As communities work to build clinically integrated networks (CINs) to better serve their patient population, many are finding that individual practices are unhappy when it comes to measuring CIN performance. Practices have unique appetites, resources, values and methodologies, affecting their perceived contribution to overall results.
In a June Becker's Hospital Review webinar sponsored by Caravan Health, part of Signify Health, three value-based care experts discussed why so many CINs struggle to hold onto their top performers and shared concrete steps to build a data-driven program to appropriately incentivize CIN practices.
Panelists were:
- Lynn Barr, chief innovation officer, Signify Health, and founder, Caravan Health (part of Signify Health)
- Manjula Julka, MD, senior population health officer and vice president of medical affairs, Signify Health
- Shawn Rhodes, regional vice president, Caravan Health (part of Signify Health) and former director of clinical integration
Three key takeaways were:
1. CINs that treat all practices homogeneously are in danger of losing their top performers. "Not everybody in the network is the same," Ms. Barr said. "You have very high performers that have been doing this work for decades who are ready to participate in all the leading-edge [value-based] programs. You also have practices that are very cautious and concerned about these programs because they have tougher economics, more difficult patients or are small and independent. Somehow, you have to figure out how to make the CIN work for everybody." Failing to do so puts the entire CIN at risk as profiteers comb the country looking for top performers.
2. Networks can stay together by keeping CINs aligned. "One size that fits all isn't working; networks are breaking apart," Ms. Barr said. "We need a different value-based program for every participant, but still one program for the entire CIN." Here are five alignment strategies:
- Assess readiness and group peers. Mr. Rhodes explained that the Caravan methodology meets practices where they are. "We often say that if you've seen one practice, you've seen one practice," he said. Caravan uses data to understand the differences. "We want actionable data to drive decisions. We want to assess each practice's readiness, structure and existing networks, technology and payment models." Same-level practices are grouped together.
- Identify shared goals and local opportunities. It's critical to engage physicians and management in goal-setting and governance, focusing on outlier performance for best results.
- Provide tools, training and support for success. "Our goal is to monitor the data so we can support individual practices, so all ships rise together," Mr. Rhodes said. "What are the key things driving them? Is it resources? Process? Workflows? And how do we collectively help them?"
- Identify and manage out-of-network spend. "A very important aspect to influence outcomes is to have a view of what's happening out of the network in terms of spend," Dr. Julka said. Patients need to be coached during an annual wellness visit to keep their primary care physician in the communication loop with specialty referrals. "We need to work collaboratively to see how we can care for patients together better to move the needle."
- Incentivize appropriately. Ms. Barr emphasizes paying doctors well. "Remember that this is a payment model and we're asking physicians to replace fee-for-service with value-based payments," she said. "The more payments we can get them, the better." Then, look at shared savings, including population health and 340B revenue, merit-based incentive payment system (MIPS) and alternative payment model (APM) bonuses, and wellness and chronic care management efforts. "Reward each peer practice group to reflect its advancement from its effort," she added.
ACO operational improvements can generate substantial results. One large ACO with 12 hospitals and 6,000 providers that implemented these strategies realized a $1.9 million savings from reduced discharges to skilled nursing facilities (SNF), $447,000 savings from reduced SNF length of stay and $2.1 million savings from fewer readmissions within one year.
By using actionable, data-driven strategies, CINs can help all practices make progress, retain top performers and advance the network as a whole.
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