Our mission is to enable physician practices in the Pacific Northwest to survive and thrive in the new healthcare environment. The vehicle for achieving that mission is a clinically integrated network of physician practices working under value-based contracts that reward practices for delivering high quality patient care in an efficient manner.
PCA keys to success:
- Engage participating physicians as leaders to drive development and operations
- Maintain favorable, value-based health plan contracts
- Deploy support infrastructure, including proven analytics and patient engagement tools
- Demonstrate quality improvement
- Reduce the total cost of care for a defined population
- Improve overall patient experience
- Reduce the administrative burden for physician practice reporting
Healthcare systems across the country are evolving to realign cost, utilization and quality incentives. The transformation in Washington State is impacting health plans, hospitals, physicians and patients. Each stakeholder is adjusting to various changes related to the Affordable Care Act, ever-increasing costs and growing employer and consumer demand. With declining margins and high regulatory uncertainty, physicians are under increasing pressure.
In 2013, in order to address the market pressures that influence the long-term viability of independent, physician-owned practices, the Northwest Medical Group Alliance initiated a study to determine the feasibility of creating a physician-led Clinically Integrated Network (CIN). A CIN is “a health network working collaboratively, using proven protocols and measures, to improve patient care, decrease cost and demonstrate value to the market”.
The Alliance determined that The Polyclinic’s Physicians Care Network (PCN) provided the best foundation for the network since it had already built much of the clinical and operational functions, staff, expertise, and experience required for its Medicare Advantage business. The CIN could leverage PCN’s long history of high quality care management and have physicians enhance and customize it for a commercial population.
In 2015, PCA was formed with significant investments from The Polyclinic, Physicians Insurance and Premera Blue Cross. PCA secured its first value-based contract with Premera with unique provisions that aligned health plan objectives with PCA goals.
Since 2015, PCA has implemented a robust population health management platform which improves patient outcomes, enhances quality reporting and maximizes shared savings opportunities. PCA has developed a practice transformation and quality program with care pathways, individualized practice support and sharing of best practices between participating groups. We now have five value-based health plan contracts with incentives that support care management and additional clinical programs. Under the guidance of strong leadership and physician-led committees, PCA has helped to improve quality across all participating groups and achieved shared savings in the first performance year in all health plan contracts.