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Physician Participation Requirements

To meet the goals of Capital Health’s Accountable Care Organization (ACO) and the Institute for Healthcare Improvement’s Triple Aim Initiative, all participants need to constantly work to improve quality at a lower cost. Assurance that our participants work toward these goals is best served by having members of the ACO who enter the program with an understanding and experience in accountable practice. Therefore, much work has been done to familiarize our medical staff in the concepts of accountable care and shared savings.

As a participating hospital in the New Jersey Gainsharing Initiative, we have had a number of training meetings where these concepts were reviewed. In addition, every physician agreement (employed and contracted) has embedded in the language the six core competencies defined by The Joint Commission and the American College of Graduate Medical Education. These require our physicians to utilize evidence-based care, remain current in medical knowledge, be clear and complete in their communications to patients and colleagues, follow approved care paths, practice in an equitable and professional manner, and respect the importance of systems-based practice related to the cost of healthcare.

Beyond credentialing a participant, we value ongoing evaluation of performance, expecting highly reliable outcomes in all care. The board of directors, senior management and medical staff of Capital Health are committed to 100% performance on all public reports of quality as the standard of performance. Physicians who value high quality outcomes and use care protocols based on current best evidence are critical to achieving and maintaining our high quality outcomes. As Capital Health ACO develops care paths to meet the 33 measures of quality, we utilize evidence-based medicine in driving best practice.

The assurance of high quality and reliable care provision in our primary care settings is critical to assure patient satisfaction, improved outcomes and lowering cost. To assure compliance with the metrics defined for shared savings eligibility, Capital Health ACO employs the currently utilized process of performance improvement found in Capital Health’s employed primary care network practices. This process is based upon the metrics defined for participation in a shared savings model and patient-centered medical home recognition. Measurements of compliance with appropriate vaccination, smoking cessation, condition appropriate screening evaluations, and behavior modification counseling is assessed as well as compliance with the United States Preventive Services Task Force recommendations for health screenings.