The University Hospitals (“UH”) Quality Care Network is a clinically integrated network (“CIN”) of UH employed and independent providers. Providers work together to improve the health of populations and the quality of care, as well as to reduce costs. The high-value network is the choice for population health and accountable care.

A CIN is a network of providers, such as physicians, hospitals, and post-acute care treatment providers, that work together to improve patient care and reduce health care costs. A CIN relies upon clinical protocols and evidenced-based practices to enhance care coordination.

The Federal Trade Commission and the Department of Justice define a CIN in their Statements of Antitrust Enforcement Policy in Health Care as: “...the network implementing an active and ongoing program to evaluate and modify practice patterns by the network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.”

University Hospitals is a national leader in population health management. The UH Quality Care Network will be the network of providers for the UH Employee Medical Plan and the network will be supported by population health services from our UHACO.
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The UH Quality Care Network providers will be supported by the UHACO infrastructure and analytics to implement clinical protocols. The UH Quality Care Network and the UHACO will work together to further expand our capabilities with network providers and population health management.

Providers are seeing rapid changes in the way that health care is being delivered along with an ever-increasing need to work together to obtain improvements in the health of populations, the satisfaction with care and the overall cost of care. The UH Quality Care Network offers the opportunity to:

   + become involved in the development of evidence-based guidelines;
   + leverage individual and group quality data to improve practices;
   + discover ways to transform and improve patient care through innovation; and 
   + become a part of a network aimed at bringing high-quality care across various industries.

The UH Quality Care Network is a physician-led organization with representation from both independent and employed physicians. There is physician leadership to ensure that quality measures and clinical protocols, which rely upon evidenced-based care guidelines, are appropriate and meaningful. The UH Quality Care Network is a high-value network that understands the role of physician leadership.

Providers sign a participation agreement that acknowledges commitment to work with other network providers in this ongoing effort to improve quality and manage the costs of care.

As part of the UH Quality Care Network, providers are expected to:

   + collaborate and share information;
   + participate in the development of evidence-based guidelines and implement them in their practices;
   + use quality information, dashboards and population health to support clinical integration programs.

In-network referrals are critical to ensuring the maximum effectiveness of the UH Quality Care Network. As part of joining the UH Quality Care Network, providers are expected to refer covered individuals to the UH Quality Care Network providers whenever medically appropriate for all covered services that the provider himself / herself does not provide.

Certain exceptions to this guideline exist. These exceptions are:

   + the patient expresses a preference for another provider;
   + a patient’s insurance requires use of another provider; or
   + the use of a UH Quality Care Network provider is not in the patient’s best medical interest as determined based upon the provider’s medical judgment.

The UH Quality Care Network may participate in or enter into agreements under which UH Quality Care Network:

   + participates as part of an agreement where providers may be eligible to share in achieved savings or receive quality incentives, and are reimbursed for covered services under their existing, direct contracts with insurers and payers; and/or
   + providers may choose to accept financial risk arrangements where the UH Quality Care Network is responsible if financial targets are not achieved.

The UH Quality Care Network will work with your current electronic medical record and data analytics system to provide practices with quality data that can improve implementation and adherence to clinical quality protocols, and ultimately reduce health care costs. UH and CliniSync, Ohio’s statewide Health Information Exchange (HIE), managed by the nonprofit Ohio Health Information Partnership, announced UH clinicians are the first in Northeast Ohio to have access to the Community Health Record through CliniSync’s single sign on technology. All participating UH Quality Care Network providers have the option to utilize CliniSync as an easier way to coordinate patient care among other providers.

This is a nonexclusive network of providers that are committed to quality improvement. Providers are permitted to be in other clinically integrated networks if they choose.

No, there is no cost to join the UH Quality Care Network. Clinical integration requires substantial investment of time and effort to develop and implement evidence-based guidelines, work with our clinical integration programs, and participate in the UH Quality Care Network activities and governance.