Navigating the healthcare maze in today's environment is challenging for consumers, employers, physicians, hospitals, and all other healthcare providers. Pressures for reduced cost and higher quality, from increased dominance of large health systems, and legislative mandates and initiatives, have created the most complex, delivery system of care the U.S. healthcare system has ever experienced.
Large systems and integrated networks vie for patients and the healthcare dollar. Consumers are experiencing higher out of pocket costs, reduced benefits, and the shifting of cost responsibility to them from their health plans.
Integrated Independent Physicians Network (IPN) was formed in 2015 by independent physicians and independent healthcare providers to develop a delivery system providing high quality and cost effective care for Orlando residents and employers.
The core of the IPN Network is to provide a complete healthcare delivery system around independent physicians, resulting in lower costs to patients, lower premiums and claims for employers, and providing the right care, at the right time, at the right place.
Clinically Integrated Networks or CINs have been formed by the large systems, but the IPN Network is the largest completely independent CIN in the area. The IPN Network consists of 1300+ independent physicians representing all medical specialties, and nearly one million patients, and includes a complete network of outpatient services like outpatient surgery centers, diagnostic and imaging, lab services, home health services, outpatient cardiology care, and a high acuity urgent care network called ER Clinix.
It is a proven fact that when patients seek care in an independent care setting, both their out of pocket costs and claims are lower.
Preserving and protecting the independent practice of medicine is vital in providing affordable healthcare, and independent physicians joining together in a clinically integrated network, allows the solo practice to participate in alternate payment models and merit-based incentive payment programs. This new model will be the future of healthcare reimbursement.
Physicians currently are trying to comprehend and understand the impact of the Medicare Access and CHIP Reauthorization Act of 2015, (MACRA) which is slated to replace the flawed sustainable growth rate formula (SGR), which determined the reimbursement value for services rendered. The CMS comment period for MACRA ended on June 27. MACRA legislation is intended to reimburse physicians for higher quality and better outcomes, versus traditional fee for service transactional billing, under a dual path comprehensive program that measures quality and cost metrics. In our next article, we will discuss the potential implications and negative impact of MACRA on independent physicians.
Information Technology and clinical integration among providers in an integrated network which shares care plans, patient records, identifies gaps in care, and addresses the total patient care, is paramount to meeting the quality metrics from both government, commercial payers, and employers in the future.
IPNConnect, IPN's Health Information exchange (HIE), a comprehensive integrated population health management system and analytics tool, is the mainstay of the CIN.
Larry Jones is the executive director of the Integrated Independent Physicians Network, and CEO of HPOF Holdings, LLC. Larry's background encompasses over 25 years of experience on both the payer and provider side of healthcare. His mission is to preserve and protect the independent practice of medicine. He can be reached at LJones@ipnetworkflorida.net