FAQ

Frequently Asked Questions

What is Clinical Integration?

The Federal Trade Commission (FTC) considers a program to be clinically integrated if it performs the following:

  1. Establishes mechanisms to monitor and control utilization of healthcare services that are designed to control costs and ensure quality of care.
  2. Selectively chooses Clinically Integrated network physicians who are likely to further these efficiency objectives.
  3. Utilizes investment of significant capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies.

What is Affinia Health Network?

Affinia Health Network is a physician-led clinically integrated network where participants collaborate on Quadruple AIM initiatives. The network engages payers to contract and reward the network based on Quadruple Aim performance.

The Quadruple Aim is:

  1. Better Care. Improving the overall health of the patient population.
  2. Better Quality. Maximizing quality of care.
  3. Lowering the overall cost of care.
  4. Reducing provider burnout and bringing the joy back to practicing medicine.

Who is Affinia Health Network?

We are 1 of 23 Clinically integrated networks in the Trinity Health System.

What is an Alternative Payment Model (APM)?

Alternative Payment Model (APM) defined:

Groups of providers held accountable for the cost and quality of care for a group of beneficiaries.

APM Goals:

  • Improve provider accountability
  • Increased quality of care and patient experience
  • Lower costs

If providers are successful, they are rewarded with shared savings.

Ensure patients, especially the chronically ill, get the right care at the right time at the right place while avoiding unnecessary duplication of services and preventing medical errors.

Alternative Payment Models (APMs) enable us to become a people-centered health system:

How has the healthcare system changed from a billing perspective? And why?

Why?

Better for the patient and a better way to practice

Proven model with increased quality and reduced costs:

  • Fewer ER visits
  • Reduced unnecessary hospitalizations
  • Higher patient satisfaction scores

Better way to practice:

  • Makes the right thing to do the easiest thing to do
  • Removes cross motivations and limitations of the FFS world
  • Focus on the needs of the patient and away from the visit

What is a bundled payment?

A bundled payment is a single payment to a provider for all services associated with a treatment of a condition (for example, knee replacement or all outpatient services for a patient with type 2 diabetes for 1 year).

  • Provider assumes risk; can profit if cost of care is below bundled payment or lose money if above bundled payment
  • Important for provider to ensure bundle is appropriately priced (that is, adequately risk adjusted)
  • Often linked to meeting certain quality measures to ensure delivery of high-quality care is maintained

What is an ACO? NGACO? THACO?

ACO (Accountable Care Organization)

  • Group of healthcare providers contracting together to provide high quality, financially responsible care
  • Previous participation was in the Medicare Shared Savings Program (MSSP) ACO with University of Michigan

Next Generation ACO (NGACO)

  • Medicare Fee-For-Service (FFS) total cost of care model
  • Upside and downside risk – 80% shared savings or losses with a 6.5% cap
  • Open only to health systems with significant population health experience

Trinity Health ACO (THACO)

  • THACO consists of 4 Trinity chapters and an independent group of New Jersey (Summit Medical Group)
  • Judged as one entity as THACO

I Have a Question About Billing and Reimbursement

Please check our Payer Information Guide page which has a lot of useful information specific to each payer.

Have a Question?

Have a question that isn’t listed here? Please email us your question at AffiniaHealthNetwork@mercyhealth.com. We are happy to help!

Interested in Joining Affinia?

Fill out the online form and apply today!