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Frequently Asked Questions

What are the benefits of participating in the PathfinderHealth ACO?

Benefits of collaboration and participation in Pathfinder Health include:

Collaboration and Coordination – Ability to strengthen the provider community through collaboration and coordination to enhance healthcare for Northern Arizona residents across the entire continuum of care.

Physician-Driven Initiative – Opportunity for physicians to take on a leadership role (i.e., ACO Steering Committee, Organization/Governance Work Group, Clinical Leadership Work Group, Network Development Work Group, IT Work Group, and Finance Work Group) in the design, development, and deployment of the Pathfinder Health ACO, ensuring that the model meets the needs of both the physicians and the patients they serve.

Information Technology – Access to shared IT infrastructure support and reporting to help transition from volume to value and reduce duplication across providers.

Common Performance Measures and Reporting – Development of common quality and other performance measures and reporting capabilities for the patient population.

Funds Flow That Aligns Hospitals, Physicians, and Payors – Potential to develop shared savings or other payment model that aligns incentives of physicians and hospitals.

Clinical Protocols and Work Flow Customization – Use evidence-based medicine to create standardized clinical protocols and access to decision support tools to manage the patient population.

Robust Provider Network – Participate with a network of like-minded primary care physicians, specialists, hospitals, and other facilities and providers across Northern Arizona.

How do I enroll?

To enroll a provider needs to sign the Participation Agreement. Practices that already have a single signature authority set up may have one person sign for all their providers.

If a practice would like to take advantage of the single signature option they must provide a copy of their resolution showing that the signature authority listed is an approved signatory for that group.

What qualifies you for membership?

To become a member a provider needs to meet eligibility requirements as set forth in the Operating Agreement and sign the Participation Agreement. These can be found on the Documents page

Is PathfinderHealth the same company as Northern Arizona Quality Healthcare Collaborative (NAQHC)?

No PathfinderHealth and NAQHC have merged.

How will my data be accessed and collected?

Pathfinderhealth will be collecting data via claims, Athena and Cerner clinical data. In the near future, a Cerner population health platform will be implemented to interface with ambulatory practices in the community.

What happens if I don’t meet quality standards?

Those providers who are below the quality benchmarks chosen will work with a technical team to review their data to confirm it is adequate and accurate, then a liaison from the provider’s practice will be contacted to ensure the documentation and coding are adequate and accurate; once these steps are taken and the data is confirmed as good the provider will be referred to the Performance Metrics Committee for remediation/education. Providers who consistently fail to meet the quality metrics and standards for their specialty face the possibility of having their membership in PathfinderHealth revoked.

Will the hospital subsidize my EMR?

Stark rules state that the hospital can only subsidize an EMR system for those practices which do not currently have a certified EMR system. Any practice who already has a certified EMR system in place cannot receive a subsidy.

How long are the Board of Managers terms?

1-3 years

What is the reserve power of NAH?

NAH is the sole equity member of PathfinderHealth and will be responsible for all expenses associated with the establishment of the group and obtaining approval by the FTC. Substantial resources will be required to cover legal and consultants fees. PathfinderHealth is structured as a disregarded entity (a business considered separate from NAH for liability purposed but the same as NAH for tax purposes). Since PathfinderHealth will fall under NAH’s 501-(c)-(3) designation, certain reserved powers must be held by NAH to meet its legal obligation as a tax-exempt hospital. To ensure that PathfinderHealth remains a physician-designed and managed entity, physicians were a substantial majority on the Steering Committee that created it and are a substantial majority on the Board of Managers going forward.

What is an "Accountable Care Organization"?

An ACO is a network of physicians, hospitals, and other healthcare providers that share responsibility for providing coordinated care to patients while being accountable for improving care, quality, efficiencies, and the health of the population while reducing costs. ACOs are typically thought of as being related to Medicare shared savings programs, but they may also be created to manage commercial or other populations.

What is PathfinderHealth ACO?

Pathfinder Health ACO is a physician-driven integrated care delivery system being developed by community providers and Northern Arizona Healthcare (NAH) to improve the value of healthcare to the community. The Pathfinder Health ACO seeks to encourage collaboration and coordination among the provider community with the goal of creating a healthier community, improving quality, and effectively managing the overall cost of healthcare services for Northern Arizona.

Will PathfinderHealth require me to place my fees at risk in some sort of withhold or capitation model?

No. While PathfinderHealth utilizes many of the same quality improvement and medical management techniques that would allow for effective management of capitalization, it does not require the use of withholds or capitation.

Does this mean that PathfinderHealth will guarantee better contracts for doctors?

No. PathfinderHealth allows participating providers to lawfully negotiate contracts with health plans on a collective basis. Whether this results in higher reimbursement rates for PathfinderHealth members will depend on the organization’s ability to achieve improved quality and efficiency through its clinical initiatives and standards. Payers may be willing to pay more for these quality and efficiency improvements, which will differentiate PathfinderHealth from other provider organizations in the area.

Are physicians involved in the development and the leadership of PathfinderHealth?

Yes. PathfinderHealth is developed and governed by physicians. Identified physician leaders from the community, along with NAH’s leadership, worked together to create this new, independent provider network. PathfinderHealth will be governed by a board composed of physicians and will operate for the explicit purpose of developing and implementing a Clinical Integration Program. Provider members will be expected to lead or otherwise participate on subcommittees tasked with developing and overseeing key components of the program.

How will Northern Arizona Healthcare facilitate the development of PathfinderHealth?

Partnering with a hospital, like NAH, can provide distinct advantages to a network of independent providers in the development of clinical integration. In instances where the hospital shares the same quality vision as the providers, the hospital can be a powerful ally in program development by:

  1. collaborating with the providers in the development of clinical integration initiatives based on existing inpatient quality measures;
  2. lending financial assistance and personnel in the implementation of inpatient and outpatient initiatives that provide true community benefit and are not tied to the volume or value of referrals; and
  3. demonstrating to payers that the clinical integration program provides tangible value in the form of improved quality and efficiency.

What will providers need to do in order to participate in PathfinderHealth?

Because membership in PathfinderHealth will be completely voluntary, providers will need to choose whether they will participate in the program by signing a Participation Agreement. Participating providers will be required to collaborate with their member colleagues in the development and adoption of the clinical initiatives that will enhance the quality, service, and cost-effectiveness of patient care. Providers will need to hold themselves and each other accountable for compliance with the initiatives of PathfinderHealth, including its disciplinary and remediation efforts should providers not meet the benchmarks set by the Performance Metrics Committee.

Why are providers across the country engaging in clinical integration and accountable care?

Providers have several motivations for participating in clinically-integrated networks. Typical reasons include:

  1. enhancing the quality of the care provided;
  2. developing their own alternatives to health plan “report cards” and other initiatives that may not accurately assess providers;
  3. providing access to technological and quality improvement infrastructure;
  4. allowing networks of providers and hospitals to market themselves on the basis of quality; and
  5. lawfully negotiating with payers as a network.

Why do a growing number of providers and hospitals believe clinical integration to be a good business and health care strategy?

Providers and hospitals nationwide are implementing clinical integration programs because they believe in its value proposition:

  1. Clinical integration allows providers to:
    1. Demonstrate their quality to current and future patients;
    2. Choose the clinical measures against which they will be evaluated;
    3. Enhance revenue through better management of chronic patients;
    4. Gather collective support for building necessary infrastructure; and
    5. Seek reimbursement levels that reflect the higher value they can furnish patients and health plans.
  2. Clinical integration gives hospitals the ability to
    1. Demonstrate their quality to current and future patients;
    2. Enlist provider support for hospital initiatives, including compliance with “core measures,” clinical pathways, standardized order sets, and supply chain management initiatives;
    3. Develop a better, more collaborative relationship with their medical staff;
    4. Improve performance on hospital pay-for-performance measures; and
    5. Position themselves at an advantage in the market on the basis of quality.
  3. Clinical integration provides patients with
    1. A better value for their health care dollar;
    2. More effective care management and outreach from a trusted source, their provider;
    3. More reliable information to support their choice of health plans, providers, and hospitals;
    4. More accurate and meaningful provider ratings; and
    5. Greater stability in their relationship with their provider and hospital, and less likelihood that they will need to choose new health care providers every year.
  4. Clinical integration gives employers
    1. the ability to more effectively manage the health care costs of employees and their dependents through the purchase of better, more efficient health care services;
    2. Increased employee productivity and reduced absenteeism through better management of chronic disease;
    3. Lower health care costs over the long term though the reduction of variation in provider practice patterns; and
    4. More reliable information to support conversation to consumer-driven health insurance products.

Why is Northern Arizona Healthcare willing to fund this organization?

Support for PathfinderHealth’s goal of improving the quality of medical care provided to our community is consistent with the Mission and Vision of Northern Arizona Healthcare. From a strategic perspective, a closer, more aligned relationship between Northern Arizona Healthcare and community practitioners and the development of a business entity will position all of us to best respond to the changes in healthcare that are coming.

Does a provider have to have privileges at NAH or VVMC to join?

No. A physician must meet the criteria set forth in the Operating Agreement to become a member of PathfinderHealth. Northern Arizona Healthcare’s resources for checking credentials will be used to verify whether a provider meets the membership criteria but provider members do not have to have Northern Arizona Healthcare privileges or be a member of the medical staff.

What notification will be given to PathfinderHealth members when the organization is ready to pursue contract negotiation?

Any member has the option to opt out of PathfinderHealth before the organization begins contract negotiations with payers. The Board of Managers will notify members a reasonable amount of time before they intend to enter into negotiations with a payer and which payer they intend to negotiate with. Members then have the option to opt out of negotiating. If a member opts out of negotiating they are then opting out of the organization and will no longer be a member of PathfinderHealth. This process will happen before each different payer negotiation.

Why should we form this type of organization now?

A culture change, for both community providers and for NAH, will be required to meet the challenges of a changing healthcare delivery environment. Working together, breaking down barriers, establishing communication and compromising on our differences will be vital skills that we must possess as we move forward. We need practice, we need a tested and sturdy business structure, we need experience setting benchmarks and generating reliable metrics, we must prepare for the future if we are to succeed.

What is the composition of the Board of Managers?

Of the 20 member Board of Managers from 18 will be physicians comprised from both Flagstaff Medical Center and Verde Valley Medical Center and 2 will be NAH representatives. The membership as a whole will approve or disapprove a slate of potential Board members each year for any Board members whose terms have expired.

Enroll

Learn more on the Enrollment page

Contact

FieldOperations@nahealth.com

1200 N Beaver Street
Flagstaff, AZ 86001
928-214-2746