Healthcare expenses are increasing in the United States. Patient satisfaction is decreasing. Fee-for-Service and Value-Based Care reimbursement models are beginning to fight for dominance in the healthcare world. The time has never been better for physicians, healthcare organization leaders and economists to experiment with new collaboration techniques that improve medical results and end goals for patients and providers alike. One result of this shifting view of healthcare is the Clinically Integrated Network (CIN). Here’s what you need to know about this up-and-coming collaborative system.
What Is A Clinically Integrated Network?
Many entities have defined the Clinically Integrated Network. In 1996, The Federal Trade Commission and Department of Justice defined it as “an active and ongoing program to evaluate and modify practice patterns by the CI network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.” According to Becker’s Hospital Review, a CIN “is commonly defined as a health network working together, using proven protocols and measures, to improve patient care, decrease cost and demonstrate value to the market.”
Essentially, a CIN is a network of physicians, providers, organizations and offices that unite to provide quality care for patients in an efficient and cost-effective manner. Accountability is paramount in this system, and physicians must share patient information through electronic health records (EHRs) in order to determine and agree upon the best course of action and standard practices for treatment. This also reduces or even eliminates both redundancy and opposing opinions on recommended treatment.
Such networks are considered CINs if they:
- Establish procedures, protocols and regulations to control and monitor healthcare services in an effort to keep costs down and quality of care up.
- Choose their physicians carefully, drawing from candidates who are most likely to pursue set objectives and work for the good of both the patient and the network.
- Use investments of funds and manpower through set protocols to pursue CIN goals and claim the benefits of united care.
Components of a CIN
1. Legal Options
In order to work legally as a care network, member providers and organizations must form into one of three types of groups: a physician-hospital organization (PHO), independent practice association (IPA) or a health system subsidiary (HSS). These options are being used by CINs to reach certain objectives, such as continuing to establish a network or providers, creating new partnership models, demonstrating care value through performance improvement initiatives and negotiating contracts with potential partners.
2. Physician Leadership
No matter what form the CIN takes, physicians must be active in its leadership and governance. A governing board must be established to determine and pursue CIN goals, and physicians must communicate with one another and be accountable to providing the best possible outcomes in patient care and finances.
3. Criteria for Participation
Physicians and organizations involved in a CIN must sign participation agreements. These documents bind them into using set care techniques, technology use, protocol compliance, participation in-network with all contracts and more. All of this is done for the purpose of improving outcomes and patient satisfaction. If a physician wants to be a part of a CIN, they must acknowledge and submit to the governance and overall objective of the network.
4. Performance Improvement
Metrics must be set up to determine how physicians in the network are serving and improving in the goals laid out for them. Beyond that, physicians themselves must help determine those metrics and keep one another accountable for making sure they are met. This system of improvement provides measurable success rates and statistics that can show in a tangible way the progress the CIN is making in patient care.
Information and computer technology are at the heart of the CIN. Without EHRs and effective ways to quickly and securely communicate patient and provider information, a CIN will fall apart. Since technology is evolving at an exponential rate and developers are seeking to provide more privacy and security without sacrificing quality and ease of use, IT must be updated often within the CIN. Members of the CIN must take part in helping it improve so all parties can benefit.
6. Contracting Options
In the overarching goal of providing better quality care while also (hopefully) reducing cost, CINs can contract work to payors, employers or health systems. But without a solid contracting method that outside contract workers agree to, their relationship with the CIN will not work properly.
7. Fund Flow
Fund distribution is based on performance, cost savings and incentives within the CIN. These funds are distributed after patient treatment, but there must be clear and fair regulations set up that determine rewards for providers and maintain measurable goals.
The Future of Healthcare?
Clinically Integrated Networks are just one type of healthcare system that providers in the industry are working with. But as both the public and the government demand easier and cheaper access to care, structures must change to accommodate need. CINs could be one way that healthcare organizations can begin to manage revenue and patient care more effectively.
At DECO, our job is to help your healthcare organization maintain a healthy revenue cycle management system, and we can tailor our methods to suit your needs. Contact us today for more information!