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A Clinically Integrated Network (CIN) is an arrangement that allows Shore Medical Center and area physicians to clinically integrate with the objective of improving the quality and cost-effectiveness of patient care while remaining independent entities. A CIN is usually a separate legal entity that enters into contracts with insurers to reward providers for improvements in the quality and cost-effectiveness of care. Clinical integration aims to coordinate care across settings, providers and conditions by establishing and implementing policies, procedures, and protocols to improve and continually assess the cost and quality of care by investing in IT infrastructure, and otherwise striving to achieve “real” clinical integration.
In general, any physician who is qualified and eligible for membership on the medical staff of SMC can join Shore Quality Partners. Physicians must also: (a) be duly licensed, without restriction, to practice medicine and surgery and be in good standing under the laws of New Jersey; (b) not have ever been convicted of, or entered a plea of guilty or no contest to, any felony, related to the practice of medicine, controlled substances, illegal drugs, or violence, and must not have ever been excluded, debarred, or suspended from participation in any governmental sponsored program, including, but not limited to, Medicare or Medicaid, and (c) meet such other qualifications and/or requirements established by the Board of Shore Quality Partners from time to time.
Medical Center Benefits
Shore Quality Partners is in discussions with several key payers in the region and aims to engage a number of commercial health plans who would be interested in contracting with Shore Quality Partners to reward providers who are truly clinically integrated, and provide high quality and low cost care to patients. SMC also manages its self-insured employees through Shore Quality Partners and seeks to reward those physicians who meet quality and cost efficiency goals.
Physician participants will continue to be paid through their individual or practice payer contracts, while Shore Quality Partners focuses on obtaining bonuses, care management fees and other incentive compensation payments from payers that will reward Shore Quality Partners and its providers for achieving agreed upon performance results. This contracting approach minimizes the level of change required to physician practice operations, while at the same time allows physicians to actively participate in Shore Quality Partners’ contracts.
Initially, Shore Quality Partners pursue shared savings and pay-for-performance contracts, but could eventually pursue various other types of arrangements including, but not limited to, bundled payments, accountable care and direct contracting with self-insured employers, if those arrangements are approved by the Board of Directors