One of the most interesting recent trends that I’ve seen is that large integrated delivery networks (IDNs) are expanding their reach by forming more diverse and sophisticated clinically integrated networks (CINs). CINs have been around for a while in a much simpler form, typically coordinating activities between employed and non-employed physicians. Today, CINs are more diverse and can include networks of large independent health systems and or physician groups. This type of “Super CIN” provides a vehicle for independent providers to collaborate to achieve shared goals such as population health management for a specific employer contract or to deliver regional care. The MyHealthFirst Network that includes our customer, Greenville Health System is a prime example of a Super CIN.
How prevalent are CINs as a whole? The Advisory Board estimates that there are 500 CINS in the US today. According to a recent research study that Caradigm conducted, 60 percent of respondents indicated that they are forming or active in a clinically integrated network that includes physicians or hospitals not part of their current system. Five years ago, this almost never happened and even basic collaboration between competitors was uncommon. From the conversations I have had with providers, I believe that the trend towards Super CINs is only going to accelerate as it has become essential to succeed in the new value-based healthcare environment. Let’s explore the drivers of this trend further.
Increased need for ambulatory care
As providers take on financial risk for patient populations, ambulatory care becomes more important in order to deliver lower cost, preventive care, and reduce the need for acute care. The challenge for hospital organizations is that they typically aren’t structured to deliver ambulatory care everywhere a large population needs access. Under the fee-for-service model, the focus was inside the walls of the hospital. Population health management now requires providers to expand their reach across the entire continuum of care, which includes primary care physicians, specialists, skilled nursing facilities, community based organizations, etc. Few organizations will be able to do it completely on their own, which is why Super CINs are an attractive option.
Scaling to manage larger populations
According to the study we just completed, 52 percent of respondents have contracted to manage at least 25,000 lives. 61 percent indicated that they are planning to take on more risk over the next 12 months with 36 percent planning to add at least another 25,000 covered lives. As providers take on more risk, they must also scale their ability to drive quality and lower costs for these larger populations. Compared to opening new facilities or growth through mergers, forming Super CINs gives providers a faster path to scalability while maintaining ownership independence.
Alignment with multiple initiatives
There are many different “flavors” of risk that providers can choose to engage in such as Bundled Payments, Medicare Shared Savings Program ACOs, Commercial ACOs, DSRIP programs, direct contracts with employers, etc. Providers often engage in multiple programs to diversify their risk while they develop new care workflows and best practices. The beauty of Super CINs is that they can support a variety of different risk-based programs. Working together, these providers can more effectively compete for payer and employer contracts because they demonstrate higher quality and greater efficiency in care delivery. Super CINs are a foundational strategy whether a provider is looking to form a broader network of hospitals to meet the needs of a large employer, partner with other organizations as part of a state Medicaid initiative such as DSRIP, or strengthen the primary care an organization can provide for a regional population.
The growth of Super CINs also creates a need for new health IT tools. Information has to be gathered and shared among a broader network of providers that may be using disparate information systems. Analytics have to be applied to that information and then shared throughout the network at the point-of-care where it can have an impact. Workflows have to be streamlined so that providers can efficiently provide care for an increasingly larger population. These are new challenges that electronic medical record systems (EMRs) were not built to meet. Ultimately, Super CINs need IT solutions specifically designed for population health management that can complement their existing infrastructure and help them evolve to value-based care. If you’d like to see the full results of the study referenced above you can send us a note or download this whitepaper to learn more about how to take the next step with Super CINs and population health.
Greene, Jay. “Ascension Health, CHE Trinity form integrated network in Michigan.” Modern Healthcare. May 7, 2014. Published on: http://www.modernhealthcare.com/article/20140507/INFO/305079982/ascension-health-che-trinity-form-integrated-network-in-michigan