CIN and ACO are two small acronyms for two very large concepts. In the healthcare industry, especially as it relates to Medicare payments, there is an increasing demand for higher quality of care and lower costs. Those two ideas do not always play nice. A single physician’s office would struggle to drastically reduce costs and upgrade care outcomes at the same time. As part of a larger group or network, however, the impossible becomes possible.
With the introduction of MACRA and the start of reporting this year, physicians may be worried about their thin profit margins getting even thinner. Joining a CIN or ACO could help reduce the financial pressure of compliance.
Read on to understand more about the differences between CINs and ACOs and how they can work together to improve healthcare.
Two goals: Improving care and optimizing revenue
A clinically integrated network (CIN) and an accountable care organization (ACO) have similar goals, though they are structured in different ways. This doesn’t mean they are mutually exclusive, however. In fact, Advisory Board noted that a CIN often serves as the physician network arm of a larger ACO.
Here’s a quick briefing on the two types of structures:
Clinically integrated networks:
- A group of independent physicians come together to identify and improve the quality of their offerings.
- A CIN grants the group a safe harbor against antitrust laws to collectively negotiate for better payment rates with insurers.
- Documentation is critical. A system must be in place to accurately track improvements.
Accountable care organizations:
- Physicians, hospitals and other healthcare providers join together voluntarily to provide improved care to Medicare patients.
- The Centers for Medicare and Medicaid (CMS) defines and provides rules for ACOs.
- This type of organization covers the entire continuum of care.
- The ACO shares savings and may receive further benefits from payers in the form of bundled payment options and global risk.
Often a CIN is the platform upon which physicians can build an ACO. Advisory Board explained the CIN provides a legal framework around which physicians can set goals for standardization, efficiency and coordination.
ACOs are on the rise
With the introduction of the Medicare Shared Savings Program (MSSP), the number of active ACOs in the U.S. has increased sharply. According to Modern Healthcare, there were just 64 ACOs in the U.S. in 2011. By early 2016, that number had risen to 838. The MSSP provides powerful incentives for ACOs, but not all organizations are equal.
Tracking and documentation are key to the success of an ACO. Using technology solutions such as big data analytics and EMR reporting systems, ACO members can keep a pulse on the success of the program and make adjustments as needed. ACOs that fail this due diligence may have to drop out of the MSSP.
CINs and ACOs complement each other. With proper technical support, these types of organizations stand to win big by improving quality of care, lowering costs for patients and getting better payment rates from insurers.