Increasing ways for patients to access care through a hospital’s clinically integrated network ("CIN") is a key to the success of new CINs, one healthcare finance advisor said Monday during a morning pre-conference session at ANI: the HFMA 2015 National Institute.
Daniel Marino, Executive Vice President at GE Healthcare Camden Group, said CINs and hospital leaders need to stop fearing non-traditional access points that patients use to enter their systems, and instead find ways to embrace them.
“Patients are accessing the system through retail clinics because it is easy, it’s convenient, and they are able to get what they need quickly,” Marino said. “Just think how those components successfully integrated into your clinically integrated network can be significant access points into your network.”
In instances when CINs identify outside providers where their patients are going to get care, he urged the CIN to establish a contractual relationship with the provider.
Such new access points come with their own challenges, including difficulty with sharing patient information and with communication. Marino described how one hospital client approached a primary care provider to act as medical director of a retail clinic.
“That helped create some alignment,” Marino said.
But hospitals need to think about the issue of access beyond patient visits to the emergency department, primary care, or even retail clinics.
One organization used social media to set up Facebook clubs to help patients manage diabetes and different cancer services, describing the step as a social support structure.
“What they found is that by creating that, they were able to monitor the information that went out, and it created a connection to the clinically integrated network,” Marino said. “The hospital wasn’t doing this, it was the clinically integrated network.”
More CINs are focusing on access points to help keep patients in their networks. When analytics indicate the leakage rate—patients going outside the network—is more than 5 to 10 percent, the providers need to find ways to keep more patients in the network.
“At the end of the day, if they leave your network then your ability to manage costs goes down dramatically and you have very limited ability to influence,” Marino said.
Increasing access can turn into a selling point for the CIN to increase volume by touting its ability to provide convenient care. Selling the CIN to patients is particularly important in the era of high-deductible health plans, where patients actively select providers based on price and quality.
An additional reason to focus on patient access points and leakage is because a CIN’s focus on reducing costs and improving clinical care can reduce revenue.
“If you are going to make up the difference in the revenue, the short play from the hospital CFO perspective is that you have to drive members into your organization, you have to create that value,” Marino said. “However, if you have created that value, then you can then negotiate those contracts with your payers. So access becomes critical.”