"If we have to deny a physician’s request for a service, we try our very best to communicate with that physician before we deny it," Dr. Blacklidge said in an interview. "I think that physician-to-physician communication goes a long way in building acceptance of the network and [demonstrating] that we’re really in this together."
HCNN now has 1 year of data to develop a baseline for cost and utilization measures for emergency department visits and inpatient visits per 1,000 members, among other statistics. Network leaders plan to determine a baseline for Healthcare Effectiveness Data and Information Set, a tool developed by the National Committee for Quality Assurance to measure care and service performance.
When considering a model such as that used by HCNN, it pays to first determine current problems in caring for at-risk patients, then to evaluate how an ACO might help, Dr. Kraft said. Questions to ask include: How can an ACO help reduce some of the hassles in treating at-risk children? How can care coordinators better communicate with doctors? How will funding be determined and distributed?
Dr. Graham stresses that a Medicaid network should be an adjunct to a practice and a team that physicians can quickly activate for the most complex children.
"Providers want streamlined patient-centered service, accurate and timely attribution data and statistics, medical authorizations based on evidence, and payment that compensates physicians for quality and access," she said. "Our health network strives to deliver all of these measures."
On Twitter @legal_med
*This story was updated on September 9, 2014.