More than 1,100 Georgia pediatricians have joined a new physician-led network that aims to improve quality of care and eventually contract for payments from insurers.
The sign-ups so far represent roughly one-third of the total number of pediatricians practicing in the state.
Children’s Healthcare of Atlanta helped create the nonprofit entity, called the Children’s Care Network.
Dr. Robert Wiskind, an Atlanta pediatrician who is the network’s board chairman, told GHN recently that members will share national “best practices’’ of medical care, such as identifying which children with concussions need to get a CT scan.
The doctors, who practice in the Atlanta region, will also share data on how the care they each give to kids compares with the care given by their peers.
The creation of the Children’s Care Network comes at a time of dramatic change in the way medical providers are paid for their services.
Medicare and private insurers are now emphasizing reimbursement based on quality of care, rather than just paying according to how many procedures are done. That’s known as a “value-based’’ model.
At first, the Georgia network will seek a payment bonus from insurers if members meet quality-of-care standards, Wiskind said.
The next step may be providing medical services to children for a fixed fee.
“At some point, once clinically integrated, we may take on [financial] risk,” Wiskind said. “We’re gearing up to be a value-based provider.’’
Wiskind pointed to a pediatric organization in Columbus, Ohio, as a model. Nationwide Children’s Hospital in that city runs a large pediatric accountable care organization, managing the care of 300,000 children on Medicaid through its Partners for Kids organization.
The pediatric organization is set up as a “clinically integrated network,” which can allow physicians to maintain their independence while taking advantage of their strength as a group.
Chris Kane, a consultant with DHG Healthcare, says that model “is appealing to physicians and hospitals because it can enhance the coordination of care yet maintain the autonomy of the parties.”
Children’s Healthcare, “with its excellent reputation and scope of services, is a natural partner in the network,” Kane said.
And James Edwards, senior vice president and managing director of SunTrust Medical Specialty Group, added that when such networks work well, “they increase quality [of care] for patients.”
These clinical networks can deliver savings on buying supplies, equipment and insurance for physicians, and boost members’ negotiating clout with insurers, Edwards said.
“We see it as a positive when they’re put together the right way.’’