Quality Alliance FAQs

The mission of CPP is to support independent physicians in Northeast Ohio in their efforts to provide the best patient care. CPP accomplishes this mission by providing its 900+ independent physician members access to innovative products and services to help improve practice efficiencies and promote high-quality patient outcomes. Cleveland Clinic employed physicians are also CPP members.

The Quality Alliance is a CPP program that provides a mechanism through which independent physicians and employed Cleveland Clinic physicians can collaborate around quality and value.

The goals of the Quality Alliance are to develop a network, led by its physician members, that will improve quality and consistency of care; reduce costs and increase efficiency; and provide access to expertise, data and experience. By practicing in accordance with evidence-based clinical protocols and gaining performance feedback, physicians in the Quality Alliance will document and provide higher-quality, more efficient care, making the Quality Alliance the best value healthcare network in Northeast Ohio.

“Clinical Integration” is a legal and regulatory term. The Federal Trade Commission and the Department of Justice define Clinical Integration as:

“...the network implementing an active and ongoing program to evaluate and modify practice patterns by the network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.” (Source: DOJ and FTC, Statements of Antitrust Enforcement policy in Health care, Statement 8).

The Quality Alliance has been designed to meet the FTC’s four primary requirements for a clinically integrated independent physician network, as follows:

• Physician-developed clinical protocols
• Common data repository and reports
• Physician-led care review
• Mechanisms assuring adherence to protocols

Independent physicians will benefit from joining the Quality Alliance by gaining the ability to differentiate themselves based on demonstrably higher quality clinical care through the adoption of evidence-based clinical protocols. Independent physicians will also be able to deliver more efficient care through shared participation in a common data repository and reporting system. The Quality Alliance offers independent physicians the opportunity to collaborate with Cleveland Clinic in achieving high quality standards while still maintaining their private practice.

Through participation in the Quality Alliance, physicians will have the ability to deliver higher quality, more efficient health care, potentially leading to recognition by Northeast Ohio health plans and employers.

Additional benefits include:

• recognition in the community as a physician practice network based on technology, innovation and extraordinary quality of care
• having the most complete history of medical care available for your patient – at the time you first see him or her
• electronic tools to streamline common tasks: maintaining and accessing patient records, referrals, admission, disease registries, prescriptions, etc.
• ability to ease into new IT systems with minimal disruption to existing office systems and protocols
• gaining IT equipment necessary to link centralized information
• reduced medical errors
• improved patient outcomes and satisfaction
• more efficient provision of care
• assistance in monitoring and patient compliance
• enhance quality of physician-patient relationships
• easy access to “best practice” Clinical Care Guidelines, community disease programs, case management programs
• ability to create our own Clinical Guidelines and monitor members for compliance
• ability to sell combined services to insurers and other payers
• assistance - both medical and technological - to succeed in pay-for-performance, quality based incentive programs and value-based pricing
• support needed to keep independent physician practices in business, providing an alternative to the employed physician model
• access to ongoing education and training as needed to meet higher patient outcomes
• a higher degree of interdependence, cooperation, and seamless care among primary care physicians, specialty care physicians and other providers such as hospitals, labs, and radiologists.

Cleveland Clinic hospitals will benefit from membership in the Quality Alliance by further aligning their objectives with independent physicians in Northeast Ohio, which enables the organization to continue to provide the highest quality care and value to the Northeast Ohio community. In addition, by improving alignment with independent physicians, Cleveland Clinic also gains the ability to better manage the additional risk prescribed by alternative payment models, such as episode-based payment, that may result from healthcare reform initiatives.

Only CPP members are eligible to participate in Quality Alliance.

Yes. CPP members who choose not to participate in the Quality Alliance can still maintain their membership in CPP, which includes access to value-added services and health plan contracts through the current messenger model process.

Evidence-based clinical protocols are an essential component of the Quality Alliance. Even without participation in the Quality Alliance, it is certain that protocols will be mandated in every part of a physicians practice as Medicare, Medicaid, and private payers struggle with ways to improve the quality of care while managing costs.

The clinical protocols are designed by Quality Alliance physician members, and establish standards of quality and safety. They are created for each specialty represented in the network. All Quality Alliance physician members are expected to contribute to the development of clinical protocols either through comment on the CPP web site, or by participation in Quality Alliance governance committees.

Access to a common clinical data infrastructure is critical to the Quality Alliance’s ability to demonstrate, track and improve its performance. CPP will contract with a third- party vendor to implement a data repository and reporting system that will collect and store information from the various independent practice management systems and Cleveland Clinic’s EMR. This will enable member physicians to access clinical information, data and reporting through a secure portal, which is protected by the third-party vendor.

No, the third-party vendor system provides a solution to manage multiple practice management systems and EMRs.

The requirements to support the Quality Alliance’s data repository and reporting system include items that most physician practices already have, such as computers, printers and internet connectivity. The 2009 American Reinvestment & Recovery Act (ARRA) provides money for meaningful use of electronic health records. The IT and Finance Subcommittees are working to ensure that CMS requirements are met so that member physicians will be eligible to receive ARRA funds based on the stimulus plan’s requirements should they need to purchase the items mentioned above. If you have questions about costs for your specific practice we can set an appointment to come to your office and provide an estimate.

Your office will need to share information on disease conditions, lab work and radiology. You will also need to record data on patient vital signs and compliance. Clinical guidelines will be available on the CPP web site, and our goal is to make them helpful and effective rather than onerous. Implementation and ongoing support will require minimal interruption of physician office day-to-day workflow.

Increased reimbursement is not the reason to participate in the Quality Alliance. Other clinically integrated networks have successfully sold their services to health plans. However, any increase in rates did not come in the form of forcing payers to raise reimbursement or using the collective power of the group as leverage in negotiations. Increased reimbursement for clinical integration participants has been the result of groups offering a higher quality, efficiently delivered product for which health plans and employers were willing to pay a premium.

We are fully aware that patient mix varies by practice and that patient non-compliance is a very real issue for physicians. Our plan is to create a point and click documentation system in the data repository that indicates what treatment was prescribed by the physician, as well as whether the patient was non-compliant. In this way, we can demonstrate that protocols and evidence-based medicine were followed, but the patient did not adhere to the recommendations.

Confidentiality is a top priority throughout the health system. The Quality Alliance’s clinical data repository and reporting system will be compliant with all current confidentiality policies and procedures within the system as well as compliant with all regulatory requirements. The point-and-click system will provide the ability to exclude patients.

The Quality Alliance requires participating physicians to refer within the network if possible, as referrals outside of the network will impact the Quality Alliance’s ability to collect a complete data set. Because the network includes Cleveland Clinic and CPP, there should be a Quality Alliance participating physician available to meet patient needs. An outside referral may be made if there is not a physician or specialist participating in the network, or if patient preference is a factor.

All CPP physicians who participate in the Quality Alliance will utilize the same, physician-developed protocols and be monitored for compliance against these protocols. Results will be shared on a regular basis with each member physician so that physicians can compare their own performance with that of their peers and national benchmark data. Results will also be reported to the Quality Alliance Medical Director, the Quality Alliance Steering Committee and the Quality and Protocols Subcommittee. In addition, results will be shared on an aggregate basis with Quality Alliance customers such as health plans and employers.

Regular reporting and feedback will allow member physicians to measure and compare clinical outcomes, efficiency, patient safety and satisfaction, ultimately driving the overall quality of care provided by the Quality Alliance.

The CPP Board of Trustees, comprised primarily of independent physicians, will review all QA agreements prior to signature. No QA agreement will be signed without approval of the CPP Board.

When you agree to participate in the QA, your CPP contract will be amended to include the terms (including reimbursement) that would be applicable to you for health plan contracts through the QA. In the event that you end your participation with the QA, the terms of your original health plan contracts would be in effect again. The physician will not be required to go through the re-credentialing process with the health plan. This process will be overseen by the CPP Board of Trustees.

No. The QA will not transfer patients from one physician to another. The contract language addressing transfer of patients is found in your current CPP agreement, and is not found in the Quality Alliance contract. The transfer of patients terms apply to full-risk, capitated contracts only, in which many CPP physicians have participated. The Quality Alliance is designed to promote cost savings through increased quality and efficiency, not through full-risk capitation.