In the eyes of these regulatory bodies, “meaningful” clinical integration is achieved when a network of healthcare providers’ investment of intellectual, physical and financial capital results in the establishment of a more competitive, higher quality healthcare product that can be offered to interested healthcare consumers and payers in the communities that the providers serve. When a network demonstrates that it is likely to increase competition in its relevant healthcare marketplace, initially through its business plans and strategic investments but over time through measureable improvements in key indicators of quality, patient satisfaction, and cost-efficiency, the FTC and DOJ have ruled that the network may be justified in engaging in joint contracting efforts, even if the network includes otherwise competing independent and/or employed physicians. Given this fact, in addition to being an opportunity for providers to optimize patient care, clinical integration can also be a means for physicians to realize fair reimbursement for the investment of time and effort that they dedicate to effecting positive change in the healthcare delivery system.

In many instances, a clinically integrated network is made up of one or more hospitals or hospital systems and a select group of the employed and independent physicians on the hospitals’ or health systems’ medical staffs. Typically, these parties work collaboratively to:

• Coordinate care across providers and sites-of care;
• Plan and implement initiatives that will promote evidence-based medicine and patient-centered healthcare;
• Address quality, cost, and/or utilization of healthcare services in and across the inpatient, outpatient, and physician practice settings;
• Enable participating providers to deliver and demonstrate optimal quality performance and clinical outcomes;
• Position all parties for financial sustainability; and
• Enter into physician-directed "pay-for-performance" and other contractual arrangements with health plans in a way that financially recognizes the physicians' efforts to improve health care quality and efficiency, as long as they remain in compliance with FTC and DOJ guidance and precedent.

No. At this time, Sequent is not planning to apply for participation in the MSSP as an ACO. That being said, the CIN will be developed with the flexibility to quickly transition to a MSSP ACO should participation be advantageous to the CIN’s participants, or should participation be mandated in the future.

All of this said it is important to note that the ultimate direction of Sequent is not controlled by GHS. Sequent is physician-led and professionally managed. Sequent is governed by a Board of Managers comprised mainly of physicians; 11 physicians and 4 GHS administrators. The physician representatives on the Board of Managers include independent and employed physicians, and represent primary care, medical, and surgical specialties. The Board of Managers oversees a number of physician led committees and sub-committees that, for all practical purposes, determine the direction of Sequent.

Participation in Sequent is likely to benefit physicians and their practices in a number of ways. In general, we believe that participation in Sequent will be the most effective way for independent practices to position themselves for success as healthcare reform legislation continues to be implemented and healthcare reimbursement transitions towards value-based payments. Participation in Sequent will provide physicians and their practices, especially independent physicians and practices, with an increased ability to influence their own destiny. From a leadership perspective participating physicians and practices will play an active role, directly or indirectly, in defining the future not only of Sequent but of GHS and the local/regional healthcare delivery system as a whole. 

One way your practice expenses can be aided by participation in Sequent is through our group-purchasing power for benefits for yourself and your employees. 

From a clinical care perspective, Sequent will provide physicians and their practices with the infrastructure to increase care coordination across providers and sites-of-care; define and successfully implement proactive population health initiatives; educate, engage and increase the compliance of their patient populations; and track and monitor their performance in regards to indicators of healthcare quality that are meaningful to the patient populations being treated in the inpatient, outpatient and practice settings. From a financial perspective, Sequent intends to provide physicians and their practices with access to incremental revenue streams as well as opportunities to decrease practice expenses; within legal and regulatory constraints. In addition, participation in Sequent will better position physicians and their practices to accommodate value-based forms of reimbursement including risk-bearing contracts should this ever be necessary. From an operational perspective, Sequent will provide physicians and their practices with access to resources and best practices to help them adapt to the ever evolving healthcare environment.

Yes. Sequent was developed as a clinically integrated network specifically to allow for the participation of employed and independent physicians.

No.

The PHO has served the needs of this community’s physicians for years but healthcare is changing and so must the PHO. For all practical purposes, Sequent (the CIN) is intended to represent the next generation of the PHO. Sequent is the result of a shared vision amongst Gwinnett Health System and over thirty-five employed and independent physician leaders to bring a more coordinated, comprehensive and competitive healthcare product to the communities and patients that they serve. Sequent is a proactive response to the continuing implementation of federal healthcare reform legislation as well as the ongoing evolution of the regional healthcare marketplace. As such, Sequent is intended to position its participating providers, whether they are employed or independent, to become increasingly competitive in their communities and to thrive in an accountable and value-based healthcare environment. To do so, Sequent will provide participating physicians with access to the management, staff, information technology, performance improvement and intellectual resources to help them not only to demonstrate but also to continuously improve the quality and cost effectiveness of care that they are delivering to patients on a day-to-day basis. As Sequent proves its business case, the organization will also serve as the contracting vehicle for participating physicians to engage in joint contracting* with payers and self-funded employers who are interested in providing their beneficiaries and employees with access to a high value healthcare network.

Sequent will charge its participants a $350 annual fee for each participating physician. For physicians currently participating in the PHO (GMC), this fee will be in addition to the annual PHO fee.

Currently GMC offers messenger model contracting, credentialing and educational services to its participants. During the transition phase, GMC will continue to provide these services for members of the PHO and the CIN. This is why we feel that continuing the $350 PHO fee continues to be justified for the next year and potentially for some time thereafter. That said, as services are transferred to the CIN over time, we will reassess the appropriate PHO fee.

Sequent’s leadership feels that an additional fee is warranted due to the significant additional benefits that the organization will be providing its participants. In addition to the services which the PHO is currently providing to its participants, the CIN will offer physicians who commit their time and effort to the furtherance of the organization’s Mission and Vision with access to information technology, population health resources and joint contracting services not currently provided by GMC.

While the details of the merger between GHS and Northside are just beginning to be discussed, it is clear that Sequent will play an important role in helping the collective organizations prepare for changes in the healthcare environment. Northside does not have a clinically integrated network (CIN) and they have expressed their commitment to the ongoing development of Sequent and its operations. The potential to combine Sequent's efforts with the physicians in the Northside medical community expands the reach and impact the CIN can have on integrating physicians across a much larger region and improving the coordination of care.

We believe that participation in Sequent will be the most effective way for independent practices to position themselves for success as healthcare reform legislation continues to be implemented and healthcare reimbursement transitions towards value-based payments. We know that Sequent is not the only option for independent physicians in our communities but we do feel that it is the best option for our colleagues and our communities. As compared to other options that physicians may be considering, Sequent’s unique set of benefits includes:

• Physician leadership and professionally management;
• Supported from a known entity (GHS);
• Local accountability;
• Community focus;
• Access to population health & chronic disease management resources;
• Access to information technologies to support clinical information exchange, coordination of care & ongoing quality improvement initiatives;
• Potential to capture incremental revenue streams;
• Access to group-purchased medical and other insurances for you and your employees;
• Incentive payments*;
• Joint contracting (commercial)**;
• Positions practices to accept risk in the future (if necessary or desirable).

*Performance based incentive payments must be earned by MDs

**Within all relevant legal and regulatory constraints