Realizing PAMED’s Long-Standing Vision

John Pagan, MD, MBA Chair and CEO at Pennsylvania Collaborative (PACN)

General Surgeon, Upper Bucks County

The Care Centered Collaborative (CCC) subsidiary of the Pennsylvania Medical Society (PAMED) has come a long way from the vision of the PAMED House of Delegates (HOD) over a decade ago that urged our physicians and PAMED to “Get in the Game” of quality and value as the healthcare paradigms and payments shifted:

“The Pennsylvania Medical Society (PAMED) must position physicians to lead and shape health care delivery to assure that the evolving system provides quality and value to patients and the community.”

Subsequently, our PAMED HOD took a bold step beyond any other state medical society and committed resources to establish the Practice Options Initiative (POI):

“For decisions that are imbued with clinical care significance, it is imperative that physicians have substantial and direct participation with real power to influence the outcome. In many cases this requires that we lead the initiative. . . The Pennsylvania Medical Society supports the development of the POI to explore collaboration among physician-led networks and enable engagement by physicians of all practice types.” – 2016, Practice Options Initiative

The PAMED HOD POI formed the Care Centered Collaborative and later its underlying Pennsylvania Clinical Network (PACN). The PACN allows quality-minded practices to collaborate to approach payors for access to value-based care and quality recognition programs that are otherwise unavailable to these practices. Importantly, PACN-member practices retain their independence to choose where and how best to serve their patient populations while linking together through a common population health data infrastructure. Over time, these practices gain the tools needed to not only survive but also to thrive in a value-based payment world. Most significantly, this bold PAMED vision provides Pennsylvania physicians and their patients with an alternative rather than consolidating into larger megahealth systems. Even physicians in employed settings can benefit from this alternative by recognizing that there are choices of practice models.

Unlike any Other Clinically Integrated Network

A clinically integrated network (CIN) is a collaborative organization of healthcare professionals and facilities that work together to improve patient care quality, reduce costs, and enhance patient outcomes by considering the care not only of the individual patient but also the populations and cohorts of similar patients in a practice.

The PACN is designed to promote the integration of care across different healthcare settings and physician offices and is composed of Pennsylvania physicians and other health care professionals who have agreed to work together and share information in order to improve patient outcomes.

The goal of a CIN is to provide patients with highquality, cost-effective care by coordinating care across all aspects of the healthcare system, while also creating a sustainable business model for clinicians. CINs typically use data aggregation and technology, and care management insights to identify best practices and ensure that patients receive appropriate care at the right time, in the right setting, and by the right healthcare professional.

The PACN was uniquely structured from inception and is the only known statewide, state medical societysponsored clinical network. Since physician-led networks have better success in achieving savings and improving quality scores with better efficiency than non-physicianled organizations, PACN physicians self-govern through a robust committee structure guided by physician leaders on its Board. This unique governance is not top-down or dictated by non-clinical administrators or investors but rather by physicians of varying perspectives and talents.

Participating practices agree to coordinate their electronic medical record (EMR) of choice with the common data backbone of the PACN which marries the clinical data of the practice with claims data to ultimately crosscheck against an insurer’s quality recognition metrics. The data aggregation infrastructure is often the most challenging and costly hurdle to forming a successful clinically integrated network. PACN monthly dues are significantly discounted for PAMED-member practices.

PACN Enters the Quality Game

The PACN is a relative newcomer to the quality arena and began quality contracts with insurers in 2020. Through the PACN’s connection to one of those payors, Highmark, PAMED-member independent practices received nearly $4 million in the Community Cares Grant funds to improve care of their respective communities in 2021.

PACN practices have additionally received over $2.5 million from commercial payers for the quality care they provide.

Celebrating our members with milestone years of medical service

The PACN also formed an Accountable Care Organization (the PACN-ACO) to participate in the 2022 Medicare Shared Savings Program (MSSP). This upsideonly CMS ACO will further grow the PACN’s practice and network quality expertise while providing yet another opportunity for our physicians to gain recognition for the quality care they provide. ACO participation is a de facto rite of passage for any integrated quality network on the long journey towards eventual risk contracting. The knowledge and experience gained in 2022 will serve the PACN-ACO, PACN practices, and most notably the network patients well in 2023 and beyond with increased resources for additional care management support tools.

While the majority of the PACN practices are in primary care, several specialist practices lend expertise and perspective to the network including GI, Allergy, pathology, ophthalmology, rheumatology, and others.

We’ve Only Just Begun . . .

The preliminary CCC successes demonstrate proof of concept and realization of a PAMED dream over a decade ago that Pennsylvania physicians can succeed in their practice model of choice when committed to data sharing and constant improvement. In addition to discounted liability insurance options, custom care management support tools, discounted data connection fees with certain EMRs, and other clinical and administrative practice support benefits, the value of the PACN is best captured in the words of its own physicians.

The below is from and internist after the very difficult COVID pandemic year in 2021:

“If it were not for the PA Clinical Network and their efforts, our office would not have finished 2021 above water. I would like to thank the quality team for their hard work with my office and for helping us to improve our focus on performance measures as healthcare transitions from fee for service to quality. Once again, thank you!”

And from a PACN family physician in 2022:

“Since converting to an independent practice, I feel my connection with patients has grown and my job satisfaction has grown. Additionally, I have found that my overall financial compensation is not much different despite working less hours and seeing less patients. I believe that the PACN is singularly focused on making sure I am successful.”

Going forward, further data enhancements and analytics will better guide our physicians to focus care on their most vulnerable populations and concurrently identify the many social determinants that influence the health of individuals and populations. For more information, please see: https://paclinicalnetwork.com/practices/ faq/