St. Vincent’s Health Partners: How URAC’s Clinical Integration Accreditation Program Helps Us Build an Internal Structure that Supports Success

| URAC Staff

Achieving URAC’s Clinical Integration Accreditation has resulted in many unexpected efficiencies and improvements for St. Vincent’s Health Partners (SVHP). But not just clinically.

True, the Bridgeport, Conn.-based clinically integrated network (CIN), which includes more than 400 independent and employed primary and specialty care providers, a flagship local hospital and several skilled nursing facilities (SNFs), home health agencies and hospices, has dramatically improved its care coordination and patient engagement, but it has also used URAC’s standards to streamline their administrative operations.

“It has really helped us improve on many levels,” says Kyle Lanning, JD, SVHP’s In-House Counsel and Associate Director of Operations & Administration. Formerly operating under the traditional model of a physician hospital organization, SVHP in 2014 became the first CIN in the nation to achieve URAC’s Clinical Integration Accreditation. And recently it became the first CIN to achieve reaccreditation.

SVHP used URAC’s Clinical Integration Accreditation standards as a roadmap for its infrastructure and process development, including contracting practices, internal governance structure and communications strategies. Lanning connects the best practices SVHP adopted as part of its URAC accreditation process to many of the measurable improvements SVHP has achieved over the past three years, including:

  • 70 percent drop in inappropriate ER utilization among an employer group
  • 25 percent drop among in inappropriate ER utilization among a commercial patient population
  • An engaged and collaborative post-acute care network of five SNFs and four home health agencies

Below are just some ways in which URAC’s Clinical Integration Accreditation program has brought value to SVHP.

Aligning internal policies and procedures with payer requirements

Because URAC’s standards align with the regulatory requirements of Medicare, Medicaid and other state and federal health payers, a CIN that acquires URAC’s stamp of approval demonstrates that the network has the policies, procedures and processes in place that make it audit-ready.

“This is the number one infrastructure that URAC accreditation really set up for us,” says Lanning, who spearheaded SVHP’s accreditation efforts. “We can show that we’re properly documenting everything, keeping records and audit trails and that we’d perform well if any regulator decides to review the services we’re providing.”

For example, SVHP can show that all employees have the required credentials and training necessary to provide their highest possible level of service to patients and providers in the network.

Entering into value-based agreements with providers

URAC standards help walk organizations through their provider relationships and agreements—one of the more difficult regulatory aspects of forming a CIN.

By aligning provider agreements with URAC standards, CINs ensure that they don’t miss elements that later become important for ensuring true provider engagement and practice transformation.

“When you create an organization like this, you have to establish relationships with providers and their practices,” Lanning says. “But there isn’t a ready-made agreement template at your local attorney’s office for how these should be structured. But there’s a URAC standard that’s very detailed and describes the important elements that are critical to include in these agreements.”

For example, one of URAC’s standards requires that all organizations within the CIN to openly provide the network with access to their clinical records.

“This element of our agreement with each practice, when presented at the beginning of the arrangement as an expectation, really paves the way for an open and collaborative system of sharing clinical records,” Lanning says. “And as more of our contracts require our team to do some degree of chart audit or data extraction to be successful, baking this element into our agreements has become increasingly important.”

Designing a governance structure

URAC standards guide organizations toward creating a compliant, effective governance structure. For example, URAC standards help CINs determine how the leadership board will make decisions and delegate responsibility.

SVHP staff monitor the CIN at the enterprise level using a variety of committees that meet monthly and adhere to a best-practice structure suggested by URAC standards, such as using detailed agendas and minutes, populating them with a variety of providers and stakeholders and tracking the progress of action items against goals.

“The diversity and number of different providers who participate on these committees is really key to ensuring that our clinically integrated network is truly provider-driven, Lanning says.

Communicating clinical information across the network

URAC standards also require CINs to create a way to share patient information with providers across the network and to have criteria for identifying at-risk patients. With its network members using 12 different EMR platforms and without a fully functioning Health Information Exchange in Connecticut to facilitate information exchange, administrative and clinical leaders across the CIN strategized ways to share information. 

One solution: SVHP is in the process of creating a data warehouse that will combine payer and provider data into one central location. The data will enable SVHP’s network providers to glean practical insights into their patient populations and identify trends in patient care that produce better outcomes, Lanning says.

But a lower-tech solution is also in place. Each day, SVHP downloads patient discharge data and destination settings from its flagship hospital and sends this information to each destination facility, such as a partner SNF or home health agency. The CIN also reaches out to primary care providers every day—either in person or via telephone—to inform them about their newly discharged patients.

For patients at high-risk for readmission, such as those who are part of Medicare’s Bundled Payments for Care Improvement initiative, SVHP hosts weekly telephonic huddles run by one of two network physicians. Joining the 10-minute lunchtime calls are social workers, case managers and other clinicians from the network facilities.

The clinicians share information about patient discharges, transfers and new admissions, providing a more complete understanding of each patient’s situation and the resources needed for a successful transition, Lanning says, adding that the value of the short conference calls is reflected in the 80-percent attendance rate.

In addition, SVHP staff visit the network’s primary care practices and post-acute settings each month to share data against the network’s goals, and discuss ways to improve communication and care coordination among patient settings.

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