Frequently Asked Questions
Q: What is clinical integration?
A: Clinical integration is a structured partnership between community and employed physicians and hospitals to enhance and progress ongoing clinical initiatives designed to add value to the quality and efficiency of healthcare services.
Q: What does a clinically integrated organization look like?
A: A Clinically Integrated Organization (CIO) involves independent physicians, along with those from CIO member Provider Organizations joining together to form a coordinated provider network. At GQPA, this collaboration allows us to:
- Identify and implement best practices for the treatment of patients
- Develop systems to monitor performance against adopted metrics
- Collaborate with GQPA member hospitals to improve processes of care across the continuum
- Enter into contractual arrangements with health plans that are cognizant of physicians' efforts to become more efficient in delivering high quality care
Q: Are physicians involved in the development of policies and leadership of GQPA?
A: Yes. GQPA is governed by a Board of Managers which is comprised of physicians representing the participating organizations. Additionally, the Executive Committee, the Quality Committee and the IT Committee (all reporting to the Board of Managers) will have physician membership.
Q: What benefits do health systems provide in the development of clinical integration programs?
A: Benefits provided by health systems include:
- Enhanced performance on payor arrangements
- Reduction in utilization/cost for DRG services
- Should the hospital (with GQPA's assistance) achieve its goals of improving quality and patient outcomes while reducing cost, it will improve both its operating margin and its ability to negotiate commercial payor rates that include performance incentives (facility and/or professional)
- Reduced outmigration based on enhanced quality and efficiencies created in hospital-based facilities by GQPA
Q: Are members of GQPA required to participate in all contracts entered into by GQPA?
A: Yes. GQPA members participate in all GQPA contracts.
Q: If I want to send my patient to a non-GQPA physician or facility, what is the prior authorization process for these referrals?
A: The prior authorization process can be managed by each GQPA partner using protocols established by GQPA or by a third party which follows GQPA guidelines. Out-of-network referral rate will be a closely monitored metric for all GQPA physicians.
Q: Do all GQPA member physician practices need to have an Electronic Medical Record (EMR) system to participate?
A: No. But, in the absence of an EMR data feed, the completeness of each participant's claim submission will be evaluated to determine if their quality metrics can be accurately calculated and compared to aggregated quality metrics across all GQPA members.
Q: How will member physician practices share clinical and administrative data with GQPA?
A: Members with EMR data will need to work with GQPA and with Optum to map EMR data to the common Optum format. Optum already works with many EMR vendors, so depending on the EMR system in place, the mapping exercise may not be that extensive. Once mapping has been established, members will share EMR data with Optum through a secure staging server set up at the client's site. Independent practices have the option of uploading claims through a secure Website.
Q: What is the duration of the agreement with GQPA?
A: The standard agreement with GQPA is perpetual with the option to terminate with 90 days written notice.
Q: What is the cost to join GQPA?
A: There is no cost to join GQPA. Fees may be charged to provide data to Optum, our data aggregation and reporting vendor.
Q: How will quality be measured for practices and providers in GQPA?
A: GQPA has defined 88 unique quality metrics across 23 specialties to continually measure the quality of the services provided by member providers.