PCCN Forms Largest Pediatric Clinically Integrated Network in Arizona

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Shared savings. Population management. Risk. Physician leadership. These are the commonly heard buzzwords in the healthcare industry today, and more and more hospitals and healthcare systems are trying to implement the concepts behind these terms within their care-delivery models.

Increasingly, hospitals and providers of adult medicine have looked to clinically integrated networks as a strategy for achieving success in these areas. For example, Phoenix Children’s Hospital in Arizona has invested nearly two years in developing a pediatric-only network, and so far, it has been a great success.

Bringing the network together

As of 2015, the Phoenix Children’s Care Network (PCCN) includes more than 800 physicians across Maricopa County, but it started with the hospital and a small group of leaders who had big ideas.

Bob Meyer, president and chief executive officer of Phoenix Children’s Hospital, said the idea for PCCN began with the need to integrate primary-care pediatricians into the hospital’s network in a manner that would provide high-quality clinical outcomes and would be financially beneficial to all parties. It also needed to have a strong contracting ability, since Arizona healthcare is primarily managed care.

The hospital employs nearly 80 percent of the pediatric specialists in the state, but it made a strategic decision against employing general pediatricians or primary-care physicians in order to focus on partnerships and not competition with private-practice physicians.

Nevertheless, while the hospital and specialists were brought on board first, it did take some time to convince the private-practice physicians to join in.

“Historically, there has been distrust between private-practice physicians and the hospital, as well as between primary-care and specialist physicians,” Meyer said. “We have had to engage all parties and build a level of trust before moving forward.”

Meyer found that with the hospitalist movement, many pediatricians stopped coming to the hospital to check on their patients. However, they still wanted to follow the care of their patients. The first part of opening a dialogue was to talk about collaboration, listening to their concerns and developing quality measures.

“With our first core group of about 60 primary-care pediatricians, we developed internal metrics and quality goals,” Meyer said. “Then those physicians were out recruiting on behalf of the network.”

Creating the governance model

In addition to the quality focus, the operational and governance structure were important to growth.

Ultimately, the hospital is the sole corporate member of PCCN. However, physicians make up the majority of the board of directors. By having a self-governance model, the physicians were not asked to put up any capital, which had been a sticking point in the past. Nor were they asked for exclusivity, as is demanded in Medicare’s accountable-care organizations.

“We listened to the physicians in building this network,” Meyer said. “We wanted participation to be their choice, which is why we didn’t demand exclusivity.”

Looking ahead to leverage the network

Now that the network has grown and shown success, payers are excited about working with PCCN. The network has two shared-savings contracts with two of the larger Medicaid contracts in the state. It is also working with commercial payers to establish partnerships.

The network has also partnered with Arizona Care Network (ACN), an adult-focused clinically integrated organization led by physicians and owned by Dignity Health and Tenet/Abrazo, to have an adult-care partner to broaden the contracting network.

With all of this integration, there is more data flowing in, allowing physicians a more complete picture of what’s happening with each child. The hospital and PCCN have worked to integrate the electronic medical records across all practices in the network to make this data merge more easily.

The group is also looking at other ways to improve care for the area’s children, as well as provide opportunities for physicians. Phoenix Children’s Hospital has about 40 residents that graduate every year. About half go into subspecialty training, and the remaining are looking for jobs in the area.

Meyer sought to leverage the network to help place those graduates without the hospital having to become an employer of primary-care pediatricians.

“Our main competitor was hiring many of these graduates, and we needed to see how our existing practices could grow and accommodate these new physicians instead,” Meyer said.

The initial conversations were not quite what Meyer was looking for.

“The first time we talked about the need to employ these residents, it was a pretty negative discussion,” he said. “However, we were eventually able to open it up into a dialogue. We now seek to find employment opportunities with our existing partners for the 10 or so graduates we want to keep. This will be a positive for our network in the long run.”

PCCN plans to keep building on its success in contracting and quality, pushing out the initiative to other cities in the state. It is currently the largest pediatric-dedicated clinically integrated organization in the state and one of few available in the United States.

-by Patricia Chaney

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