracted through Managed Medicaid Contracts, such as CareSource. Like Medicare Advantage Contracts, it is anticipated that in addition to fee-for-service payments at Medicaid rates, these contracts may provide for a distribution of a portion of any savings achieved if attainment of performance targets on selected quality measures is met.
Kettering Physician Partners will seek to establish delegated credentialing certification, which will allow Kettering Physician Partners to manage the credentialing process on behalf of the contracted payers. The National Committee for Quality Assurance Credentials Verification Organization Certification Program allows organizations to conduct the credentials verification process, report the credentialing information to payers and maintain systems in place to protect the confidentiality and integrity of the information.
This delegated credentialing process is very similar to the hospital's credentialing process for medical staff privileges, and every effort will be made to reduce duplication and to streamline the process for the physicians and for Kettering Health Network.
The Operating Agreement was created by the Steering Committee along with outside attorneys with many years of experience creating Clinical Integrated Networks across the U.S. That committee, with Kettering Health Network physician leaders, established the Operating Agreement for the organization to provide for annual elections amongst the participating physicians to fill any unfilled or expiring physician Board of Director's seats.
Given the need to convene the initial Board of Directors before the end of the year in order to make many of the initial decisions of Kettering Physician Partners, the initial board was established based on recommendations from current Kettering Health Network physicians and administrators. As these initial physician board positions expire, future board seats will be filled by a vote of the participating physicians at the time of each election.
Yes. Kettering Physician Partners is designed to have physician leadership and physician members on each of the board committees. The Contracting Committee will be the group charged with recommending general contracting parameters and subsequent definitive contracts to the Board of Directors for acceptance on behalf of Kettering Physician Partners.
Strict confidentiality guidelines and commitments will be adhered to by the members of this and other committees of the board, given the extremely sensitive nature of the information that will be shared and discussed.
Yes. The goal of Kettering Physician Partners is to lay the foundation for participating physicians and Kettering Health Network to develop a system of care aligned across the entire patient care continuum which will result in seamless high quality and high value care-safe, timely, effective, efficient, and both team-driven and patient-focused.
Value in healthcare includes incentives for quality and transparency while offering disincentives for overtreatment. Physician, hospital, and ancillary patient care data will be reviewed by the Care Delivery and Quality Metrics and Analytics Committees and reported to the Board of Directors.
Yes. The physician-led Board of Directors along with the Kettering Health Network board representatives will have full access to all financial information. The board will make the decisions about what level of transparency will exist with individual members of Kettering Physician Partners regarding the revenue and expenses of the organization and the ultimate distributions to the participating physicians of Kettering Physician Partners.
As a participating physician in Kettering Physician Partners you will be expected to participate in all requested credentialing submissions, provide quality data requested from time to time or on a routine basis, review quality report cards you receive as our systems mature, and commit to work toward continuous quality improvement within your practice and across the care continuum.
You may also wish to consider participating in one of the five physician-led committees: Contracting and Finance, Quality Metrics and Analytics, Care Delivery, Participation/Credentialing and Information Technology. In the inaugural year, these committees are expected to meet 9-12 times for an estimated monthly meeting time of 90 minutes.
In addition, attendance will be expected at an annual meeting to be held late in the year for all participating physicians.
Yes. Advance practice providers are welcome to participate in Kettering Physician Partners. At the current time, advance practice providers are not being offered the opportunity to participate in board or committee leadership as we develop the physician governance structure.
The CMS Comprehensive Primary Care Initiative contracts through CMS are ending in 2016. Several major payers have developed similar programs as well. The Comprehensive Primary Care Initiative does not allow physicians to participate in multiple incentive programs providing per member, per month management fees and potential shared savings with the same insurance carrier concurrently.
While Kettering Physician Partners intends to engage payers in Comprehensive Primary Care Initiative-like quality incentives and shared savings, no such arrangements will be entered into with payers that participate with the Comprehensive Primary Care Initiative in 2016. As a result, there is no contractual conflict for those practices currently participating in the Comprehensive Primary Care Initiative. As incentive programs are explored on behalf of Kettering Physician Partners, appropriate contractual understandings and/or opportunities for individual practices to change their contracting status with Kettering Physician Partners will be created so as not to conflict with current Comprehensive Primary Care Initiative restrictions. As further protection from any unintended conflict, participation in Kettering Physician Partners allows for an annual change in contract category selection as well as an anytime 90-day termination clause.