While the concept of “clinical integration” traces back to the mid-1990s, clinically integrated networks (CIN) remain a relatively new phenomenon. In fact, the first major one launched in 2013. Yet despite their growth in number — now topping 500 in the U.S. alone— they remain relatively unknown.

There is currently no universally accepted legal definition of a CIN, so it makes sense that there would be uncertainty about the cost of creating one. What’s more, even though the Federal Trade Commission provides guidelines — as opposed to hard-and-fast rules — on how to set one up, there is a big difference between a merely existing CIN and one that thrives.

If joining or forming a successful CIN is something you are considering for your group, here are a few important considerations.

What are the start-up costs to form a CIN?

Although CINs are incredibly involved by virtue of their multi-layered composition — including administration, electronic medical records support, claims analytics and network management, to name a few — they cost less than you might expect. In fact, according to analysis conducted by McKinsey & Company, when including legal advice, start-up costs are typically right around $1 million.

That $1 million, though, is just what you need to make the bare bones of a CIN. There are many other critical costs involved, and it is important to weigh them out when deciding whether to join or form a network.

6 Essential Clinically Integrated Network Requirements

According to the American Academy of Orthopedic Surgeons (AAOS), the following elements must be present in a CIN that is properly integrated and truly effective:

1. Significant capital investment

“Significant” is a relative term, but it’s safe to say that the amount will necessarily be well above $1 million. Additionally, CIN investments should not be solely considered from a dollar perspective, but human as well. The people involved in a CIN include:

  • Residents
  • Practitioners
  • Nurses
  • Primary care physicians
  • Specialists
  • Chairpeople
  • Boards

The multilayered nature of CINs not only enhances integration but can also help improve quality control and the successful measurement of health outcomes. With more physicians in the CIN, patients can benefit from a holistic care plan built on a single source of truth.

Form a CIN

2. Practice protocols that make healthcare improvements

Practice Protocols That Make Healthcare Improvements

More than anything else, CINs are designed to advance and improve health outcomes. That requires relying on time-tested treatments and guidance that lead to positive results for patients. However, studies show that far too many physicians either ignore these guidelines or do not even know they exist.

To ensure that protocols are leading to ongoing improvements in healthcare delivery, network administrators must first advertise and systematize them for all CIN providers. By improving these procedures, you can also significantly reduce the number of readmissions within your network and increase treatment effectiveness.

3. Methodologies that evaluate quality and care utilization

Disease registries, integrated information systems, electronic health records, clinical support portals — these efficiencies all serve as mechanisms for practices to track how care is delivered and to what extent patients are getting better in terms of wellness. As noted by the AAOC, CINs “should have standard systems consisting of people, processes, and technology for measuring and monitoring performance at the individual and group levels, as well as systems for sharing clinical information among physician participants.”

A CIN should seamlessly connect EHR systems for optimized communication and greater treatment. Providers within a CIN have various treatment styles, so visibility into a patient’s treatment across the network is important. This enables them to design personalized care plans that work with other ongoing or previous care. Applied at scale, a connected data management system can help close care gaps in populations and improve overall outcomes.

4. Bi-directional data integration from disparate EHR systems

Since communication and EHR connections are important parts of a CIN, data integration determines its effectiveness. Data is critical because it enables your providers to make the most informed decisions in their treatment plans. Even if every provider in your CIN uses a different EHR system, a centralized data warehouse can reduce friction and enable easier data analytics for more effective insights into patient treatment.

This repository should be able to integrate the data it pullsfrom the various sources within your network as well as push data back to each EHR. Essentially, your data warehouse creates a single source of truth for all your providers while making vital insights accessible for immediate deployment of care.

5. System of checks and accountability

Even though CINs aredifferent from accountable care organizations (ACOs), they both work from the same principle: ensuring that patients receive high-quality treatment by holding practitioners accountable.The delivery of disciplinary measures must be consistent with the violation, whether that means flagging oversights that could have been avoided or reducing reimbursement rates for failing to follow best practices. Depending on the severity of the healthcare infraction, these measures may even include suspension or termination from the CIN.

However, these penalties must not conflict with the patient-centered nature of CINs. In other words, the extent of the disciplinary procedures should not be to the detriment of the affected physician’s patients.

6. Method of operation for bringing new physicians into the fold

In order to add value and enhance choice, network administrators should add new physicians to the CIN whenever appropriate, replacing those who retire or to further advance collaboration across multiple specialties.

It’s important to set up a system in which there are methods or procedures that clearly dictate when new physician members can or should join the CIN. Additionally, as noted by McKinsey & Company, the doctors who come aboard must be allowed to contract with those payers who are out of the network, thereby decreasing antitrust risk. This speaks to the “non-exclusivity” characteristic of CINs, as recommended by the FTC.

Join or Form a Strong CIN With Tangible Solutions

Although CINs come in many different forms and include various healthcare professionals, they are not CINs without data. Tangible Solutions is your partner in facilitating accurate data sharing across the healthcare ecosystem, whether it is to or from providers, medical facilities, registries or patients.

We can help your CIN not only meet but extend its potential by increasing efficiency while decreasing costs and waste. As an experienced Integration as a Service (IaaS)provider, we can help you ensure your CIN’s digital tools communicate so you can have the most complete data on every patient at all times.

Our mission is to help our customers achieve healthcare data delivered right, every time. Contact us, and let us be your teammate in shared success.

Join Or Form A Strong Cin With Tangible Solutions