The Lee PHO has established a Clinical Integration Program.
This voluntary, collaborative effort between Lee PHO, its member physicians and Lee Memorial Health System has been developed to help better align care between health care providers.
The ultimate goal is to improve health outcomes and reduce the cost of patient care. This is possible through improved care coordination, active and ongoing management of chronic diseases and physician leadership and participation in clinical quality improvement initiatives. The Clinical Integration Program
(CI Program) will also incorporate performance based payments for participating physicians based on quality and cost measures. It’s better health care for all – patients and providers. This is the right care, in the right place, at the right time and for the right cost.
Physician involvement in the decision-making process is essential as we develop common goals, guidelines, operational framework and performance measures and monitoring for the CI Program. After all, it’s physicians who will be on the front lines driving and leading a clinically integrated physician hospital organization.
The existing Lee PHO Operating Committee, a 15-member committee that includes a minimum of 12 physicians, governs the
CI Program and is supported by physician-led subcommittees. Lee
PHO physicians will have an opportunity to contribute to committees and work groups, as well as take part in education and training.
The Lee PHO Operating Committee has adopted the following vision and guiding principles:
Our Vision: To develop advanced care management capabilities across the PHO network that will:
§ Improve the coordination and quality of care provided to the community, thereby lowering costs and improving the health status of the community.
§ Position the provider community for continued success and stability as health care transitions to value-based payment models.
Our Principles:
§ Performance metrics must be meaningful and related to the goals of the health plan and should not incentivize a reduction in care.
§ All initiatives should foster care coordination, improved quality and cost efficiencies.
§ The program must deliver value to patients, as well as the health plan.
§ The distribution model will be fair and balanced among program participants and not be based on volume of services or value of referrals.
§ A portion of any of the program’s derived savings should be reserved to fund the CI Program’s operations.
§ All compensation arrangements will be reasonable, consistent with fair market value, and consistent with applicable laws.
Contracting is a necessary step in achieving clinical integration.
Initially, the CI Program will serve members of the
Lee Employee Health Plan (LEHP), which is offered to eligible Lee Memorial Health System employees and dependents. Lee PHO physicians participating in clinical integration will continue to receive fee-for-service payments under the
LEHP contract with an opportunity to earn performance based payments for meeting quality and cost targets.
In the future, the Lee PHO may expand the CI
Program to other patient populations and other payors, including commercial insurers, government plans (e.g., Medicare Advantage) and self-insured employers. Some contract arrangements may be based on payment methodologies other than fee-for-service.
8250 C OLLEGE P ARKWAY , S UITE 103     Ÿ F ORT M YERS , F LORIDA 33919 Ÿ P: (239) 466-6700 Ÿ F: (239) 466-0008