Children's Care Network Seeks Better Payer Data, Faster Credentialing and Protections During CMO Transitions
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Summary
A leader of Georgia's largest pediatric clinically integrated network told the committee that payer data are often delayed, credentialing can take months and an upcoming CMO transition risks disrupting care; he urged contractual standards for timely notifications and oversight of payer transitions.
Dr. Brad Wesselman, representing the Children's Care Network, described a physician-driven clinically integrated pediatric network that serves roughly 965,000 children around Metro Atlanta and beyond. He said the network invests in population-health tools and has demonstrated improvements in preventive care and reduced hospitalization for asthma, but faces operational and payer-related obstacles that limit its ability to coordinate care.
Wesselman highlighted four core problems: quality measures that are not actionable because payers do not provide timely or usable lists; lagging adjudicated claims data that prevent meeting short follow-up windows (for example a 7-day follow-up after behavioral-health hospitalization); prolonged credentialing and payer-roster processes that can prevent new physicians from billing for months; and anxiety among providers about an upcoming care management organization (CMO) rollout that may reassign patients away from existing providers.
"We're supposed to arrange that follow-up and coordinate their care within 7 days," Wesselman said, noting that 97% of behavioral-health inpatient encounters occur out of the network and that adjudicated claims-based reports are often too old to support timely action. He recommended contractual and administrative reforms including requiring timelier notifications (ADT or real-time billing data), reexamining CMO contract terms to require transition planning, and creating oversight mechanisms to resolve credentialing and payment delays.
Committee members probed who typically prescribes antipsychotics to children and how notification systems might be adjusted; Wesselman said psychiatrists and emergency departments are common prescribers in crisis situations and reiterated the need for data-sharing improvements. He offered the network's data and experience as a resource for policy design.
