What is Monument Health?
Monument Health is a clinically integrated network (CIN), which is a network or team of independent health care providers working with patients and with each other to provide better health care at a lower cost.
What is a clinically integrated network (CIN)?
A clinically integrated network is a group of independent physicians, other providers, facilities and organizations who collaborate to improve quality and reduce the cost of health care using a shared infrastructure. While the structure allows the partners within the network to collaborate, they also remain independent.
Networks meeting these criteria are permitted to transform the way they are paid so providers are paid for value and good health outcomes—rather than volume of visits, tests, etc.
In 1996, the FTC and Department of Justice offered a working definition of clinical integration as “a network implementing an active and ongoing program to evaluate and modify practice patterns by the network’s physician participants, and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.”
What are the goals and objectives of Monument Health?
The objectives of Monument Health are
- To develop and grow an accessible, high-performing provider network;
- To improve the quality and coordination of care; and
- To lower the overall cost of care.
Ultimately, the achievement of these objectives will lead to our goal of an overall healthier Mesa County.
What do you mean by “appropriate” care?
Appropriate care is the right care, at the right time, and in the right place. Network providers agree to follow clinical practice guidelines, and quality outcomes are measured regularly. Following care coordination guidelines and sharing data reduce duplicated tests and unnecessary treatment, sometimes eliminate hospital admissions and reduce bed days, and ultimately, reduce cost.
How can Monument Health's approach contribute to making care more affordable?
By keeping the healthy in good health, mitigating risk for those in poor health, and improving the health of those with chronic conditions, we can lower overall costs. Payments to providers are based on how well they do, not how much they do. Innovations in clinical practice and new payment models are leveraged through benefit plan design to achieve long-term, sustainable cost savings—for both employers and individuals.
Why are physicians throughout the country engaging in integrated, accountable care?
There are multiple reasons physicians are engaging in integrated, accountable care: (1) to enhance the quality of care via better, more coordinated care; (2) to proactively respond to new government and health plan-sponsored payment models; (3) to collaborate with local employer groups for better care at lower costs within the community where we all live and serve; (4) to have improved visibility into total cost of care performance data and outcomes; and (5) to restore the joy of practicing medicine.
Can my practice join the network?
Monument Health is committed to being a comprehensive network of providers who share a common vision for improving care in the community. Admission requires advanced practice transformation, agreement to certain operating guidelines and infrastructure, and approval from the Monument Health Board of Managers.
How does my practice demonstrate advanced practice transformation?
Because we believe in the importance of a medical home, the Monument Health network is rooted in primary care. Prospective primary care practices are required to meet the following “advanced practice transformation” requirements: (1) Complete all three of Rocky Mountain Health Plans’ (RMHP) Practice Transformation courses: Foundations, Masters 1 and Masters 2; OR, as an alternative to the RMHP coursework, (a) undergo a practice assessment to determine equivalency or placement relative to the courses or (b) demonstrate the practice has actively participated in the Comprehensive Primary Care Plus (CPC+) program for 12+ months. In addition to these requirements, primary care practices must also achieve the NCQA Patient Centered Medical Home (PCMH) designation. More details can be found here.
Prospective specialty practices will be evaluated on a practice-by-practice basis as it relates to their ability, infrastructure and resources to meaningfully engage with advanced primary care practices, our hospital, other partners and the Monument Health network.
How long does it take for a primary care practice to complete the requirements toward advanced practice transformation?
The timelines likely vary from practice to practice. For a primary care practice starting at the very beginning of the practice transformation trajectory, it would take approximately three+ years because each RMHP Practice Transformation course (Foundations, Masters 1 and Masters 2) is approximately 12 months long, then the PCMH designation would also need to be achieved. Other, already more advanced practices may be on shorter timelines.
We invite practices to learn more. You may also contact Monument Health at (970) 683-5630 or download the RMHP Practice Transformation brochure. You can also contact RMHP’s Practice Transformation Team directly. Call 970-254-5752 or email firstname.lastname@example.org
What are the other requirements to join the network- besides advanced practice transformation achievement?
Prospective network partners, whether a physician practice, a hospital or another facility, must meet other requirements: (1) Have a certified electronic health record that has both inbound and outbound data capabilities with our regional Health Information Exchange (HIE), Quality Health Network (QHN); (2) Develop and implement clinical guidelines and/or care coordination guidelines and regularly report performance; and (3) Participate in certain “citizenship” and/or operational activities.
What are the Monument Health clinical guidelines?
Monument Health currently has five clinical guidelines and measures on which primary care practices are held accountable and measured: asthma, diabetes, hypertension, BMI and pediatric weight assessment. Specialist have their own guidelines and measures. And each provider partner–primary care, specialists, hospitals, home health, etc.– has some accountability regarding our 10 care coordination guidelines.
How often is a provider measured on the guidelines?
Providers are measured on their guidelines quarterly.
Is employment by St. Mary’s Hospital a requirement?
No. St. Mary’s employment is not a network requirement whatsoever. In fact, a key benefit of participation in Monument Health is that it allows physicians, hospitals and payers to collaborate, improve quality and reduce cost without sacrificing any autonomy.
Will participation in Monument Health require me to change the way I practice medicine?
To some extent, yes. Participating providers design and implement their guidelines which support a cross-continuum care model that is based on whole-person care, provider coordination, evidence-based medicine and patient engagement. Physicians will be financially rewarded for achieving success in improving quality and access and lowering cost because of their efforts.
If my practice is not part of the Monument Health network, does that mean I will not have patients referred to me or will lose patients who have Monument Health insurance?
First and foremost, providers make referrals based on necessity and the most appropriate care for the patient. Secondly, patients may choose any provider or hospital they wish. That said, Monument Health members are indeed encouraged to select Tier 1 practices (primary care, specialty care and hospitals), and Tier 1 providers are indeed encouraged to work within the network because it’s our Tier 1 practices who have the infrastructure, guidelines and commitment to whole-person, highly efficient care (and therefore where patients will experience the lowest out-of-pocket expense).
Is this an effort to exclude other Grand Valley providers?
No. Any Mesa County providers who meets the data, integration, practice transformation, quality and contracting requirements of the Monument Health network are invited to engage with Monument Health.
If I participate with Monument Health, will I be required to abandon medical staff appointments or stop seeing patients at other hospitals or facilities outside of St. Mary’s?
No. Participation in the Monument Health clinically integrated network does not preclude physicians from practicing at other facilities. Participation in Monument Health is also non-exclusive, meaning physicians, hospitals and other providers may participate in other networks or accountable care organizations as they choose.
How will key decisions be made, and will my voice be heard if I’m not employed by St. Mary’s or Primary Care Partners?
Monument Health is a physician-led, professionally managed and patient-centric network. Its various committees (clinical effectiveness, care coordination, contracting, etc.) are comprised primarily of physicians, many of whom are from the community. Participation in these and other groups will be invited of network participants, ensuring that your voice is heard.
What is Monument Health doing to ensure patients have sufficient accountability for their own health?
We recognize the importance of engaging patients in their health and decision-making. As part of its Patient-Centered Medical Home (PCMH) accreditation and Comprehensive Primary Care Plus (CPC+) involvement, our primary care providers focus on developing a meaningful relationship with patients and their families. Also, Monument Health has developed a patient onboarding protocol to educate patients about their benefits, cost-effective options for care and evidence-based medicine. And we are proud to continue our “engaged benefit plan designs” (and to work with the employer community in so doing) such that patients are incentivized for their engagement and health care consumerism.
Will savings from the network be reinvested into Mesa County?
Yes. Network savings will be reinvested directly into our own community. Right-priced premiums and lower out-of-pocket costs ensure savings stay in our local economy. And any surplus generated at the network level will be used to reward our physician partners and to reinvest in our local health care infrastructure and technology.
Call us. 970.683.5630