Frequently Asked Questions
What is the Children’s Hospital of Michigan Premier Network?
The Children’s Hospital of Michigan Premier Network (CHMPN) is a clinically integrated network of highly respected pediatric physicians who have chosen to actively collaborate and participate in ongoing clinical initiatives designed to improve the quality and efficiency of care provided to patients. Through these collaborative efforts, the CHMPN has the ability to collectively negotiate for quality enhanced reimbursement from various health plan partners.
What makes the CHMPN different from other clinically integrated networks in the market?
CHMPN is Pediatric Specific: Only providers caring for children can be members of CHMPN which means that we will finally have a voice all our own in the marketplace. Insurance contractors are already looking at us as a strong and united group, caring for an important part of their membership. As well, the Children’s Hospital of Michigan is uniquely positioned to create this integrated network, taking the next step in putting pediatric patients at the center of everything we do. The Children’s Hospital of Michigan, a nationally-recognized hospital for pediatric specialty care and patient quality and safety, with its affiliated pediatric medical and surgical physician specialists offers more than 40 specialty services and includes hundreds of primary care physicians on its medical staff. The CHMPN is the one of the few clinically integrated organizations that specifically focuses on pediatrics. This allows us to concentrate our efforts on improving the quality of care offered to children in our area.
What types of contracts will the CHMPN enter into?
The CHMPN will only enter into arrangements with health plan partners that provide additional, quality-enhanced, reimbursement on top of your current fee-for-service contracts. Economic opportunities are expected to include, but are not limited to – primary care physician care coordination fee, bonus pool (shared savings), percentage increase on current fee schedule or pay for performance (P4P) rewards. The CHMPN is not currently looking at shared risk or capitated arrangements. Additionally, participating providers will be able to benefit from the national expertise and centralized approach Tenet utilizes with payer partners.
Periodically, the CHMPN may have the opportunity to negotiate narrow network or new-to-market health plan contracts which will be presented to the physician-led board for evaluation.
Why should I join CHMPN?
The CHMPN presents great opportunities to improve health outcomes for our patients. By providing care in an integrated network with providers communicating, devising quality programs, and working toward the highest quality care from the medical home to the ER, ICU, OR and beyond we can achieve improvements that can’t be achieved on our own. Since everyone in the organization is a pediatric care provider and we will be designing the programs ourselves, these quality programs and improvements are specific to our patient population and relevant to our practice life. Because of this robust focus on improved care coordination, physicians participating in the CHMPN will be eligible to obtain quality enhanced reimbursements for their achievements funded by contracted health plans. Working together in a clinically integrated network will enable us:
- Enhance the quality of patient care
- Legitimately negotiate with payers as a network
- Allow networks of physicians and hospitals to market themselves based on the quality of care they provide
- Provide access to technological and quality improvement tools and processes that will allow physicians to better coordinate the delivery of care across specialties
- Respond to health plans that use “report cards” that exclude “inefficient” physicians
What other benefits does the CHMPN participation provide?
The CHMPN is Physician led: CHMPN is run by pediatricians. Over half of the Operating Committee which runs the organization is composed of private practice pediatricians. We understand that high quality care starts in the medical home and primary care providers deliver the vast majority of the care for all the patients in CHMPN. Our goal is to meet your needs as well as the needs of your patients. We welcome your involvement in the organization and the lines of communication will always be open. Additionally, as a CHMPN provider, you will be able to take advantage of:
- Population Health Management Reports
- Care Coordination Focused on Pediatrics
- Provider Education
- Quarterly Webinars And CME Opportunities On Relevant Topics
- Access To Group Purchasing Organization at no Additional Charge
What is the clinical program and how was it developed?
The CHMPN clinical program is the cornerstone of our organization and encompasses measures that will help us improve the quality of care offered to our pediatric patients. The program was developed by our local pediatric physician board members and incorporates pediatric-specific measures that are recognized by other renowned children’s hospitals. The measures reflect nationally recognized quality standards from entities such as AHRQ’s PDI and NCQA’s HEDIS programs and focus specifically on pediatric evidence-based interventions that are important to purchasers where appropriate and applicable.
How will you collect the clinical data?
We will be implementing data solutions to assist in the data collection efforts. Vendors will work with your office staff to collect the quality coding information from your system. The information will be synthesized and reported back to you via our reporting portal which will enable you to view your performance compared to peers in your same specialty.
Is my clinical data safe?
Yes. Physicians who choose to join the Clinical Integration Organization will enter into a Physician Participation Agreement, which details the rights and obligations of both parties, including protection of the physician’s data. Additionally the data capture methodology must always include industry-standard secure transport protocols and several levels of security.
How can I participate?
Participation in the CHMPN is completely voluntary and non-exclusive. You can be a full, active member of CHMPN while still participating in other physician contracting organizations. And your existing payer contracts remain in place with your practice; CHMPH is focused on negotiating value based bonus arrangements that are in addition to the direct agreements you hold. In order to participate, physicians will need to sign a network participation agreement and agree to follow a program of clinical initiatives aimed at improving the quality and efficiency of care provided to your patients. Medical staff privileges at the Children’s Hospital of Michigan as Active Affiliate or Membership are also required.
What if I decide I no longer want to participate?
Our participation agreement has a no cause termination with a 90 day notice.
Who can I contact to learn more?
A member of the Operating Committee is available to meet with you at your office or discuss with you on the phone. You may reach CHMPN at 833-564-5073 or firstname.lastname@example.org.
- Brian Engle, MD
- Mary Lu Angelilli, MD
- Joshua Evans, MD
- Brian Gendelman, MD
- Joseph Lelli, MD
- Greg Naman, MD
- LaSharon Samuels, MD
- Lalitha Sivaswamy, MD
- Sharon Tice, MD