In today’s health care landscape, organizations and individual physicians have many incentives to provide better care at lower costs. With the introduction of the Medicare Access and CHIP Reauthorization Act, the industry as a whole has had to make structural adjustments in regard to finances, care practices, technology and administrative tasks. Although the Centers for Medicare and Medicaid have provided months of ramp-up time for organizations to comply with MACRA, the process has been slow going.
In this changing environment, practices need something to help them get an advantage. After all, providing better services at lower costs is not an easy task. This is where the concept of a clinically integrated network can save the day. This is not to be confused with an ACO.
What is a clinically integrated network?
A clinically integrated network (CIN) is a way for like-minded healthcare providers and hospitals to share their goals for performance improvement, quality, value and efficiency. The ultimate motivation behind these smaller goals is to improve the quality of care while lowering the cost of healthcare services.
“A CIN helps practices deliver better care at lower costs.”
These advantages are achieved through joint efforts between practices to improve IT infrastructure and via collective bargaining, as sanctioned by the Federal Trade Commission. According to The Advisory Board, this type of collective bargaining is given a safe harbor by the FTC, making it possible for physicians to gain greater leverage when negotiating with insurers for better payment rates. The reasoning is that, because CINs can provide better care – and thus have fewer cases of patient readmittance – they qualify for better rates.
Senior Associate of the American College of Physicians, Neil Kirschner, says that this legal structure allows CINs to do what they could not as independent providers — provide integrated and coordinated care while bargaining with payers.
Benefits of Clinically Integrated Networks
Independent practices can win big by joining a CIN. For physicians who purposely avoid employment by a hospital network, a CIN gives them a financial and practical advantage without giving up control over their practice. Patients win as well, because they can receive higher-quality care at lower costs from doctors they know and trust.
The added benefits of sophisticated technology solutions can give physicians greater insight into patient populations, regional registries, financial activities and advanced care options. Using integrated EHR systems, practices can share important medical information as well as billing, demographic and continuity of care information easily. The result: better physician engagement. This enhanced communication means practices cut down on the resources they spend on administrative tasks, freeing up personnel to spend more face time with patients.
CINs are a legal structure that helps independent practices have the leverage they need to bargain with insurers on behalf of their patients. They also help make IT improvements and more to ensure patients receive the best care possible.
How to Create a Clinically Integrated Network
Creating a clinically integrated network involves a lot of varying steps, but each is necessary to create a viable CIN:
- Identify potential participants: Determine what other organizations you want to work with in your CIN. Find organizations that complement yours, share goals with you and fill gaps your organization has.
- Develop a shared vision and value proposition: This step involves identifying stakeholders and determining their value propositions and that of the entire network. You should create value propositions that encompass the shared strategy in your network despite inevitable differences in opinion.
- Develop the governance framework and participation agreements: This step falls on your stakeholders to develop a governance framework that includes leaders from each organization who will work as one leader.
- Select quality measures: You will want your network to have meaningful quality measures so that clinical and physician representatives can create an appropriate value proposition for payers and employers.
- Recruit physicians: It is important to have physicians involved in the network and to strengthen ties with those already connected to it. They are the ones who will communicate your network to the right audience.
- Measure and improve: As with any process like this, it is important to stop periodically and assess how things are progressing and how they can improve. It is important to define performance measurements at the beginning so you have markers to track as time progresses.
- Engage payers: After all of this is done, engage your payers in negotiations. They should be involved in the process after settling all the legal standards.
These steps will set you up to have a successful CIN and allow your network to see the benefits of clinical integration.
Contact us today for more on our CIN solutions.