Vibrant Kids Pediatrics is now a member of The Children’s Care Network.
What is TCCN?
The Children’s Care Network (TCCN) is a pediatric clinically integrated network (CIN) created by a collaboration between Children’s Healthcare of Atlanta and independent community-based primary-care pediatricians and pediatric specialists. As the only pediatric CIN in the state of Georgia, its purpose is in enabling its member practices to work in collaboration with each other and with the hospital system to improve the health outcomes of patients. Member practices remain independent, while benefiting from collective engagement with third-party payors and operational cost savings from group purchasing power.
Why is TCCN needed?
The need for TCCN is summed up in three words: third-party payors. An independent practice faces numerous pressures on it as a small business, but none is more burdensome and threatening to their overall financial health as third-party payors, or simply “payors.” Working with payors places enormous financial, labor and technology costs on a practice’s operations, and coupled with payors’ hostile treatment can make remaining independent financially ruinous for the practice.
At present payors are transitioning from existing fee-for-service payment, or “reimbursement,” structures to “value-based” fee structures. Now—on the surface given the language being used—would not reimbursement based on the “value” of a practice’s services be a good thing? After all, shouldn’t a practice that provides higher quality care be paid better than one that doesn’t? This is how payors will market this to their members. However, that is not the “value” being measured in this context. Under value-based payment models, practices are being judged on their “value” to—ah! not their patients—the third-party payors. “Value” to a payor is cost savings, i.e., less money being paid out in claims. (Be warned this focus on “value” will manifest itself as payors pressuring healthcare providers to provide fewer services to their patients, i.e., a provider’s “value” increases with the fewer services billed.)
The value-based model requires a practice to statistically demonstrate that its practice of medicine among its established patients, or “patient pool,” is reducing claim costs for payors. An independent practice’s patient pool is too small to be statistically meaningful, thus the practice will have its payor reimbursements reduced as it struggles to prove sufficient “value.” The future for an independent practice is either to struggle/go out of business or sell to a large corporate/hospital-based practice group. (Don’t think this an “unintended” consequence. This is a design feature: force independents out of business or put under the thumb of “big box” corporate medicine.) TCCN offers a third option: join in a collaborative practice group that creates a large patient pool by combining the patient pools of each member practice. This large combined pool can generate statistically meaningful data, and allows the member practices to share the burden of the added data analysis/record keeping, and to “earn” the enhanced payment “incentives” offered to practice groups demonstrating sufficient “value.” (TCCN also being a large practice group forces payors to negotiate in good faith with the CIN, giving its member practices better payor treatment—well, better relative to that offered independents.)
Why join TCCN?
Our reason for joining TCCN is summarized by the reason for TCCN’s existence. We are a fiercely independent practice, and we will remain independent, continuing to provide the quality, common sense pediatric primary-care our patients expect from us. What does our joining TCCN mean to our patient families? Continuing to have the option of using payor “insurance” polices as a payment option in our clinic. For us it means even more data entry, and… committee meetings.
The need for your consent.
All TCCN member practices must submit to TCCN the claim data it submits to payors. All we need ask of you is for your consent for us to share your patient data with TCCN for pooling with the patient data from the other member practices. Your health information is your health information, and you retain your right to determine how it is used. We understand any hesitancy you might feel, and we want you to be comfortable with sharing your data. Please know the following:
- The only data being shared is the same pre-adjudicated claim data that is sent to your third-party payor for the submission of a claim—only claim data, not your medical records.
- All data is shared with TCCN electronically via secure, HIPAA-compliant software and data interfaces.
- The shared data is used only within TCCN for the purposes of statistical analysis to demonstrate the CIN’s “value,” to grade member practices’ compliance with TCCN “quality initiatives,” to observe health trends in the pooled community of patients, and to identify potential areas for improvement in patient outcomes.