7 Predictions for the Future of Clinically Integrated Networks

Clinically integrated networks have grown in number in recent years, as hospitals and physicians attempt to align for population health management. The groups in a CIN are linked contractually, electronically and through processes used to improve healthcare delivery, according to Jeff Hoffman, senior partner with the Kurt Salmon healthcare group.

Forming CINs is one tactic to better manage a population's health. Mr. Hoffman describes the model as "the engine" behind population health management.

In a recent report titled "Special Report: Clinical Integration," national healthcare consulting firm Kurt Salmon and Community Hospital 100 shared seven predictions for how CINs will develop in the next five to 10 years. Here, Mr. Hoffman dives deeper into each prediction.

1. Health systems will lead the way in CINs. To develop a true CIN, organizations need the infrastructure to connect and share information, such as an electronic medical record system. Often times, physician groups have not had the capital at their disposal to build that infrastructure. "We typically don't see physicians having the capital wherewithal to do that," Mr. Hoffman says. Hence, hospitals and health systems have become the capital partners for the CINs, while the physicians bring the expertise. "Health systems will be the investors and the organizational catalyst in pulling clinical integration together."

2. CINs will move to accept full risk. Kurt Salmon experts predict CINs will move away from fee-for-service and even shared savings to a global payment model, where providers receive a set amount of money from a payer. In a global payment model, the providers take full financial risk, but they get to pocket any and all savings — it's a full-risk model. The global payment reimbursement model is the best model to incentivize providers to manage population health and to improve their financial positions, though they will also have to be able to accept the losses if they do a poor job of care management, Mr. Hoffman explains.

3. The governance structure of the CIN will become more important. The role of the CIN's governance will move to the forefront as the CIN, instead of the individual health systems and physicians, contracts with payers. "[CINs] have to have shared governance between the physicians and the health system," Mr. Hoffman says. In other words, the CIN should have a board with representation from physician members as well as administrative leaders from the hospital or health system.

4. Single-organization CINs will dwindle in number. Based on local markets, CINs will begin to consist of multiple organizations, in combinations such as multiple hospitals, a hospital and an independent practice association, or a hospital, an IPA and independent area physicians, and so on. "It's evolving uniquely across the country based on [what providers are] available," Mr. Hoffman says, noting that CINs formed solely by a hospital and its employed physician base will become less common.

5. Hospitals not in CINs will be treated as vendors. In areas where physician groups and IPAs are leading CIN development, or areas where other health systems are developing CINs and a local hospital does not participate, hospitals risk being treated like a vendor unless they get involved. If hospitals do not, the CINs will use the hospitals as contracted vendors for services. "You need to get involved," Mr. Hoffman warns hospital executives. "You have to have a [clinical integration] strategy that goes beyond just aligning or employing physicians."  

6. Solo and small physician practices won't survive. Other than in small rural areas, small or single-physician practices will cease to exist in the future. Mr. Hoffman said it's "really hard to imagine" physicians earning an income in this type of business model years from now. Current CINs made up of many independent physicians or small practices need to prepare to transition to larger group practices or to an employment model in the future.

7. CINs will outsource informatics and analytics. As CINs become more complex and gather more data, the organizations will need a way to analyze it efficiently to develop disease registries and conduct risk assessments, for example. "[CINs] don't always have to build everything from scratch," Mr. Hoffman says. "It's a daunting task for some organizations." So, in the future, it's likely many CINs will turn to vendors that have already created tools that can do this, similar to how the majority of health systems turned to a vendor for their EMR system.

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