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Healthcare is in a state of transition as we move from today’s fee-for-service reimbursement models to new performance and value-based payment models. Carolinas Physician Alliance is a CIN that allows healthcare providers to join together to improve the health of our communities. Patients, payers and physicians benefit by enhancing transitions of care, coordinating chronic disease management, and managing the health of a population.

For answers, click on each question below.

What is a Clinically Integrated Network (CIN) and why do we need one?

A clinically integrated network is designed to drive quality and cost improvements for the patients we serve as we move toward this value-based model. To be a compliant CIN, Carolinas Physician Alliance must produce clear measures of this value improvement at the physician and population level.

How is Carolinas Physician Alliance structured?

Carolinas Physician Alliance is a wholly owned subsidiary of Carolinas HealthCare System and is managed by its own Board of Managers. The Board of Managers is made up of 16 physicians; half of the board members are Carolinas HealthCare System physicians and the other half are independent physicians.

When was Carolinas Physician Alliance formed?

Carolinas Physician Alliance officially formed on February 8, 2016 as a CIN. Carolinas Physician Alliance’s first contract is effective January 2017.

How many participants are there?

There are currently more than 2,500 participants.

Do participants join individually or as a group?

Carolinas Physician Alliance is designed for groups to join. Small and solo groups are welcomed. Physicians who practice outside of Carolinas Physician Alliance’s current 12-county coverage area would not be included.

Does it cost to join?

There is no enrollment fee to join Carolinas Physician Alliance.

Who can join?

To ensure the best value for patients and payers, Carolinas Physician Alliance is open to physicians who want to be accountable and raise the quality of care within the current 12-county operating area.

Can I join Carolinas Physician Alliance if I’m already a member of another Clinically Integrated Network?

Yes, you can join. Carolinas Physician Alliance does not have an exclusivity clause in the Network Participation Agreement and understands that groups may join other CINs in addition to Carolinas Physician Alliance.

Who benefits from Carolinas Physician Alliance?

By enhancing transitions of care, coordinating chronic disease management, and managing population health, Carolinas Physician Alliance benefits patients, payers, employers and physicians alike.

What is the difference between a Clinically Integrated Network and an Accountable Care Organization (ACO)?

According to the Centers for Medicare and Medicaid Services, an ACO is accountable specifically for Medicare beneficiaries. It is an organization of healthcare providers that agrees to be accountable for the quality, cost and overall care of Medicare beneficiaries enrolled in the traditional fee-for-service program who are assigned to the ACO. Similarly, a Clinically Integrated Network is an alignment model, coordinating care across affiliated caregivers and developing contracts to improve quality while controlling growth in total cost of care. However, a Clinically Integrated Network contracts with commercial payers and employers rather than the Centers for Medicare and Medicaid Services.

I am currently a Carolinas Physician Alliance participant. How do I get involved?

Carolinas Physician Alliance has opportunities for physicians to get involved through multidisciplinary workgroups. These workgroups will create pathways and protocols for priority diagnoses and related clinical improvement efforts. Workgroups will include affiliate and system care team members who may be involved in the care of a patient across a particular condition. Carolinas Physician Alliance will continually seek diverse leadership from across the physicians participating in the alliance.

Will all affiliate groups eventually be on the same electronic health record?

No. Carolinas Physician Alliance recognizes the amount of infrastructure work and expense necessary to support an EHR or a migration to a different EHR system. Work is underway to develop the infrastructure that Carolinas Physician Alliance will need to share data across the Alliance. There will be some amount of work and infrastructure expense required for participation in the network related to the ability to exchange patient information across a variety of EHR systems to improve communication.

Can a provider be removed from Carolinas Physician Alliance for performance issues? If so, can they also be removed their own group?

A provider may be removed from Carolinas Physician Alliance for performance issues or inability to meet minimum quality outcomes. Such action would occur within specific, transparent guidelines and only after failed efforts to remediate or counsel provider’s methods to improve citizenship and elevate guidelines. Carolinas Physician Alliance respects the individual governance of its physician groups. Any further corrective action beyond removal from Carolinas Physician Alliance would be at the discretion of the practice group.

How do I get more information or join?

If you or your group would like more information or interested in joining Carolinas Physician Alliance, please call Leah Maul, Lead Executive, Network Integration at 704-446-3116 or email her directly
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