This partnership exists to provide comprehensive, integrated and coordinated healthcare at the optimal price point for both patients and providers. NWHP has formed a Clinical Integration Program (CIP) that spans a range of settings and efforts, from multi-setting care coordination initiatives focused on a single condition to networks of caregivers accessing and exchanging a variety of clinical and financial information to deliver quality care. Clinical integration is a continuous process of alignment across the care continuum that supports the triple aims of healthcare:
We’ve entered into agreements with more than 400 dedicated primary care and specialty physicians to make the CIP as robust as possible. Its purpose is to evaluate and modify practice patterns to create a high degree of interdependence and cooperation among providers in order to improve the quality and efficiency of healthcare in the communities served by NWHP.
Our mission is to provide high-quality care with innovative treatment and state-of-the-art technology to all our members. Our PHO has been awarded 5 out of 5 stars in Quality Measures by Blue Cross and Blue Shield of Illinois (BCBSIL) for the past three years—the highest rating that can be received, demonstrating “excellent performance.”
NWHP is delegated by BCBSIL to administer their HMO products, including Blue Advantage, HMOI, Blue Precision and Medicare Advantage.
There are many benefits to joining our PHO, such as:
However, we do have membership criteria set in place to ensure that we maintain the highest levels of care for our patients. These criteria state that:
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All physicians who are active members of our medical staff are eligible to apply.
The PHO usually credentials a complete application and enrolls to managed care entities within 120 days. Process time is shorter if you are currently on our medical staff.
Once your application is approved, you will be given a PHO Risk and CI contract to sign. All physicians seeking membership must take all risk products and participate in CI. There are additional managed care plans that you can opt in or out of; a form will be provided with those options.
Each physician is responsible for applying and completing a CAQH application. A CAQH number is necessary to enroll in managed care plans. Each physician is responsible for ensuring his or her office meets ADA requirements and must provide a completed form to the PHO.