Over the past several years, evolving health policy and market forces have prompted drastic changes to the landscape of clinically integrated networks (CINs). Yet, progress toward consistent financial and clinical improvement is slow and pressure is mounting for providers to optimize performance and take on more risk and accountability. In a new white paper, Premier experts delve into the basics of CINs, including shared challenges of first-generation networks and common success factors needed to make the jump to an enhanced, second-generation model. Here, we provide a high-level overview of the paper and reflect on key considerations for CINs moving forward.
Early adopters of CINs share common characteristics and typically face similar challenges. Most first-generation CINs are organized by integrated health systems, benefiting from existing infrastructure and resources. Most pursued upside-only value-based payment contracts involve limited financial risk. Physicians in the first-generation model are heavily involved in governance, and many CINs are adept at employing data analytics to hone in on high-risk patients, monitor utilization, manage care and measure outcomes.
These early CINs typically focus on learning and experimenting, and fostering a culture around value-based care and shared accountability. And, in some respects, these networks have been successful. Across the board, physicians are engaged and quality performance has improved. But despite this progress, financial success – curbing costs and qualifying for bonus payments – has proven difficult for many.
Evolving policy and payment models, and a competitive market and shifting demographics are pushing CINs to step it up, and quickly move from the “trial and error” phase to achieving consistent and sustainable results.
The Tipping Point
Existing CINs, for the most part, have established an infrastructure to change operations and embraced a culture of value-based care and population health. The industry is reaching a tipping point, and CINs should be thinking about how to solidify their market position and differentiate themselves from other CINs to attract payers, providers and patients. This includes considerations such as how to recruit and retain talent, and expand to larger geographies and engage different entities with common interests Networks need to make deliberate and systematic investments in strategies to improve care and lower costs, including new care delivery and payment models, and robust technology platforms and analytics. Innovation and “outside the box” thinking about health and healthcare will play a big part in establishing a favorable market position.
Fertile Ground for Innovation
CINs hold enormous potential for cultivating innovation in healthcare and rapidly expanding what works. These networks should serve as incubators, and eventually distribution channels, for new ideas, interventions, and technologies to improve care and lower costs. Data is at the heart of innovation, and CINs must think beyond clinical and claims data and invest in tools to integrate social and environmental data and patient-reported outcomes to inform care. With robust and integrated data systems in place and supportive leadership, CINs are fertile ground for piloting new ways to engage patients, target care, diagnose and manage disease, and measure and benchmark performance.
Advancing to Second-Generation
Readying your organization for the transition to a second-generation CIN is not an easy undertaking. To help guide you, Premier has devised a “formula” of enhanced capabilities needed to build strong partnerships with physicians, take on more financial risk, and deliver high value care. As a whole, this formula underscores the importance of building and maintaining relationships – with providers, commercial payers and employers, and most importantly, patients.
In a forthcoming blog series, we’ll explore these specific capabilities and action steps in more detail. In the meantime, we encourage you to read our recent white paper on the future of CINs and a blueprint for success. And for additional information on two-sided risk contracts, download our white paper “Building Successful Two-Sided Risk Models.”