CIN accreditation: A framework for financial, legal and operational success

Whether physicians and hospitals are looking to create a new clinically integrated network or strengthen the efficiency of an existing CIN, many CIN administrators find vetting processes, like URAC's Clinical Integration Accreditation, can provide a framework for financial, operational and legal success, and ultimately serve as a mark of quality in the industry.

This content is sponsored by URAC.

A CIN is a physician-led legal entity consisting of independent providers within a community who commit to sharing clinical practice guidelines to improve care, develop ways to measure and share performance, and invest in data infrastructure that supports these activities. CINs allow physicians to jointly negotiate contracts, and they often form the basis of other value-based care arrangements, like accountable care organizations. As of 2015, there were an estimated 500 CINs in the U.S., according to data analytics firm Caradigm. This number is expected to rise as interest in value-based care grows, particularly under MACRA.

Establishing a CIN, though, poses challenges for physicians and administrators. Although CINs provide a safe harbor from antitrust laws when set up properly, they put physicians at risk in an incredibly complex regulatory environment. Moreover, a CIN's ability to improve quality and cost depends on active engagement from clinician partners, who can be difficult to gain without strong communication, governance and management structures. And while CINs have potential to leverage collective negotiating power, this is only possible if the networks can demonstrate population health management and cost control.

To address these challenges, many CIN stakeholders see value in using accreditation programs to best position their organization for success. URAC's Clinical Integration Accreditation — the only program of its kind — can help streamline CIN operations, ensure legal and regulatory compliance and improve market value, enabling physicians to provide better, more valuable care to patients.

Based on the testimony of three administrators whose CINs sought accreditation through URAC, this article explores three major advantages of accreditation and provides six tips for successful accreditation.

The accreditation advantage

1. Compliance integrity. Bridgeport, Conn.-based St. Vincent's Health Partners was the nation's first CINs to earn URAC accreditation. It sought this status right from the start.

"We needed to create an organization that would give us the structure and flexibility that would allow us to meaningfully participate in healthcare reform," says Kyle Lanning, JD, associate director of operations and administration and in-house counsel for SVHP.

SVHP's founders used accreditation as a tool to ensure they were playing by the rules to eliminate the need for antitrust scrutiny. "Connecticut has a rich history of transgressions by physician groups in terms of antitrust," says Mr. Lanning. The URAC Clinical Integration accreditation was created to align with Federal Trade Commission, Department of Justice and state-level antitrust requirements. Thus, when SVHP achieved accreditation, the network's leadership team gained confidence that the organization was compliant, even in Connecticut's stringent antitrust environment.

2. Operational efficiency. Phoenix Children's Care Network established itself as CIN in 2013 when Phoenix Children's Hospital and the area's community physicians came together to improve care continuity and help keep children out of the hospital.

"We wanted to make it easier to navigate our system, easier to access and easier for physicians to engage specialists," says Casey Osborne, vice president of PCCN. About three years into its clinical integration journey, PCCN sought accreditation from URAC, becoming the first pediatric CIN to do so.

Even after three years as a CIN, one of the greatest benefits of the accreditation process was streamlining PCCN's operations, according to Mr. Osborne. By going through each of the 35 URAC standards for accreditation and documenting their processes, PCCN was able to identify and streamline their best practices, thereby improving efficiency. "It was really the No. 1 thing we could have done to fully stand up our operations," he says. "I cannot overstate the importance we found in becoming accredited."

This newfound efficiency has increased PCCN's reach. In one year, it has doubled its patient panel to 100,000 lives from 50,000 lives. Accreditation also helped PCCN achieve significant cost savings by deploying a fully self-sustaining care model staffed by case managers and care coordinators. "In January 2017, we were only lightly working in engaging patients and members, and now at any given point we have hundreds of members being engaged," says Mr. Osborne.

3. Enhanced market value. Similar to PCCN, Seattle Children's Care Network began as a model to create a pediatric primary care network integrated with specialty providers. Somewhat uniquely from other pediatric CINs, however, SCCN to date has served the commercially insured market and supports several direct-to-employer contracts. The CIN was developed as a pediatric partner for a direct-to-employer contract between Boeing and University of Washington Medicine, as well as UW's larger ACO, which currently encompasses more than 1,000 primary care providers and more than 4,000 specialists.

SCCN began the URAC accreditation process in 2017 to build credibility in contract negotiations with payers. "We were talking with more and more purchasers about other value-based arrangements," says Ginger Hines, senior director of operations at SCCN, which is currently in the midst of their accreditation review process. "We realized accreditation would allow us to demonstrate we were organized and in full compliance with FTC regulations. It would help give our board and sponsoring organization — Seattle Children's — the confidence we are in alignment around being clinically integrated."

URAC accreditation is recognized as a seal of approval by many health plans because most state-based payers and Medicaid managed care companies are also URAC accredited. "It's very well respected in the health plan market," Ms. Hines says.

Tips for success

Achieving accreditation is no easy feat. Here are six top suggestions to make the process smoother, pulled from the playbooks of St. Vincent's, Seattle Children's and Phoenix Children's integrated networks.

1. Make sure accreditation is right for your organization. Accreditation is a major undertaking. "You don't go into this lightly," Ms. Hines advises. "It's a lot of work, but if you are serious about becoming a CIN, it's totally worth it."

Mr. Lanning agreed the process is extensive. CINs will gain the most from accreditation if they are in it for the right reasons. "Make sure you are doing it to improve yourself and keep it going on an ongoing basis, not just to get a rubber stamp every few years."

2. Get buy-in from the top. "Make sure you have support from the top down," Mr. Osborne says. His key to success: Ensure C-suite leadership and board members have a clear vision of what community physician engagement and accreditation will look like in their delivery network. Empowered with that vision, administrators can deliver a consistent message and engage stakeholders throughout the process.

3. Choose your accreditation team wisely. "Traditionally, networks have relied on current hospital expertise [to oversee accreditation]. However, CINs are a totally different ballgame," Mr. Osborne says. "Fresh talent with good, innovative ideas really helps support achieving the accreditation." Building a robust team doesn't require a massive human resource investment. However, Mr. Osborne recommends enlisting the appropriate number of employees to ensure the workload is manageable.

4. Start early and stay organized. "If I were starting a new CIN, I would start the URAC process sooner," Ms. Hines says. "Or at least look at the 35 standards and make sure you are dotting the I's and crossing the T's as you set up your CIN."

Mr. Lanning agreed. "I would have started a year earlier than I did," says Mr. Lanning. "It's a lot even though we are a small organization." The process requires a significant amount of documentation, which is easier to organize proactively than to sift through reactively.

5. Dedicate a space to the process. "It takes some resources in terms of time and manpower," Ms. Hines says. "We set up a war room to get us over the hump." After months of work, the project coordinator at SCCN pulled together approximately 1,000 pages of documentation for URAC's 35 standards for accreditation. They used the "war room" to map out the standards on the walls and the documentation together so executives, staff and management could review and redline the content.

6. Keep it simple. Organizations should be mindful that accreditation is an ongoing improvement process. "Don't overcomplicate it," Mr. Osborne says. "We spent so much time overthinking a lot of the aspects. A lot of health systems spend time thinking this is something we need to create systems for and buy technology and overstaff and engage hundreds of employees. Even 50 employees — it doesn't necessarily take all that. Start simple. Keep it simple, and don't let perfection stand in the way of progress."

Differentiate your CIN with accreditation

As the healthcare industry moves toward value-based care, independent providers see value in joining CINs to gain access to clinical resources and improve their market standing. Accreditation is one way to bring the CIN to the next level. For hospitals, medical groups and community physicians just starting their CIN journey, accreditation programs help ensure their newly launched CIN is positioned for long-term success. Not only will it instill a culture of continuous improvement, but the accreditation process will provide a framework for operational efficiency and antitrust compliance. URAC accreditation is recognized as a seal of quality throughout the industry, helping newly minted CINs gain credibility with potential partners and supporting existing CINs thrive in the time of value-based contracts.

While the process may seem formidable, your organization will come out on the other side as more efficient, more organized and more focused on improving the value of care for patients.

"URAC very much acts as a partner," Mr. Osborne says. "Their No. 1 goal is to ensure we are not just checking the boxes, but we are really doing what we say we're doing."

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