Hospitals across the country are partnering with local physicians to form clinically integrated networks. The goal is to coordinate care around quality outcomes and cost management.
But the drive to manage outcomes and costs is leading many local networks into the business of population health. That, in turn, is putting pressure on the boundaries that separate one clinically integrated network from another. There is a growing awareness of the need to coordinate care at a regional level.
Now, provider organizations in many areas are responding to this need by developing “Regional Clinically Integrated Networks (CINs).” This is good news:
- Regional CINs hold the promise of delivering truly effective population health management.
- The Regional CIN model can accommodate the many hospitals and physician groups that want to take part in a coordinated care strategy, but continue to have a strong preference for remaining independent.
Defining “Regional” Clinical Integration
A Regional CIN is collaboration between multiple hospitals within a wide geographic area. The hospitals remain independent while pooling clinical, technological and strategic resources. This includes employed physicians as well as strategically important community physicians within their local networks.
Expanding the organized system of care allows participants to better influence quality outcomes, reduce costs and pursue value-based contracting. Factors driving the Regional CIN trend include:
- Significant interest from independent physicians in partnering with hospitals in response to healthcare reform.
- The desire of many independent hospitals to develop a population health management strategy without participating in a merger.
- The need of large regional health plans to secure provider partners in developing population health insurance products.
The Regional CIN Planning Process
An effective regional network strategy will focus on four key goals:
Create a Vision and a Business Strategy
Begin by defining the population health goals of the Regional CIN. Identify the resources needed to achieve these goals, develop financial models and forecasts, and craft a comprehensive budget. Take care to develop an appropriate legal structure for the network.
Define a Payer Strategy
Start by identifying potential managed care partners. Some Regional CINs are focusing first on their own employees. Member organizations are pooling their self-insured beneficiaries and enrolling them in the Regional CIN. This allows participants to reduce their direct healthcare costs. More important, it enables the network to create a “proof of concept” that can later be promoted to payers.
Develop a Shared Infrastructure
Focus on building the key competencies of population health management:
- Coordinated medical management around clinical protocols
- Leveraging of information systems to optimize patient care
- Clinical, financial and operational analytics/reporting
- Provider enrollment and integration
- Alignment of financial incentives with network goals
- Risk-based contract negotiations
Build a Shared Culture
Organizational culture drives the effectiveness of any provider network. While pushing to grow the Regional CIN, leaders should also carefully consider provider eligibility and selection criteria.
Three questions that drive regional strategy
As a first step to developing a Regional CIN, healthcare leaders should ask:
1. Is There an Opportunity?
What is the state of care coordination in your region? Is there an opening for a true population health approach? What community health needs represent your most promising starting point?
2. How Will Participants Benefit?
How would a Regional CIN create value for each member hospital? What’s in it for physicians?
3. What Resources Can We Leverage?
What services can be pooled and leveraged for greatest impact? Do potential partners have enough self-insured employees to launch a “beta version” of the population health concept?
The most important question for many organizations will be, “How soon can we begin?” Providers across the country are actively developing the Regional CIN model as a “platform for change” that will help them thrive in the emerging healthcare environment.
As President/CEO of Health Directions, Daniel J. Marino shapes strategic initiatives for healthcare organizations and senior health care leaders in key areas such as population health management, clinical integration, physician alignment, and Health IT. With a broad background in all aspects of practice management and hospital/physician alignment, Dan is nationally recognized as a strategic leader in Accountable Care Organizations and clinical integration development. He frequently speaks at national conferences and regularly authors articles for the nation’s top healthcare industry publications related to current transformations in healthcare delivery. Dan may be reached via email at firstname.lastname@example.org or by phone at 312-396-5400.