In 2015, Atrium Health in Charlotte, NC, composed of 45 hospitals and about 60,000 employees, recognized the need to prepare itself and its market for a transition to value-based care and payment. Key to the effort would be engagement of key employed (“system”) and independent (“affiliated”) physician leaders in the market. Leaders from large, sophisticated specialty groups agreed that they could contribute to providing better value to constituents, including patients, employers, and insurers.
The health system and physicians collaboratively developed Carolinas Physician Alliance (CPA), a clinically integrated network (CIN) composed of more than 1,700 system physicians and 900 affiliated physicians. CPA serves as a framework to improve the affordability of care for healthcare purchasers by driving cost and quality improvement.
Atrium Health partnered with Guidehouse Inc. in the evaluation and development of the CIN from mid-2014 through late 2015. The network was legally formed in early 2016 and spent the remainder of that year developing its network and operating model, including the hiring of an executive team led by a physician CEO and a chief operating officer.
Based on Guidehouse’s recommendations, CPA focused its 2017 clinical integration program on:
Reducing medical expenses and improving quality within the “LiveWELL” population (Atrium’s employees and dependents).
Improving quality and reducing internal costs within the walls of the hospital via a Hospital Quality and Efficiency Program (HQEP).
Guidehouse recommended HQEP as a “no regret” program for CPA to pursue, given that it:
Improves hospital performance in both a fee-for-service and value-based payment environment.
Engages specialists and hospital-based physicians in meaningful clinical work.
Accelerates time to distribution of quality funds to physicians.
Provides a return-on-investment source for the health system on its population health efforts.