Comparing Accountable Care Organizations (ACOs) and Clinically Integrated Networks (CINs) is a little like comparing alligators and crocodiles.
It’s not often that you hear these popular healthcare concepts compared to some of the most ferocious reptiles on the planet, but you’ll soon understand the juxtaposition.
Read on to learn more about the similarities and differences between ACOs and CINs (and a little bit about alligators and crocodiles) that can help you better understand which option could benefit your organization.
A quick lesson in biology
If you need a refresher on animal taxonomy, How Stuff Works has you covered. The site explained that while all alligators are crocodiles, not all crocodiles are alligators.
Both alligators and crocodiles are members of the reptilian order Crocodylia, but the families they belong to, Alligatoridae and Crocodylidae respectively, differ. While you’d technically be correct to say an alligator is a crocodile, a crocodile would never be classified as an alligator.
The same can be said for ACOs and CINs: While all ACOs are essentially CINs, not all CINs are ACOs. Although the two networks have many upfront similarities, it’s the details that can help to understand how a CIN can be the platform for building an ACO.
First and foremost, it’s important to understand that ACOs and CINs share the ultimate goal of improving the quality of patient care while reducing costs. It would be difficult for any single practice to accomplish these two seemingly contradictory goals alone, and that’s the appeal of joining an ACO or CIN. As part of a larger organization or network, physicians and other healthcare providers can receive the support and resources necessary to improve patient outcomes and receive financial incentives.
ACOs and CINs also have other factors in common, Repertoire Magazine explained. Both groups rely on a strong IT infrastructure to support the secure, organized exchange of patient data among participating providers. With the common goal of improving care and optimizing revenue, both networks must have strong systems in place to monitor their performance against their objectives.
Although ACOs and CINs are both collaborative groups and share comparable goals reliant on physician leadership, that’s typically where the similarities end.
Defining the differences
The first major difference between ACOs and CINs is their structure. ACOs typically consist of physicians, hospitals and other healthcare providers with the common goal to provide improved care to Medicare patients. They are organizations that span the entire continuum of care and therefore are more geared toward being corporate structures. ACOs are created in-line with rules set by the Centers for Medicare and Medicaid Services.
A CIN, however, can be formed by a group of independent physicians to improve any number of objectives related to their offerings. As opposed to working with CMS, a CIN could be created to provide a higher quality of care in their community, form an economy of scale in negotiating for higher reimbursements or to reduce the barriers to information sharing, just to name a few examples.
Additionally, while an ACO is limited to sharing one contract, usually with CMS, to reduce a population-specific cost of care, a CIN can support multiple contracts at the same time, each supporting a different goal.
ACOs and CINs are also bound by different legal obligations. Due to their direct involvement with CMS, ACOs must follow strict rules to participate in the program and receive incentives.
For instance, the Medicare Shared Savings Program is currently one of the most popular ACOs, with 517 participants providing care to 11.2 million beneficiaries. To participate in this alternative payment model and be considered an ACO, an organization is requested to meet the following standards outlined by CMS:
- Have a formal legal structure to receive and distribute shared savings
- Have mechanisms in place for identifying and addressing compliance with the ACO
- Have at least 5,000 Medicare fee-for-service beneficiaries
Additionally, an MSSP ACO must have defined processes to promote evidence-based medicine, report necessary data on quality and cost measures and demonstrate it meets a patient-focused criteria, among other things.
A CIN, on the other hand, is not required to have a formal legal structure. Likewise, participants don’t necessarily participate in a CMS program. In this sense, ACOs are much more rigid in their structures as they need to follow rules set by CMS. There is a fixed path to follow to compliance and meeting goals, while CINs are more organic in nature and more flexible to change with an organization’s growing goals.
Which is right for you?
So, what will it be for your practice, an alligator or a crocodile? As you can see, a CIN is often the jumping-off point for physicians to build an ACO. They provide the technological infrastructure and systems for standardization that serve as the foundation of a stricter ACO model.
If your care community is just beginning its journey with incentive-based programs or simply wants to increase efficiency and reduce costs, a CIN is an ideal start to meeting these goals.
The first step for creating a successful CIN is deploying the technology solutions that make tracking and document sharing across practices possible. With the digital infrastructure in place, your organization can be on the way to becoming an advanced ACO.
Tangible Solutions connects your care community so you can compete in the modern healthcare landscape. Contact us to learn more about how our technologies and support help CINs and ACOs improve their quality of care, lower costs for patients and receive better incentives from government and insurance initiatives.