Data Analytics & Reporting
Accountable Care Organization
Training & Implementation
Value Based Contracting
Board of Trustees
How to Become a Member
Data Collection FAQ’s
Cleveland Clinic + Oscar
Cleveland Clinic + Oscar
CCQA MSSP ACO 2017 Quality Measures
Capturing Risk Initiative
Maintenance of Certifications
Practice Transformation Webinars
What is the Quality Alliance?
The Quality Alliance is a program through which independent physicians and employed Cleveland Clinic physicians can collaborate around quality and value in healthcare.
The goals of the Quality Alliance are to develop a network, led by its physician members, which will improve quality and consistency of care; reduce costs and increase efficiency; and provide access to data analytics and professional expertise. 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.
Why would physicians want to participate in the Quality Alliance?
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.
What is the value proposition for the physicians?
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
access to the most complete history of medical care available for your patient – at the time of initial visit
electronic tools to streamline common taskssuch as, maintaining and accessing patient records, referrals, admitting patients, utilizing disease registries, prescribing medicine.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
enhancedquality 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
Receive 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.
How does the Quality Alliance relate to “Clinical Integration”?
“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
What is the value statement for the Cleveland Clinic hospitals?
Cleveland Clinic hospitals will benefit from membership in the Quality Alliance by further aligning the care provided with the objectives of independent physicians in Northeast Ohio, which enables the organization to continue to provide the highest quality care and value to the community. 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.
Can I refer to a physician who may not be part of the Quality Alliance?
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 capture a complete data set. Because the network includes Cleveland Clinic employed Physicians, 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.
What are the Quality Alliance’s clinical measures and who develops them?
Evidence-based clinical protocols are an essential component of the Quality Alliance. Regardless of participation in the Quality Alliance, it is certain that measures will be mandated in every part of a physicians practice as Medicare, Medicaid, and commercial payers struggle with ways to improve the quality of care while managing costs.
The clinical measures 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 measures either through a comment forum, or by participation in Quality Alliance governance committees.
How will my performance be measured and reported? Who sees my results?
All 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. Aggregate results will also be reported to the Quality Alliance Finance and Quality Committee as well as the Board of Trustees. 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.
Do I need an EMR?
Yes, Members of the Quality Alliance are now required to be on an OHIP (Ohio Health Information Partnership) preferred EMR.
How much will this cost?
The requirements to support the Quality Alliance’s data repository and reporting system include technology that most physician practices already have in place, 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 with MyPractice Community to come to your office and provide an estimate.
How does Medicare define “Primary Care”?
Internal Medicine, Family Practice, and Geriatrics.
What IT platform is required?
Access to a common clinical data infrastructure is critical to the Quality Alliance’s ability to demonstrate, track and improve its performance. The QA contracts with a third-party vendor to implement a data repository and reporting system that collects and stores information from the various independent practice management systems and electronic medical records (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.
How will this impact the workflow in the physician’s office?
Your office will need to share information on disease conditions, lab work and imaging. You will also need to record data on patient vital signs and compliance. Clinical measures will be available on the QA web site, and our goal is to make them helpful and effective rather than onerous. Implementation and ongoing support will require minimal interruption of day-to-day workflow in your medical office.
Are all practitioners billing under a TIN required to join?
Yes, there is an all in requirement. All practitioners billing under the same Tax ID number are required to join the ACO.
Can a specialist join the Cleveland Clinic ACO?
At present time, the initial invitation to join the ACO is limited to PCPs only. This in no way affects the ability of QA PCPs to refer patients to QA specialists and has no effect on other aspects of the program, including incentive distribution based on achievement in specialty-specific metrics.
How are we selecting practices for ACO membership?
One of the most important components of an ACO is the ability to share clinical information. All QA PCP practitioners are eligible to join the CC ACO if they meet guidelines for data sharing. IBM Watson Health (QA data vendor) and the Ohio Health Information Partnership (OHIP) have endorsed the Meaningful Use 2 Certified EHRs listed below as preferred selections with the ability for IBM Watson Health to connect, for the ACO. Only physicians currently using one of these EHRs is eligible for participation.
Allscripts (Pro, SCM, Touchworks)
How do I join?
Those practices who wish to participate should complete the attached participation agreement and return to the Quality Alliance by July.
If I don’t join now, when is my next opportunity?
QA members are also welcome to sign on at a later date, but patients of those members will not be included in the ACO data collection until the following January.
Membership in another ACO?
The Medicare Shared Savings Program (MSSP) requires PCP participants to be exclusive to one MSSP ACO.
What CMS Medicare Share Savings ACO program is the CC applying for?
CMS Medicare offers two shared savings programs. The Cleveland Clinic has elected to apply for participation in the no downside risk program where Medicare agrees to a 50/50 split of any cost savings with the ACO group.
Will ACO membership affect the way I bill for services?
Joining the ACO will not change the way you currently bill Medicare for services provided to your patients. Medicare will continue to reimburse on a fee for service basis. Any savings that may result from the ACO will be available for distribution by QA to ACO members who achieve QA approved performance metrics. The ACO will not otherwise affect participation in the present QA incentive distribution program.
Will my QA membership be affected if I decline joining the Cleveland Clinic ACO?
No, your QA membership will be unaffected and you will maintain your membership and all related benefits