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GE Healthcare Camden Group Insights Blog

Super Clinically Integrated Networks: 8 Components to Consider

Posted by Matthew Smith on May 4, 2016 11:31:47 AM

By Susan Corneliuson, MHS, FACHE, GE Healthcare Camden Group 

Clinically Integrated Networks ("CINs") are evolving quickly across the country in response to changing reimbursement trends and the move to value-based payments. Estimates indicate more than 500 CINs are in operation in the country today.

In most markets, single healthcare systems have formed independent CINs in an effort to more formally align independent and employed physicians in the region. In certain markets, we are starting to see the development of Super CINs or Population Health Alliances. 

The formation of Super CINs and Alliances is motivated by the perceived need to reach larger populations and to form more comprehensive delivery networks, in many cases fueled by increased competition within the marketplace. The main goals of most Super CIN/Alliance structures is to expand network offerings and services through direct-to-employer products and to effectively pool resources to build robust population health infrastructures. 

Independent systems believe they can achieve greater benefits through joint collaboration than on their own and trust that they will ultimately be better positioned for value-based care. 

Alliances are formed by integrating a number of healthcare institutions under one CIN structure, in which hospitals remain independent while pooling clinical, technological, and strategic resources. This includes employed physicians and community physicians within local networks.

Super CINs are the product of multiple CINs under a single superstructure. Super CINs and alliances allow smaller systems, hospitals, and physician organizations to leverage infrastructure costs, management and governance oversight, care management protocols, population health management capabilities, as well as population financial risk while still retaining their independence.

Structuring and effectively managing Super CINs formed between competing healthcare entities is a complex undertaking that should not be pursued without clear and deliberate discussion among the respective parties. There are a number of strategic, operational, and tactical components that need to be evaluated to determine how systems can work together and what challenges may be encountered.

Eight components to evaluate before forming a CIN

1. Leadership and governance. Do the management and physician leaders of each organization understand and embrace the principles and cultural change requirements of forming a Super CIN/Alliance? Have goals and objectives been clearly identified and articulated? Can necessary cultural transformation be executed across the network to deliver on the value proposition? Are individual organizations willing to cede certain functions and/or decisions to the Super CIN?

2. Strategy, sustainability, and transformation. What strategies need to be developed to create a sustainable model? Is there market demand for the product offerings and will it disrupt existing relationships? What activities and services will be provided by the network, and what services will be retained by each individual entity? How can knowledge and expertise be harnessed across the network?

3. Network composition and access. How comprehensive and accessible is the acute, post-acute, allied provider, and facility network in meeting patient care needs? How accessible are these segments today, and what would change under the new superstructure?

4. Population health management capability. What services are required to support the network? What are the population health management and analytic capabilities of each organization? Does one entity have a greater depth of experience, knowledge, and infrastructure? How will the alliance support the integration and launch of value-based products, including network development and management, care management, claims adjudication, risk management and compliance?

5. Clinical care models and coordination. What clinical care models are in place to manage high cost, chronic disease patient groups? What are the gaps and optimal approaches to integrate care to gain efficiencies across the network? Can existing programs be leveraged and re-tooled to support a larger population base?

6. Quality, value and transparency. What quality metrics are being measured and tracked at each organization? How are outcomes reported to providers to promote cost effective and high quality care? What reporting capabilities need to be developed? What will it take to aggregate meaningful data among these groups?

7. Financial management and reimbursement. What are the current financial incentives within the respective CINs? How will funds flow models be integrated across the network to incent and reward providers for improved health outcomes?  How will risk be shared across the network versus borne by individual organizations?

8. Patient experience and activation. What communications, educational, and community support programs are needed to engage patients and improve compliance?  How will these be shared across the network?

Other challenges to consider

The assessment of these critical components is essential and requires leadership to work collaboratively with institutions that are typically considered competitors under traditional reimbursement models.

Cultural differences between Super CIN/Alliance partners can also create governance challenges particularly as infrastructure expenses and shared savings distribution discussions and modeling are initiated.

It is a time of significant transition as providers and payers begin to work under the new healthcare paradigm and a lot remains unknown. In some markets, there is still significant resistance and uncertainty about value-based payment models and overall reform.

Regardless of the skepticism, the formation of Super CINs is gaining momentum across the country. Ascension Health and CHE Trinity Health announced the launch of their alliance in spring of 2014, creating one of the largest clinically integrated networks in the country uniting 27 hospitals, 12 physician organizations, and 5,000 physicians within Michigan.

Other examples of systems that have formed super CINs  include: The Population Health Alliance of Oregon, a collaboration of seven health systems in Oregon and a major medical insurer; Greenville Health System; and Integrated Health Network, a seven health system collaboration including Froedtert Health, the Medical College of Wisconsin, Wheaton Franciscan Healthcare, Columbia St. Mary's, Ministry Health Care, and Agnesian HealthCare. 

The impact on payer contracting and a shift to value-based payment models is among the greatest challenges for both the provider and insurance sectors. As healthcare providers begin to assume more risks for their populations, the roles and financial relationships become more interdependent and blurred. In markets where Super CINs are being formed, managed care contracting has become consolidated as plans begin to work with several institutions that were previously independent.

Timing the activities around care model and financial integration is pertinent to the design of Super CINs. Legal and regulatory issues around antitrust require that the organizations be clinically or financially integrated in order to jointly contract with payers.

Fully developing the payer strategy along with the timing and phases of integration of the Super CIN will support success. However, Super CINs that do not successfully integrate and remain unable to enter into joint agreements may be left with limited functionality.

Thoughtful planning and a well-constructed and executed vision will serve all entities well as they pursue further alignment in the ever changing healthcare landscape.

This article was originally published by Managed Healthcare Executive


Susan_Corneliuson.png

Ms. Corneliuson is a senior manager with GE Healthcare Camden Group and has over 15 years of healthcare management experience. She specializes in physician integration strategies, practice assessments, operational improvement, care and workflow redesign, and compensation arrangements. She is the co-author of The Governance Institute’s signature publication for 2012, Payment Reform, Care Redesign, and the New Healthcare Delivery Organization. She has a strong background in physician practice management with experience in medical foundations, provider-based clinics, and specialty hospital settings. She may be reached at susan.corneliuson@ge.com.


 

 

Topics: Clinical Integration, Clinically Integrated Networks, Susan Corneliuson, Super CIN, Super Clinically Integrated Networks

Strength In Numbers: Super Clinically Integrated Networks Built to Improve Healthcare Value

Posted by Matthew Smith on Mar 22, 2016 2:27:39 PM

Graham A. Brown, MPH, CRC, Vice President, and Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

As organizations assess their capabilities, resources, and infrastructure to succeed in evolving value-based reimbursement structures, many health systems have begun to partner with other health systems in a manner that allows organizational independence but fosters collaboration in areas where synergies may exist, specifically around population health management.

The creation of super clinically integrated networks ("SCINs") reflects this trend. For some, these SCINs are merely a stepping stone to full integration or merger, but to most, these affiliations are viewed as a vehicle to strengthen each of the independent members by collectively joining forces to improve healthcare value.

These SCINs could have significant strategic potential if they are able to organize appropriately, prioritize initiatives, and advance to the level of jointly assuming risk, developing effective care models, and positioning the members as an attractive option to healthcare purchasers.

Often, SCINs embark on relatively low risk activities at the outset such as optimizing the supply chain, sharing services and overhead, sharing clinical knowledge around best practices, and improving patient access (particularly when organizations are in different markets).

While these may be reasonable starting points that help to garner trust and build momentum, they will not be solid long-term strategies on their own to support sustainability of the SCIN or lead to return on investment for its members.

Establishing goals and objectives of the SCIN at the outset with cohesive strategy formulation and buy-in, as well as ensuring that it is properly resourced, will be integral to their success.

As mentioned, most SCINs that have been formed have a goal of developing joint population health management infrastructure. Defining exactly what this means and responsibilities of the SCIN versus responsibilities of each individual member is a key initial step.

Certainly, there is extensive cost associated with developing the proper infrastructure to support population health. Thus, the economic opportunities to the SCIN should be evident when compared to resourcing population health initiatives as individual organizations.

Ultimately, as the population health infrastructure is built and care model effectuated, there are many opportunities to better manage care and impact overall value. Many SCINs endeavor to offer an attractive, efficient delivery network to self-funded employers via direct to employer contracting; and this activity often begins with their own collective employee health benefits programs. More advanced SCINs progress to joint payer contracting but will need to have achieved clinical and/or financial integration to an acceptable level.

Shifting of financial risk from major payers to the SCIN through a plan-to-plan type arrangement or global capitation are other alternatives as the SCIN evolves and is better equipped to manage risk. Further, the individual exchange marketplaces and Small Business Health Options Program (“SHOP”) allow these advanced delivery networks to access individuals and small groups in an efficient manner and compete more quickly with larger carriers.

Depending on the overall goals, objectives, market characteristics, and current capabilities of each individual member and the SCIN, a provider sponsored health plan may be another opportunity to consider. Between 2012 and 2015, 54 percent of the new Medicare Advantage plan entrants were provider owned.

There is great risk in starting a health plan, but sharing this risk across organizations in the SCIN could be a mechanism to diffuse risk and share collective resources. Additionally, the mere scale in size of the SCIN provides a larger pool of lives than any individual system would have on its own. While the task seem to daunting, particularly at a time when the healthcare system is changing rapidly, embarking on these initiatives collectively may prove to be the best strategy.

There is significant opportunity for super clinical integrated networks to chart their own path and truly transform the delivery system in a positive manner. However, coordinating efforts across multiple large organizations that remain independent is not without its challenges.

Starting with the basics is a reasonable first step so long as there is a well thought out strategy and plan to more fully develop the organization to its potential.

Each individual organization will have its separate priorities. Determining how the SCIN moves forward as “one” while supporting the independence and priorities of the individual organizations will be key to their success.

An effectively designed governance structure of the SCIN that includes the chief executive officer of each member, along with one other key leadership position, is recommended. This will allow nimbleness of the SCIN in decision-making, but will also foster effective communication and alignment of strategies.

Those organizations that can pull it all together could easily set themselves apart and have significant strategic advantage in their respective market(s). Developing a detailed strategic framework for the SCIN that all parties support and holding each other accountable will serve as a foundation of success for these organizations.


BrownG.jpgMr. Brown is a vice president and clinical integration practice leader with GE Healthcare Camden Group and has over 25 years of experience in the areas of payer negotiations, program administration, and change management with healthcare provider, payer, government, and human service clients. He is an experienced leader in business planning and implementation for clinical integration and accountable care organization development across the U.S. He may be reached at g.brown@ge.com.

 

MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at marc.mertz@ge.com.    

 

This article was originally published by Modern Healthcare Executive, November 27, 2015

Topics: CIN, Clinically Integrated Networks, Clinically Integrated Network, Marc Mertz, Graham Brown, Super CIN

Super Clinically Integrated Networks Offer Unique Opportunities

Posted by Matthew Smith on Dec 8, 2015 2:09:45 PM

By Graham Brown, MPH, Vice President and Clinical Integration Practice Leader; Marc Mertz, MHA, FACMPE, Vice President and Physician Services Practice Leader, GE Healthcare Camden Group

As organizations assess their capabilities, resources, and infrastructure to succeed in evolving value-based reimbursement structures, many health systems have begun to partner with other health systems in a manner that allows organizational independence but fosters collaboration in areas where synergies may exist, specifically around population health management.

The creation of super clinically integrated networks ("SCINs") reflects this trend. For some, these SCINs are merely a stepping stone to full integration or merger, but to most, these affiliations are viewed as a vehicle to strengthen each of the independent members by collectively joining forces to improve healthcare value.

These SCINs could have significant strategic potential if they are able to organize appropriately, prioritize initiatives, and advance to the level of jointly assuming risk, developing effective care models, and positioning the members as an attractive option to healthcare purchasers.

Often, SCINs embark on relatively low risk activities at the outset such as optimizing the supply chain, sharing services and overhead, sharing clinical knowledge around best practices, and improving patient access (particularly when organizations are in different markets).

While these may be reasonable starting points that help to garner trust and build momentum, they will not be solid long-term strategies on their own to support sustainability of the SCIN or lead to return on investment for its members.

Establishing goals and objectives of the SCIN at the outset with cohesive strategy formulation and buy-in, as well as ensuring that it is properly resourced, will be integral to their success.

As mentioned, most SCINs that have been formed have a goal of developing joint population health management infrastructure. Defining exactly what this means and responsibilities of the SCIN versus responsibilities of each individual member is a key initial step.

Certainly, there is extensive cost associated with developing the proper infrastructure to support population health. Thus, the economic opportunities to the SCIN should be evident when compared to resourcing population health initiatives as individual organizations.

Ultimately, as the population health infrastructure is built and care model effectuated, there are many opportunities to better manage care and impact overall value. Many SCINs endeavor to offer an attractive, efficient delivery network to self-funded employers via direct to employer contracting; and this activity often begins with their own collective employee health benefits programs. More advanced SCINs progress to joint payer contracting but will need to have achieved clinical and/or financial integration to an acceptable level.

Shifting of financial risk from major payers to the SCIN through a plan-to-plan type arrangement or global capitation are other alternatives as the SCIN evolves and is better equipped to manage risk. Further, the individual exchange marketplaces and Small Business Health Options Program (“SHOP”) allow these advanced delivery networks to access individuals and small groups in an efficient manner and compete more quickly with larger carriers.

Depending on the overall goals, objectives, market characteristics, and current capabilities of each individual member and the SCIN, a provider sponsored health plan may be another opportunity to consider. Between 2012 and 2015, 54 percent of the new Medicare Advantage plan entrants were provider owned.

There is great risk in starting a health plan, but sharing this risk across organizations in the SCIN could be a mechanism to diffuse risk and share collective resources. Additionally, the mere scale in size of the SCIN provides a larger pool of lives than any individual system would have on its own. While the task seem to daunting, particularly at a time when the healthcare system is changing rapidly, embarking on these initiatives collectively may prove to be the best strategy.

There is significant opportunity for super clinical integrated networks to chart their own path and truly transform the delivery system in a positive manner. However, coordinating efforts across multiple large organizations that remain independent is not without its challenges.

Starting with the basics is a reasonable first step so long as there is a well thought out strategy and plan to more fully develop the organization to its potential.

Each individual organization will have its separate priorities. Determining how the SCIN moves forward as “one” while supporting the independence and priorities of the individual organizations will be key to their success.

An effectively designed governance structure of the SCIN that includes the chief executive officer of each member, along with one other key leadership position, is recommended. This will allow nimbleness of the SCIN in decision-making, but will also foster effective communication and alignment of strategies.

Those organizations that can pull it all together could easily set themselves apart and have significant strategic advantage in their respective market(s). Developing a detailed strategic framework for the SCIN that all parties support and holding each other accountable will serve as a foundation of success for these organizations.

This article was originally published by Modern Healthcare Executive, November 27, 2015


Mr. Brown is a vice president and clinical integration practice leader with GE Healthcare Camden Group and has over 25 years of experience in the areas of payer negotiations, program administration, and change management with healthcare provider, payer, government, and human service clients. He is an experienced leader in business planning and implementation for clinical integration and accountable care organization development across the U.S. He may be reached at gbrown@thecamdengroup.com or 585-512-3905.

 

mertz_headshot.pngMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at mmertz@thecamdengroup.com or 310-320-3990.    

 

Topics: CIN, Clinically Integrated Networks, Clinically Integrated Network, Marc Mertz, Graham Brown, Super CIN

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