Seton Health Alliance is what is known as a “clinically integrated network.” A clinically integrated network, as defined by the Federal Trade Commission, is a program that evaluates the quality of care provided and then makes changes to improve care.
By personalizing patient care for each individual’s needs, prioritizing patient education and expanding access to health facilities and resources, we allow providers to improve member satisfaction without high dollar premiums. Participating providers remain independent while working more closely with other doctors in the network, allowing employers and brokers alike to offer all the benefits of administrative-level collaboration. This helps control healthcare costs and improves the quality of patient care.
We have the following building blocks:
- A proactive focus on health
- Health information technology
- Physicians who work together to manage the network
- Financial incentives for providers
Physician-led management plus accountable care that focuses on the patient add up to make a more organized system, while improved coordination and communication can lead to reduced healthcare costs.
ACO vs. HMO
Many people think that an accountable care organization (ACO) is similar to a health maintenance organization (HMO). However, these two types of groups serve very different purposes.
In an HMO, providers receive incentives based on the number of services performed. This means that the number of patients matters more than the quality of care that’s delivered. An HMO also has rules about which doctors a patient can see. An ACO, on the other hand, wants patients to choose their own primary care physician (PCP) and take charge of their healthcare decisions.
In an ACO like Seton Health Alliance, member providers are held responsible for the health of their patients. Incentives are based on the value of care, from patient education to customized health plans. Additionally, by using PCPs to coordinate healthcare, finding ways to decrease patient costs becomes easier. At the same time, providers can ensure better health outcomes.
Clinically integrated networks avoid violation of anti-trust laws and regulations by:
- Improving care
- Reducing unnecessary costs
- Maintaining quality standards
While our member providers share infrastructure like staffing, IT and analytics, provider practices are maintained and run completely separately. This allows providers to ensure the highest quality care for each individual with all the tools of a large collaborative network.