Provides a blueprint to health systems seeking to accept added levels of risk and effectively implement value-based payment models
CHARLOTTE, N.C.— Premier Inc., a leading healthcare improvement company, today released a new definitive implementation guide to help providers make strategic decisions for continued growth in the new world of value-based care and risk-based contracting.
Entitled Ready, Risk, Reward: Aligning for Success with the Second Generation of Clinically Integrated Networks (CINs), the guide summarizes lessons learned from Premier’s experience with health systems forming CINs, and recommends strategies for optimizing performance as these networks move up the continuum to accept two-sided risk, care arrangements for larger patient populations, and participate in advanced alternative payment models with commercial, employer and government payers.
“CINs can serve as a core organizing strategy and platform for providers participating in value-based care, including the Medicare Shared Savings and bundled payment programs,” said co-author Tony Malcoun, Premier’s vice president of population health advisory services. “Yet, only a third of CINs are reaping financial rewards from these programs, suggesting that many need to be strengthened before they accept greater risk and extend their capabilities to new geographies, service lines, provider groups and payer partners. This need becomes even more urgent in today’s environment, where CINs face pressure to move into two-sided contracts where they are at risk to repay financial losses to payers.”
The CIN guide provides recommended strategies for optimizing CIN performance based on Premier’s experience establishing stand-alone CINs nationwide, as well as optimizing CIN performance through the Population Health Management Collaborative, which helps hundreds of hospitals and thousands of clinicians in more than 80 different markets work together to align, measure and improve population health management. Premier CINs typically perform 57 percent better on average in achieving shared savings payments through value-based contracts with Medicare, all while outpacing peers in clinical quality scores.
“Core to CIN efforts to move into two-sided risk involves developing an overarching, three-year strategy for growth and improved performance,” said report contributor Steve Valentine, Premier’s vice president of population health engagement and delivery. “Some of the toughest challenges they will face are enhancing and managing culture and ensuring provider capabilities to accept added levels of financial risk. Other formidable challenges include creating more inclusive governance structures that both expand primary care participation, while extending into other services areas to involve specialists and post-acute care.”
Beyond these capabilities, the guide recommends 10 additional best-practice steps to enhance performance and prepare for two-side risk contracting, including:
- Conducting a market assessment to determine whether conditions are favorable for moving into two-sided risk contracts;
- Financial modeling to ensure optimal flow of funds and appropriate offsets to make up revenue due to utilization declines;
- Streamlined data assets and data insights with a consistent flow of complete, accurate and timely claims and quality data;
- Consistent measures of cost, utilization and quality that can apply across payers, as well as satisfy professional and regulatory reporting requirements;
- A payer partner strategy with a clear strategy and road map that targets opportunities;
- Unified and coordinated contracting functions and terms that can be leveraged across the network and across payers;
- A strategy for measuring, managing and articulating the value of in-network utilization to minimize referral leakage;
- A clear, data-driven set of evaluation criteria that will be used to determine high-value providers that are asked to join an expanded CIN;
- An expansion strategy that differentiates the high-value network of providers for commercial and employer payers; and
- Coordinated and centralized care management functions across the continuum to spread fixed costs and optimize patient engagement.
“The current competitive environment, MSSP requirements and incentives in the Medicare Access and CHIP Reauthorization Act (MACRA) are all driving CINs to perform at optimal levels,” said report co-author Joe Damore, Premier vice president of population health management. “Making the major step up the risk continuum requires a thoughtful approach in order to ensure financial viability, sustainability and success. This guide synthesizes the best practices we’ve learned from our members and clients, and will greatly help any CIN prepare for the next steps in value-based care and risk contracting.”