What is Clinical Integration?

Clinical integration is a concerted effort among physicians and a hospital/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 assume shared responsibility for the care of a defined population of patients and contract as one entity with payers.

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.

Are physicians involved in the development and leadership of the UM QCN?

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.

What will physicians need to do in order to participate in the UM QCN?

  • 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.

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 with 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.

As a patient of a UMQCN physician or care team, how can I submit a complaint?

Tell your physician or care management team about your concern. If you believe further action is needed and a complaint needs to be submitted take the following steps:

  • Patients have the ability to submit written or verbal complaints in person or via one of the complaint intake methods – Phone or Online. Please provide information needed including demographics, department/parties involved and the nature of the complaint using one of the following methods:
  • Phone:
    • UMQCN Phone Line: 1-833-UMMS- QCN
    • UMMS Compliance Hot Line: 1-833-5-TELL-US
    • Patient Advocate: 410-328-8777 or Deaf-Friendly Videophone: 410-650-4213
    • Maryland Office of Health Care Quality: 410-402-8016
  • Online through the UMMS Webline