What is Clinical Integration?

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 (UM QCN) 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.

What does the UM QCN 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 UM QCN 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 UM QCN 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 UM QCN. 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 UM QCN 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 UM QCN, will physicians have to abandon their current payer contracts?

No. Providers may maintain direct contractual agreements with payers, particularly those with which the UM QCN does not have an agreement. In some cases a payer may require each provider to have a direct agreement in addition to the UM QCN’s agreement. However, a payer agreement into which the UM QCN enters will supersede any individual payer agreement with that payer.

For more information, please contact:
Patrick Dooley
VP, Executive Director, UMMS Population Health
410-328-6047
pdooley@umm.edu