Frequently Asked Questions
Q: What is Clinical Integration?
A: Clinical integration is an effort among physicians, often in collaboration with a hospital or health system, to develop active and ongoing clinical initiatives that are designed to control costs and improve the quality of health care services. The University of Maryland Quality Care Network (UMQCN) is a clinically integrated network of providers that have shared responsibility for the care of a defined population of patients and can contract as one entity with payers.
Q: What does the UMQCN actually look like?
The UMQCN includes both employed and independent physicians. The network uses a “medical home” model most often led by a primary care physician. The UMQCN also includes other providers, including hospitals, skilled nursing facilities and home health.
Q: Is the UMQCN compliant with the Federal Trade Commission’s (FTC) definition of clinical integration?
Yes. The UMQCN is managed in compliance with the FTC’s clinical integration guidelines and other regulatory requirements. Maintaining clinical integration through an FTC-compliant program provides a means for the QCN to comply with antitrust regulations regarding arrangements between economically independent providers.
Q: Are physicians involved in the development and leadership of the UMQCN?
Yes. The UMQCN is governed by a physician-led board for the explicit purpose of implementing a clinical integration program and participating in value-based contracts. The board is comprised of a majority of physicians participating in the UMQCN. Of these physicians, the majority are primary care physicians.
Q: What will physicians need to do in order to participate in the UMQCN?
- Sign a Participation Agreement and Business Associate Agreement.
- Collaborate with their colleagues and the UMQCN in developing and adopting clinical initiatives designed to enhance the quality, service, and cost effectiveness of patient care.
- Review quarterly reports to understand how the practice and its providers compare with benchmark information.
Q: By agreeing to participate in the UMQCN, will physicians have to abandon their current payer contracts?
No. Providers may maintain direct contractual agreements with payers, particularly those which the UMQCN does not have an agreement. In some cases a payer may require each provider to have a direct agreement in addition to the UMQCN’s agreement. However, a payer agreement into which the UMQCN enters will supersede any individual payer agreement with that payer.
For more information, please contact:
Senior Director, Population Health Management