Hospital Impact: The case for earning clinical integration accreditation

Phoenix Children’s Care Network recently became the nation’s first pediatric network to achieve URAC’s clinical integration accreditation. (Getty/Dreamframer)
Casey Osborne

How do you make your best even better? Regardless of the industry or the organization, answering this question is a driving force behind any leadership team’s efforts to continually fulfill its mission, vision and goals.

At Phoenix Children’s, our defining purpose is to provide hope, healing and the best healthcare possible for children and their families, and our entire organization works to achieve that aim each day, across each part of our organization.

In 2013, Phoenix Children’s Care Network (PCCN) was launched with this principle in mind, and with a focus on bringing a system-of-care approach to pediatric medicine in the Southwest region.

PCCN’s first order of business was to develop one of the nation’s first pediatric-dedicated clinically integrated organizations (CIO).

The PCCN pediatric CIO is rooted in the development of a robust quality-improvement program with accountability among independent physicians and the connected health system. It rewards and integrates physician members around a common commitment to quality measures based on scientific evidence and cost improvement.

RELATED: Payer and provider executives talk about breaking down the historical barriers to collaboration

In just a few short years, the PCCN model has grown to be Arizona’s largest children’s care coordination network and one of the nation’s premier pediatric CIOs. Yet, as a team, we knew that continued excellence depended on “pushing the envelope.” The innovative spirit that cultivated PCCN’s success was driving us to pursue the next level of patient care quality.

Recently, PCCN took a step in that direction and became the first pediatric network in the U.S. to earn URAC accreditation as a clinically integrated network. URAC is a nonprofit organization that develops evidence-based measures and standards through inclusive engagement, with a range of stakeholders committed to improving the quality of healthcare. This distinction recognizes PCCN’s commitment to superior care and improved processes, plus better patient outcomes and cost savings for patients, their families and the community.

Becoming the nation’s first pediatric network to achieve URAC’s clinical integration accreditation is certainly an achievement our PCCN professionals are extremely proud of; however, the effort was no small task. The accreditation process was a yearlong effort that required all-hands-on-deck participation from staff in every department at PCCN, our governance team and network practices.

On this journey, our team learned valuable lessons that can be implemented by other health systems as guideposts in their own accreditation processes.

Best practices

PCCN followed URAC’s clinical integration accreditation standards, built on these four pillars:

  • A governing structure that provides compliance and oversight
  • Top-down organizational alignment that ensures business arrangements are patient-centric and structured around improving outcomes, quality and costs
  • Care coordination built around a population health mindset
  • An integrated IT infrastructure that enables information exchange and data aggregation

PCCN has exemplified these practices by establishing new policies around financial distribution that explains how and why it will incentivize primary care providers with bonuses for quality. Those payments are based on the physicians’ patient volumes and respective scores on 15 quality measures.

The accreditation process also served in a due diligence capacity. The methodology demonstrates to insurers that we are sophisticated, have integrity and are operating within the highest standards of the industry. Most of the health plans in Arizona are accredited by URAC, so insurers understand that PCCN is matching or exceeding those same high standards. Health systems nationwide, which face this similar landscape, can benefit from the rigorous process.

Future steps

When we look to the future, geographic expansion is on the horizon. We aim to do this by pursuing delegation arrangements with payers that will deliver case management and care coordination, among other provisions.

The URAC accreditation recognizes that the more than 1,000 PCCN healthcare providers, 85% of specialists and 65% of primary care providers in Arizona, are committed to supporting and providing the best care for kids. This accreditation speaks to our continued commitment to being the best of the best at achieving our mission—and the work we do each day to get there.

Casey Osborne is the vice president of PCCN operations at Phoenix Children’s Hospital.