A clinically integrated network (CIN) can be a fantastic system that improves the patient experience and creates fair relationships between healthcare organizations and insurance payers. It takes work to make a CIN function optimally, however. Here are five common hurdles CINs need to overcome to function efficiently:
1. Reluctance to share patient data
As physicians transition into a CIN, it may be difficult for them to let certain old habits die. For years, physicians have subscribed to strict data regulations, notably the Health Insurance Portability and Accountability Act. However, since the advent of electronic health records, more stakeholders have easier access to secure patient data.
Within a CIN, doctors should understand that patient privacy is still a top priority. In fact, when patient data is shared throughout the network, it is typically part of an aggregated set, meaning any identifying information has been removed from the documents. A basic rundown of how data is used, stored and transferred may help reticent doctors come to terms with information sharing.
2. Struggle to connect disparate health information technologies
When multiple health care organizations come together under the banner of a CIN, there are bound to be technical issues. When EHR systems don’t play nicely together, the very core of the CIN is threatened. After all, a network that is poorly connected serves very little purpose.
Organizations forming a CIN should partner with a health information technology (HIT) expert to ensure that every node within the system can communicate effectively. Doing so will make it easier for patients to move between primary care physicians and specialists within the CIN. Interoperability is an integral component of a successful integrated network.
3. Difficulty keeping referrals in-network
Referring patients to specialists outside the network is bothersome for everyone involved. Patients have to orchestrate the transfer of their data – often via complicated phone trees – and physicians run the risk of losing patients to another network. However, the situation cannot always be avoided. If an in-network specialist is too expensive, too distant or too busy, patients will go elsewhere.
Becker’s Hospital Review suggested using real time analytics to see when, where and why patients are leaving the network. Doctors can also use mapping technologies to pinpoint in-network colleagues to reduce the number of out-of-network referrals. Better technology improves the network’s ability to function as a clinical ecosystem.
4. Unclear leadership roles
When organizations come together to form a CIN, there may be some confusion around leadership roles. Specifically, the leaders of the network should represent all aspects of the organization. In other words, physician leaders and business leaders need to be present on the CIN’s governing board to ensure that the network meets its clinical goals as well as its financial responsibilities.
To achieve these widespread goals, CIN leaders need clear lines of communication with all stakeholders within the network. Thomas Enders, a senior managing director of Manatt Health Solutions, speaking with Trustee Magazine, explained that, unless everyone’s on the same page, a CIN cannot function properly.
“A CIN has to be very clear about, ‘Here’s where we have to improve,’ and the people in it have to say, ‘It’s true, we need to improve, we’re going to improve together, and we’re going to benefit from it,'” he said.
5. Weakened relationships with payers
One of the main objectives of a CIN is to make healthcare more affordable for patients. That’s why CINs are exempt from certain collective bargaining rules laid out by the Federal Trade Commission. Working together, the organizations within the CIN can gain a much better position when they meet with payers at the negotiation table.
However, a CIN doesn’t automatically get better payment rates – it needs to prove that it’s actually providing a higher level of care first. To do that, a CIN has to show that it has invested in the technology that will allow them to do so. To strengthen their position relative to payers, CINs should work with technology vendors to adopt customized solutions that benefit the patient experience.
To learn more about how Tangible Solutions tailors can benefit your CIN, please contact us today.