The role of CIN in securing value-based contracts

NS San Jises, MD, Executive Vice President, HealthEC

It was Recently calculated The United States spends $ 3.8 trillion on health care, or 18 percent of the national economy. The current health care situation shows that this spending rate will not soon slow down due to the ongoing health care crisis, the COVID-19 pandemic. Value-based care models such as Accountable Care Organizations (ACOs) and Clinically Integrated Networks (CINs) address the tremendous growth in medical costs and at the same time improve the quality and coordination of care in the United States. Was formed in. Let’s take a look at these models and their models. Ability to secure value-based contracts for better illness and population health care.

ACO creates value and cost savings
As of January 2021, 512 Medicare Accountable Care Organizations (ACOs) accounted for 12 million Medicare beneficiaries. These Medicare ACOs have saved $ 8.5 billion in total Medicare savings since 2012, according to a report from the National ACO Association. Providers and medical systems coordinated to manage chronic conditions or complex illnesses throughout the patient population. If cost control is successful, ACO will share the savings of this low cost, high quality care model. The transformative ACO shares five common goals to provide value and efficiency in clinical care.

  1. Advanced coordination between patient care teams
  2. Extraordinary patient experience
  3. Patient-centered communication
  4. Combined vertical electronic medical records
  5. Quality metrics report and data analysis

Medicare Shared Savings Program (MSSP) Providers Are Affected 2021 regulation of CMS This includes some positive adjustments. Transforming care models like ACO and CIN need to cover the pillars of data, analytics, finance, and patient care to prove the value of high-quality, patient-centric care delivery.

Definition of clinically integrated network (CIN)
Formation Clinically integrated network (CIN) Providers can remain independent while working with other providers under the umbrella of the network to coordinate patient care. The American Medical Association (AMA) has described clinical integration as “safe, timely, effective, efficient, impartial, patient care over time, conditions, providers, settings, and time to achieve patient care. A means of facilitating adjustments. ” Focused. “

Providers participating in CIN have many advantages.

  1. Physicians can maintain clinical independence while participating together to negotiate a better managed care rate
  2. Using indicators and quality data, CIN can demonstrate improved quality of care, along with cost savings and spending efficiency.
  3. CIN can support multiple managed care contracts
  4. CIN is recognized by FTC along with criteria and guidance for defining clinical integration

Clinical transformation supports patient-data-centric collaborative care, reducing waste while delivering superior quality and value of care. The overall approach to achieving clinical integration includes:

  • Clinical practice guidelines and efficiency definitions for high quality, low cost care that can be monitored and controlled
  • Working with providers working to manage patient populations efficiently
  • Measurement and evaluation of compliance with the guidelines of each participating provider
  • Investing in people and technology to promote clinical integration and implement practical guidelines for care and quality efficiency

A clinically integrated network (CIN) is a viable option for independent physicians to participate in value-based care models. Information sharing and value-based performance measurements ensure accountability among participants.

Barriers to clinical integration
Manual work associated with reporting, accessing, and referencing patient data can impair productivity and positive clinical outcomes. With the technical tools that data track patients and facilitate follow-up care, CIN is the most successful and ready for a highly value-based care model. The benefits of data analysis when negotiating value-based contracts are astronomical. Beyond data analysis, physicians need to address potential barriers to forming CIN.

  1. Different electronic health record systems (EHR) that are not integrated
  2. Manual work to extract, combine, or pool data is costly and less likely to occur
  3. Lack of workflow automation to manage patient referrals in the network
  4. Data analysis capabilities for assessing quality, cost and care metrics
  5. Physician Champion on IT Infrastructure and Usage

Health providers who do not have a comprehensive data analysis solution to stratify risks and identify care gaps are at a disadvantage when it comes to negotiating the best terms and conditions with payers in the value-based care market. increase. Tools for clinical decision support and care management determine the effectiveness of payer-provider collaboration.

CIN success
Throughout Pennsylvania, physician-owned clinics have been successful, working together as a clinically integrated network. Specifically, Care Centered Collaborative helps independent physicians and groups of physicians establish or further enable a selected clinical integrated network (CIN). A multi-year joint venture creates an opportunity for these CINs to secure value-based care contracts with payers. I was excited to expand this discussion with Dr. Jaan Sidorov, CEO and President of the Care Center Collaborative of the Pennsylvania Medical Society. Medical Group Management Association..

Collaborative’s artificial health management platform initially received data from 160 providers. This data included claims and clinical information across 23 different EHRs over a two-year period. Population factors to analyze:

  • Patients at highest risk of emergency visits, readmissions, or complications
  • Duplicate testing and other redundant or unnecessary care
  • Targeted population areas with high incidence of specific childhood diseases for targeted programs and interventions

Recently, the Pennsylvania Clinical Network Value-based agreement For Medicare Advantage members of Etna, Pennsylvania.

CIN can increase its geographic footprint through contract, network, and service expansion. Their ability to expand their operations determines how efficiently and effectively they can manage the growth of the patient population. Replicating the same care value model for high quality, outstanding patient experience and cost savings can be achieved through enthusiastic physician and clinical leadership teamed with technology capabilities to manage patient influx.

ACO and CIN respond to the call to address the issue of rising health care costs and improve the quality of care. These care models successfully manage illness and accelerate patient-centric data capabilities. As the healthcare situation continues to evolve, the basics of ACO and CIN will not change. That is, the doctors involved, patient data between communities, and population health management tools. More healthcare providers will have the opportunity to share their savings and succeed through alternative payment models. This is invaluable for transforming healthcare delivery.

This article was originally published Health EC Blog It will be reissued here with permission. The role of CIN in securing value-based contracts

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