Pursuing Clinical Integration
To succeed under new payment models, providers must work collaboratively to improve quality and efficiency of care. A clinically integrated network, or CIN, provides a vehicle for such collaboration.
Clinically integrated providers are accountable to each other and for delivering value to their community. They accomplish this by collectively defining and enforcing standards of care and coordinating patient care.
A CIN is a lean infrastructure to support provider accountability. Its core functions include promoting evidence-based decision-making, engaging in performance improvement, facilitating care coordination, and supporting care management. Properly structured, a CIN can serve as a contracting entity for its participating providers. PYA’s Network Formation and Acceleration Programs help providers design, implement, and optimize CINs.
- Provider education and recruitment
- Consensus-building around governance structures
- Structuring terms included in participant agreements
- Establishing initial operations, including technology solutions
- Applying for the Medicare Shared Savings Program and other CMS initiatives
- Contracting with Medicare Advantage, commercial plans, and employers
- Proprietary Network Gap Analysis for compliance with CIN standards
- Operational and tactical planning
- Gainsharing arrangements (hospital quality and efficiency programs)
- Adoption of evidence-based guidelines and related performance-improvement activities
- Establishment of ambulatory care management programs
- Data analysis and development of work plans to reduce total cost of care