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. In addition to there being no universally accepted legal definition of what makes up a CIN, there is some uncertainty as to how much they cost to put together. 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?
Between administration, electronic medical records support, claims analytics and network management – just to name a few – CINs are quite involved by virtue of their multi-layered composition. From a dollar perspective, however, they cost less than you might think. In fact, according to analysis conducted by McKinsey & Company, when including legal advice, start-up costs are typically right around $1 million.
However, that is just for the bare bones. In order to make a CIN properly integrated and truly effective, according to the American Academy of Orthopaedic Surgeons, the following elements are crucial for success:
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 shouldn’t be solely considered from a dollar perspective, but human as well. This includes residents, practitioners, nurses, primary care physicians, specialists, chairpeople and boards. The multilayered nature of CINs not only enhances integration but can also help improve quality control and the successful measurement of health outcomes.
“CINs are designed to enhance and improve health outcomes.”
2. 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 not only do not follow these guidelines, but don’t even know they exist. Protocols must be advertised and systematized to ensure they are leading to ongoing improvements in how healthcare is delivered and readmissions reduced.
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.”
4. System of checks and accountability
Even though CINs are different from accountable care organizations, they both work from the same principle: ensuring that patients receive high quality treatment by holding practitioners accountable. Whether that is reducing their reimbursement rates for not following best practices or flagging oversights that could have been avoided, disciplinary measures should be delivered in a manner that is consistent with the violation. It may even include suspension or termination from the CIN depending on the severity of the healthcare infraction. 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 his or her patients.
5. Method of operation for bringing new physicians into the fold
In order to add value and enhance choice, new physicians should be added 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 as to 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.
While CINs come in many different forms and are composed of a variety of healthcare professionals, they stop becoming CINs in the absence of data. Tangible Solutions is your partner in facilitating the sharing of accurate data 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 exceed its potential by increasing efficiency while decreasing costs and waste. Contact us and let us be your teammate in shared success.