CINs are a way for hospitals and physicians to work together in managing the health of a population of patients. They are networks of hospitals or health systems and providers that collaborate to develop and sustain clinical initiatives within the CIN. Participants use evidence-based guidelines and share data and patient information in order to coordinate and manage care efficiently. Additionally, the ability to contract as one network with a payer is important for CINs.
Here, Mr. Reiboldt, Aimee Greeter, a senior manager with Coker Group, and Justin Chamblee, a vice president with Coker Group, share nine keys to success for hospitals when forming a CIN.
1. Find the physician-hospital structural model best suited for the situation. The experts say CINs work best when a hospital or health system works with both employed and private practice physicians. “Having both in the CIN is the most advantageous model,” Ms. Greeter says, to broaden the provider base. However, if a hospital’s entire medical staff is employed, she says, then the inclusion of private physicians may not be necessary.
2. Cover the complete continuum of care. The most successful CINs include providers and care sites throughout the care continuum, such as primary care physicians, diagnostic testing and imaging centers, outpatient centers and post-acute care sites. “The more aspects of a continuum that are invested in the network, the more successful you can be,” says Ms. Greeter. “We recommend that [a CIN] is established with as broad of a provider base as possible.”
3. Build trust among all parties involved. In many markets, independent physicians are leery of working too closely with hospitals. So, it may be necessary to take interim alignment steps, short of a CIN, to overcome the baggage. However, while alignment through employment or professional services agreement/management services agreement models may have been sufficient in a fee-for-service or volume-based business model, it is not going to be sufficient in a value-based business model where full integration of physicians and hospitals or healthcare systems will be necessary to do things like population health management and risk contracting. So, while a trade-off may be necessary, it is unlikely that can continue to occur in perpetuity.
Once physicians have agreed to be part of a CIN, it is paramount for them to truly understand the time commitment that comes along with joining a network. “They need to know what they’re signing up for, what is expected and what their estimated time commitment is,” says Mr. Chamblee. “Activities in a CIN can be cumbersome. Being forthright will make the process easier and allow for a lot more buy-in.”
4. Ensure utilization of evidence-based medicine throughout the CIN. When it comes to appropriate, consistent population health management, evidence-based clinical protocols are key to success. Development of protocols, education regarding their existence and benefits and periodic evaluation of provider adherence to these protocols are important in ensuring that each patient (and the entire population of patients being served), receive the best possible care. “While it may be a process to establish the finite criteria for delivering care using evidence-based medicine and clinical best practices, it will be worthwhile in the end,” Mr. Chamblee says.
5. Enlist physicians to develop the key performance indicators that measure success. Key performance indicators range from the shared savings a CIN is generating to patient satisfaction rates to specific quality measures. “The investment of providers — the investment of their time and intellectual capital — in setting up metrics is invaluable,” Ms. Greeter says. Physicians generally know best when it comes to measuring true outcomes (as opposed to just process measures), and where areas of cost savings can actually be accomplished. Since value versus volume production is the new business model, CINs must be able to measure these factors to successfully do business.
Here, it is also important to establish baseline levels, usually on historical trends or national or regional data, according to Mr. Chamblee.
6. Ensure compliance with relevant laws and regulations. One of the biggest potential legal pitfalls for CINs is antitrust regulations. “I see it as a challenge, because what we’re talking about here is pulling together independent entities into consolidated consortiums and their function is to speak as one voice and function in unison,” says Mr. Reiboldt. “Antitrust is adverse to that. You can’t pull together a CIN without antitrust review.”
Beyond antitrust considerations, there are several other laws and regulations to keep in mind when developing a CIN. For instance, if a group in the network is a nonprofit or tax exempt, it needs to be cognizant of maintaining that status when it comes to incentives distributions. Additionally, CINs must follow HIPAA regulations at all times when sharing data among providers.
7. Identify support systems already in place and determine what needs to be added. Hospitals need to consider areas such as human resources, technology, equipment, space considerations and capital needs when developing a CIN, according to the Coker Group experts. However, there is one support system area that deserves the most attention: “All of the support systems are critical, but teeing up on information technology is really very important,” Ms. Greeter says. This leads to the next key…
8. Integrate information systems. Simply having an electronic medical record is not enough to support a CIN. Many networks are not aggregating the data necessary to enhance the quality of care, according to Ms. Greeter. In order to be as successful as possible, CINs should have information systems that can reconcile outliers in the data set and turn data into useful, actionable information.
While adding or changing IT and EMR systems is not an inexpensive feat, the experts say the investment will ultimately be worth it when providers in the network, be they employed or in a private practice, can share data back and forth appropriately.
9. Clearly define participation. Successful CINs will have a well-defined participation agreement, according to Mr. Chamblee. The agreement should define exactly what participation in the CIN entails and what restrictions are placed on groups or individuals for participating in other CINs. “If you sign up with a system’s CIN, by nature, it may preclude you from participating in others,” he says. Level of participation should also be factored into the distribution of any profits generated in the network.
