- What is Pediatric Alliance?
As one of only a few pediatric ACOs in the nation and the first pediatric ACO in North Texas, Pediatric Alliance is positioned as the preferred pediatric partner for adult ACOs and employer groups across North Texas. Pediatric Alliance allows adult organizations to complete their offerings for the entire family by adding a pediatric ACO with groups of doctors, hospitals and other health care providers unified to provide high-quality care to children. This organizational model incorporates care coordination into everyday practice while avoiding unnecessary duplication of services and providing enhanced care coordination for children with more complex care needs. When an ACO succeeds in delivering high-quality care and spending health care dollars more efficiently, our Triple Aim is met. This brings vast new benefits to health care providers, patients and the entire community
- What is an Accountable Care Organization (ACO)?
An ACO is an integrated network of doctors, hospitals and other health care organizations that come together and share responsibility for providing coordinated care to patients. Collectively they benefit from shared savings found with greater efficiencies – driven by the common objective of improving the quality of care and creating a better patient experience.
- What is Pediatric Alliance’s Triple Aim?
I. Improving the health of the North Texas pediatric population
II. Reducing cost and increasing efficiency of healthcare delivery for the North Texas pediatric population
III. Improving the patient experience and quality of care for the North Texas pediatric population
- What makes Pediatric Alliance unique?
I. First pediatric ACO model in North Texas from a proven pediatric leader, Children’s Health.
II. Serves both commercial and Medicaid populations.
III. Care coordination provided by Registered Nurses with years of pediatric experience.
IV. Community focused – Health and Wellness Alliance.
V. School-based health initiatives.
- Are all ACOs the same?
No. ACO structures include various models of clinical and financial integration shaped by the participating entities, local market conditions and provider participation. The population of patients may also vary with many ACOs covering only certain segments of the population such as Medicare, Medicaid or commercial patients.
- How is Pediatric Alliance led?
Pediatric Alliance is governed by a pediatric physician-led board consisting of primary and specialty care disciplines. The board provides overall direction and monitors and reviews committee recommendations for progress. The board actively leads the ACO towards success in improving quality of healthcare while reducing costs. For more information re: governance, please contact Larry Roach at Larry.Roach@childrens.com or 214-456-0636
- Why should a provider participate in an ACO, like Pediatric Alliance?
Pediatric Alliance empowers physicians facing today’s challenging health care marketplace by providing access to enhanced care coordination and data analytics, and the support of experienced registered nurses for disease management. Physicians have the opportunity to contribute and shape innovative care models for the patients in their community and beyond through the following:
-Collaborating with other physicians who share the same vision
-Expanding your patient network and adding potential revenue opportunities
-Positioning your practice as a thought leader, shaping the forward edge of the health care transformation
-Increasing access to support services for your patient by bringing proactive quality support and assisting with complex care management.
-Providing 24/7 support through the Children’s Health Nurse Advice Line
-Participating in quality-based incentive programs.
- What does Pediatric Alliance mean for physicians?
As the region’s only pediatric ACO, Pediatric Alliance empowers physicians in their marketplace with an expanded patient network that brings new efficiencies and savings opportunities. By incorporating care coordination into everyday practice, physicians have a more patient-centered practice, with less duplication of services and enhanced care coordination for children with more complex care needs.
- How do I join the ACO?
You need to join Pediatric Partners. Members of Pediatric Partners have the opportunity to opt into Pediatric Alliance’s contract offerings. Participation includes the potential for individual physicians to be included in the preferred networks of a wide range of payor and employer groups, expanding your patient market. For more information on becoming a member of Pediatric Partners, please contact us at 844-456-HELP or go to the Pediatric Partners site.
- What is the difference between Pediatric Partners and Pediatric Alliance?
Pediatric Partners is an integrated regional network of pediatric primary care and specialty providers. This network is driven by clinical integration initiatives. The Pediatric Alliance enters into value-based agreements that provide incentives to our network providers for improving quality and lowering total costs over time.
- What are the additional requirements to participate in the ACO?
I. Providers must have an existing contract with affiliated payors, such as Cigna or Aetna. Contact your Pediatric Alliance liaison for a listing of qualified payors.
II. If you are already a member of Pediatric Partners, speak to your liaison and ask for a Provider Election Form.
III. Future health information sharing may be requested for quality based incentive programs.
- Are patients required to access care within a certain network? How will patient cost be impacted?
Network access is still determined by the patient’s health insurance plan. Participation with Pediatric Alliance does not dictate patient access. Patient out-of-pocket cost will be based on the tiers of their provider network, as defined by their health insurance benefits.
- What is a narrow network?
A narrow network is a subset of an existing provider network provided by a health plan. It is a group of physicians who have chosen to collaborate in improving care outcomes while continuously working toward a better patient experience.
- How does Pediatric Alliance determine and define quality?
The competitive marketplace is shaping ACOs as tomorrow’s vision of care. Quality in Pediatric Alliance is measured by exceeding patient satisfaction, achieving preventative health and managing at-risk populations. Quality indicators and clinical pathways are built and implemented by participating physicians based on clinical experiences of evidence-based care. Reviews for medical relevance and efficiency are regularly conducted.
- Is utilizing an Electronic Medical Records (EMR) required?
EMR use is currently required for all new Pediatric Partners members. Sharing and analyzing data directly impacts the ability to identify efficiencies, cost savings and care coordination opportunities. To achieve clinical integration and make an impact on quality of care, we must be able to do these things. Utilizing an EMR makes this goal more realistic and efficient.
- What is the difference between EMR and a Health Information Exchange (HIE)?
EMR is simple electronic record keeping contained within a single organization. HIE is the platform that enables providers and health care professionals across the spectrum of care to access and share real time health information that benefits their partners and patients.
- What are the benefits of utilizing a private HIE?
- Connecting and integrating health care providers for a quality continuum of care
- Coordinating patient care between providers and facilities, reducing duplicative services and costs
- Saving crucial time in patient diagnosis
- How does Pediatric Alliance define Care Coordination?
Care coordination is built on all the available information within Pediatric Alliance and focuses on engaging and educating patient families in both treatment and preventative care for better outcomes. This includes the vital support of connecting families with care and disease management programs, as well as admission and discharge coordination from the various health care professionals they see throughout the care continuum.
- What is the difference between an ACO and an HMO, and how will this affect my patient?
The Pediatric Alliance is a physician-led organization, operating downstream from insurers. We contract with select insurers to assist our physician network in the care of their patients through value-based contracting arrangements that might not otherwise be available through a direct agreement with insurers. Through these contracting arrangements, the Pediatric Alliance has the ability to aggregate and disseminate data from multiple sources and provide additional care management services to your patient population. This approach is designed to reduce the total cost of healthcare while also improving health outcomes and offering meaningful incentives to physicians.
