A high-quality healthcare experience – both for patients as well as physicians – rests on three pillars: patient satisfaction, ongoing improved health outcomes and cost containment. In a nutshell, these pillars form the foundation of the clinically integrated network. With the medical industry increasingly shifting from a fee-for-service to a value-based model, CINs are actively engaged in furthering this quality control goal, with the ultimate aim of building a healthcare formula that is the envy of the world.
“You can’t build a CIN without a method of approach.”
But much like building a house from scratch, you can’t build a CIN without a method of approach, or more specifically, a strategy for how to design the CIN in terms of its structure and an idea of how the finished product will look.
So, before you go about building that CIN, here are a few things to keep in mind at the outset so no steps are missed and the foundation is solid.
1. Determine legal structure
Clinical integration and clinically integrated networks are frequently used interchangeably. They obviously have similarities but the key distinction between the two terms is CINs are bonafide legal structures with the means to facilitate high-quality healthcare. The Department of Justice and Federal Trade Commission are the government bodies that determine acceptable CIN frameworks. They may include the following:
- Joint venture PHOs
- Health system subsidiaries
- Independent practice associations
Each structure has slightly different players (e.g. physicians, medical offices, employers, health systems, etc.) and levels of participation. There’s also the matter of how big they will be, encompassing a given region or an entire state, according to Becker’s Hospital Review. Geographical composition can help you determine which legal structure is best.
2. Define the goal so it can be measured
As previously referenced, the overarching objective of any CIN is to improve health outcomes without increasing the cost of care. You won’t know if you’ll ever achieve this without a system that allows you to measure growth. Quality data measures include MACRA, HEDIS, IQR/OQR, AHRQ and MSSP ACO. You will want to familiarize yourself with these metrics so you can determine what the benchmarks are so you can evaluate how participating physicians or medical offices are getting better. This can also aid in recruiting interested stakeholders, as they’ll want to know what’s in it for them by joining your CIN.
Megan North, president of Conifer Health Solutions, noted at a Becker’s Hospital Review Conference that understanding participants’ goals can help you determine what quality measures to select.
“You need to be able to communicate back to physicians on how they’re doing,” North explained. “The goal is to get people to focus upfront on process-based measures and good citizenship measures.”
3. Understand core characteristics of a CIN
You may have an idea for the health organizations or practitioners you would like to approach about joining your network. But you may not realize that they can’t be just anyone. For example, in terms of forming a governing body, the players must all be physicians, CIN members must promise to follow a predetermined set of guidelines and a data sharing system must be in place.
Whether you’re forming a CIN or ACO, it hinges on strategy. Tangible Solutions can help you formulate one and put into motion. We recently produced an e-book that can help you put together a data strategy. You can download it for free. In it, you will learn more about the various ways data can be obtained and transported, as well as how a partner like Tangible Solutions can help you put all of the pieces together.