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Clinically Integrated Networks: Control Your Own Momentum

Posted by Matthew Smith on Nov 4, 2015 3:18:18 PM

By Daniel J. Marino, MBA, MHASenior Vice President, The Camden Group

Many hospital leaders fear the consequences of moving too fast. Last year, we talked to healthcare leaders nationwide about preparing for value-based payment. For many, the biggest fear is reducing their hospital revenues. What will happen if you transition care to lower-reimbursement ambulatory settings faster than you can grow value-based revenue? How do you increase volume to cover the shift in revenue from acute to ambulatory or post acute? Others are concerned about investment costs. Value-based care is new territory. That means many big upfront investments could end up being unnecessary.

Yet moving too slowly carries significant risks. Hospitals that fail to act now could soon lose market share to value-driven competitors. Lagging organizations will be forced to accept lower reimbursement on their remaining volume. They will not be in a position to accept value-based contracts from payers and will also be unable to offset utilization reductions with new revenue streams.

The ultimate penalty of inaction is that you will allow others to dictate your future. How do you find the right pace in transitioning your hospital to value-based care? The key to establishing the right momentum is to clinically integrate with other providers. A well calibrated clinical integration strategy will allow you to maximize value for your organization while minimizing risk.

The Basic Framework

Clinically Integrated Network, CINA clinically integrated network (“CIN”) is a group of provider organizations that come together to form an organized system of care. The network can include one or more hospitals, their employed physicians, independent community physicians, post acute providers, and other provider organizations. Member organizations remain independent but are aligned contractually. The entire network is physician-led and incorporates a multi-stakeholder governance body that oversees quality initiatives, financial goals, and other strategic issues.

Leading clinically integrated networks share a handful of key attributes and capabilities:

  • Physician-led organization with a focus on quality of care within a patient-centric model.
  • Care management capabilities to help improve quality and outcomes while reducing costs.
  • Clinical programs that optimize services for specific diseases and patient groups.
  • Advanced technology that is leveraged to improve electronic interoperability, standardize optimal care, and improve services at the point of care.
  • Population health capabilities that allow the CIN to aggregate data and manage the high-level factors that influence health outcomes.

The ultimate goal of a CIN is to secure value-based payment contracts. Providers receive financial rewards for superior quality and outcomes along with successfully managing cost trends. Value-based contracts align provider incentives with the needs of payers, employers, and patients.

Plan to Evolve

While clinical integration is complex and challenging, it is also a versatile strategy. CINs can develop infrastructure and capabilities step-by-step. Member organizations are able to assume risk at a steady pace while achieving powerful forward momentum.
Here is a simplified pathway for transitioning your organization from traditional volume-based payment to robust value-based care:

Phase 1: Lay the CIN foundation. Start by assembling the building blocks of a clinically integrated network. The risk is low, and potential gains are moderate. Key activities include establishing the appropriate governance structure and building the provider network. Establish the desired care model and the focus of quality programs with the ability to track outcomes. Network leaders should begin negotiating limited risk-based contracts that include provider quality and cost management incentives. Emphasize referral management strategies to keep patients within the CIN and the organized system of care. CINs that properly execute on the foundational elements and establish an organized system of care can create opportunities to increase revenue five to ten percent.

Phase 2: Develop a clinically integrated collaborative. As a CIN begins to experience success in creating an organized system of care, the next step is to assume additional risk, but target bigger rewards, by expanding the network regionally. Move strategically into other markets by partnering with providers that can benefit from your CIN’s provider network, technology, and care management infrastructure. At the same time, refine the network’s ability to manage costs, expand clinical guidelines, and support risk-based contracts. Hone capabilities for managing the entire enterprise through monitoring, analytics, and reporting. Explore opportunities to partner with payers in narrow-network health plans.

Phase 3: Transition to full-risk contracts. The most advanced CINs are creating provider-sponsored health plans that offer compelling revenue opportunities. This phase carries the most risk, but it can be mitigated substantially through strong care delivery, cost management, and utilization management capabilities. Networks at this stage can function as full-service ACOs, including organizations acting as provider sponsored health plans assuming full-risk contracts, similar to Geisinger Health System, Intermountain Healthcare, or Northshore Long Island Jewish Health System. Another strategic option is to offer insurance products directly to the market, either alone or in partnership with a payer. Direct employer contracting allows the CIN to “commoditize” its services, potentially increasing revenue 10 to 15 percent over traditional contracts. In order for this to be achieved, provider-sponsored health plans would need to be in place accompanied by a large provider network and organized systems of care. If “payer dependencies” are removed or limited, the healthcare spend decrease translates into revenue opportunities for the CIN.

Target Financial Opportunities to Mitigate Risk

One key to reducing the risk of value-based care is to take full advantage of its unique financial opportunities. Pay attention to four categories:

  • Infrastructure cost savings. Creating a strong shared administrative and care management infrastructure can allow a CIN to reduce per-member per-month (“PMPM”) costs 20 to 30 percent within 5 to 10 years.
  • Increased volume. Entering into narrow-network contracts with payers and employers can drive strong membership growth and patient volumes.
  • Increased domestic utilization. Minimizing patient leakage allows the CIN to maximize influence over care transitions and quality, a key to controlling costs.
  • Advanced care programs. Hospitals have the opportunity to develop advanced clinical programs and centers of excellence. Offering these programs to other network providers will increase revenue while further leveraging network effects.

The Starting Point

As you plan and launch a CIN, keep in mind one absolute necessity. Your organization must offer a strong value proposition to participating providers, payers, and patients.

For physicians, participation in your network must be an opportunity to improve patient care through access to care management, as well as clinical program and technology resources. Your CIN should also provide a management infrastructure that eases the challenges of practicing medicine today. It must facilitate care redesign to enhance care efficiency and patient focus, and optimize clinical resources.

For payers, your network must provide higher quality care, better patient outcomes, and better patient access, all while reducing the cost of care.

For patients, your network must provide access, affordability, and tools to facilitate care coordination and engagement.

A strong value proposition is key to finding the right “change momentum” for your organization. Focusing on providing value helps make sure you do not embrace change too quickly for your market. It also ensures your organization can maintain a steady forward pace by balancing appropriate risk with solid potential for clinical and financial gains.

Clinical Integration Networks, CIN, Daniel J. Marino


Mr. Marino is a senior vice president with The Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. He may be reached at dmarino@thecamdengroup.com or 312-775-1701.
 
 

Topics: Clinical Integration, CIN, Clinically Integrated Networks, Daniel J. Marino, The Camden Group

The Latest From The Camden Group's Thought Leaders

Posted by Matthew Smith on Apr 10, 2015 3:02:26 PM

SMB-thought-leadership-300x200Each month, thought leaders from The Camden Group share their expertise through original posts, articles, speaking engagements, and interviews.

Below are links to the top thought leadership information shared recently by The Camden Group. 

Bylined Articles

In the News

Upcoming Speaking Engagements

To request more information about scheduling a thought leader from The Camden Group to speak at your organization's next event, please click the button below.

The Camden Group, Speaking Opportunity

 

Topics: The Camden Group, Articles, Speaking, Interviews, Conferences

The Latest Thought Leadership from The Camden Group

Posted by Matthew Smith on Feb 11, 2015 3:57:00 PM

The Camden Group, Thought Leadership, Population Health, Clinical IntegrationEach month, thought leaders from The Camden Group share their expertise through original posts, articles, speaking engagements, and interviews.

Below are links to the top thought leadership shared recently by The Camden Group. 

 

Email Newsletters

►“Top 10 Trends and Implications for Medical Groups in 2015” by Mary Witt

►“Prevent 2017 Medicare Penalties Now” by Lucy Zielinski

►“Improving the Financial Performance of Your Newly Acquired Medical Group” by       Tawnya Bosko

Bylined Articles

In the News

Upcoming Speaking Engagements

To request more information about scheduling a thought leader from The Camden Group to speak at your organization's next event, please click the button below.

The Camden Group, Speaking Opportunity

Topics: Value-Based Care, Medicare, Medical Group, Deirdre Baggot, Daniel J. Marino, The Camden Group, Steve Valentine, Physician Services.

Top 10 Trends and Implications for Medical Groups in 2015

Posted by Matthew Smith on Jan 27, 2015 2:23:00 PM
By Mary Witt, MSW
Senior Vice President, The Camden Group


016_healthcare_consultant.juSuccess in 2015 requires clear thinking and decisive action. Whether independent or hospital/system-owned, medical groups cannot continue to do business as usual and expect to succeed in 2015. Increasing financial pressures, the move to fee-for-value, and increased expectations for quality require new ways of doing business. Here are the top 10 trends for 2015 that can provide direction and focus as medical groups plan for the year ahead.

1. A focus on performance optimization is necessary for success. Medical groups can no longer be satisfied with median performance. Medical groups that are not pushing themselves to excel will find themselves left behind as top performers emerge and gain market dominance. Also, as financial pressures increase for hospitals and health systems, they will no longer be able to sustain the high losses experienced by many hospital-owned medical groups. It is critical that medical groups assess their performance as compared to industry best practices and implement a performance improvement plan to address any deficits. To sustain forward momentum, medical groups should establish clear accountabilities for performance throughout the medical group by creating measurable performance standards, continually measuring performance against targets through the use of dashboard reports, developing action plans to address variances, and incorporating performance expectations into job descriptions.

2. Patient collections cannot be ignored. With the increase in high deductible plans and patient copays, medical groups are seeing a significant increase in the dollars owed by patients. Therefore, an effective patient collection process that starts when the appointment is scheduled is critical to ensuring that all revenue owed is collected. When the appointment is scheduled, patients should be informed of copay and deductible amounts as well as outstanding balances, and the expectation that payment is due at the time of the visit should be established. Time of service collections should include collection of all monies owed for the services provided that day as well as any outstanding balances.

3. 2015 brings increasing competition from nontraditional organizations. New, non-traditional competitors are entering the outpatient medical care market. Retail firms such as WalMart, Walgreen’s, CVS, and RiteAid have created primary care clinics; while some have partnered with local providers, more often they have created their own clinics or partnered with national firms. Target and Kaiser Permanente have developed a partnership to provide primary and specialty care in clinics in Target stores that will be open to nonKaiser enrollees. Payers such as Anthem California are marketing e-visits directly to their enrollees bypassing the traditional in person physicianpatient relationship. Partnering with non-traditional organizations is an option that should be assessed as well as considering non-traditional practice locations. It is important to understand what patients want and expect of the practice to retain them. Regularly survey patients about their experience with the practice; consider the use of focus groups to gather more in-depth data on what is important to them.

4. Physician compensation models require redesign. As medical groups prepare for fee-for-value payment, increasing competition, and a focus on quality, there is likely a need to redesign their compensation model to better align incentives with the new environmental realities. What worked in the past is unlikely to work in the future. It is important to understand how quickly the market is shifting from fee-for-service to value-based payment in order to determine what needs to be changed and how quickly it needs to happen. Medical groups will want to develop a road map to broaden compensation incentives to prepare for fee-for-value payments. Consider adding incentives for care coordination, quality, and efficiency in addition to productivity. Initially, it may make sense to devote a small percentage of compensation to these new metrics to prepare for the future if the market is not demanding immediate change.

5. Transparency is becoming increasingly important. The era of transparency in cost and quality is here. Payers are publishing provider charges by Current Procedural Terminology (“CPT”) code; CMS has published Medicare payments made to physicians. Employers are demanding price transparency, especially as they move to high deductible plans and pass more cost on to their employees. States are creating multipayer pricing databases based on payer claims data and providing access to consumers. Many new websites enable consumers to shop price and quality. Quality is being tracked more vigilantly, and quality scores are readily available to the consumer through a variety of websites. With all of this data available, it is important that medical groups understand how their pricing and quality compare to their competitors and take action to ensure that high prices and poor quality do not cost them patients.

6. Mastery of technology cannot be ignored. Medicare demands that medical groups report on quality or face penalties, and payers increasingly link payments to quality reporting or results. Therefore, medical practices need to be able to collect, analyze, and exchange data. Also, as expenses increase, and operational demands become increasingly complex, the ability to automate work is critical to improving efficiency. New care models increasingly rely on real-time access to patient clinical data as well as access to tools such as telemedicine or health monitoring devices. Effective use of technology to improve results is a necessary element for future success. Evaluating current work flows and looking for inefficiencies (e.g., duplicate data entry, multiple handoffs) can lead to identifying opportunities for automation. Explore the use of telephone technology to automate tasks such as appointment and payment balance reminders. Participate in a health information exchange that provides two-way communication and clinical results with hospitals, referring physicians, and other health providers. Use an electronic health record to assist clinicians in the care of their patients; the use of real-time prompts assists physicians in performing preventive services and informs them when test results are outside of normal.

7. Managing a population of patients requires new care delivery models. Managing a population of patients requires a change in how care is delivered. The focus is no longer on episodic care, but instead focuses on managing the total healthcare needs of a population of patients. The emphasis shifts to “providing the right care at the right time in the right place.” Redesigning care involves transforming both how care is delivered and who delivers the care. Re-examine roles within the practice to ensure that everyone is working to the top of their license/expertise. Successful management of a population of patients requires an expanded team approach to care. New care team members can include advanced practice clinicians, care managers, social workers, pharmacists, nutritionists, and health coaches with leadership and direction provided by the physician. Reexamine the workflow in the office to assure that as the care model evolves, the work flow is adapted to facilitate efficient use of space and staff. Explore the feasibility of using e-visits, tele-health, and group visits to improve access, responsiveness, and maximize patient engagement. Consider the operational and financial feasibility of implementing Medicare’s newly reimbursed chronic care management.

8. Patient engagement leads to better outcomes. Patients actively engaged in their care have better outcomes and utilize fewer health resources. In order to maximize patient engagement, medical practices must move from telling patients what to do to assisting them to develop the knowledge, skills, and confidence necessary to be an active partner in their care. Train physicians and staff on communication skills and motivational interviewing and integrate expectations into physician and staff performance expectations. Ensure that patients are actively engaged in discussing their health and developing their care plan. The use of patient portals can be an effective means of maintaining communication with patients and monitoring their adherence to care plans.

9. Patient demand for access is not going away. Thus, ensuring timely patient access has to be a medical group priority if the practice is to have satisfied patients. To understand patient access, routinely monitor third next appointment availability. Calculate the practice’s patient demand versus practice capacity, and implement strategies to increase capacity as needed. Consider allowing patients to schedule their own visits through a patient portal, providing evening and weekend hours, offering e-visits, and communicating by email and text. Practices should also employ strategies to facilitate regular communication with their patients through e-mail blasts, texting, and social media.

10. Physicians will continue to move toward the employment model. As the complexity of medical practice and economic pressures increases, and the demand for capital for practice infrastructure (e.g., electronic health record, care team staffing) grows, more physicians are choosing to become employed, and that trend is likely to accelerate over the next few years. This provides opportunities for existing medical groups and hospitals/health systems to add physicians to their practices as they seek to capture a greater population. To ensure a successful employment relationship, medical groups and physicians both need to clearly define their goals and expected outcomes and then develop a set of criteria to guide decisions as opportunities are considered.

As medical groups grapple with the many challenges of 2015, it is important to focus on optimizing performance and preparing for value-based reimbursement by meeting the needs of patients efficiently and effectively. Concentrate on how to create a strategic advantage by establishing capabilities or attributes that will distinguish your group from competitors. In difficult times like these, superior, nimble, focused performance will lead to success.

Mary Witt, The Camden Group, Physician ServicesMs. Witt is a senior vice president with The Camden Group and has over 25 years of healthcare experience. She has held management positions in hospitals, health systems, and management services organizations (MSOs). She has extensive experience in medical group and integrated delivery system development and management. This includes developing patient-centered medical homes, practice management, performance improvement, physician compensation, managed care, strategic planning, healthcare marketing, and physician recruitment. She may be reached at mwitt@thecamdengroup.com or 424-201-3971.

 

Topics: Clinical Integration, Population Health, HIT, HealthIT, Mary Witt, Medical Group, Medical Groups, Clinically Integrated Networks, Physician Compensation, Patient Engagement, The Camden Group, Trends

Six Strategies for Improving Primary Care Access

Posted by Matthew Smith on Jan 23, 2015 9:52:00 AM

By William K. Faber, MD, MHCM
Vice President, The Camden Group

Primary Care Access, The Camden Group, William K. FaberPrimary care providers are the heart of clinical integration. Ready access to primary care services is fundamental to disease prevention, chronic illness management and the reduction of unnecessary testing and treatment. Unfortunately, primary care physicians are scarce and getting harder to find.

Approximately 40% of primary care physicians are over the age of 55, and many will retire before age 65. Fewer medical school graduates are going into primary care. Most primary care physicians feel stretched to capacity and often work 12-hour days, and financial incentives alone are inadequate to entice these physicians to add more patients to their schedules.

Given these constraints, healthcare systems need to expand primary care access through other means. Following are six strategies to increase primary care access by improving staffing models and practice operations.

1. Hire more non-MD providers

Physician Assistants (PAs) and Nurse Practitioners (NPs) can meet the needs of most primary care patients and both are more plentiful than primary care physicians. Integrating these providers into a practice will expand access for patients and allow physicians to focus on more challenging cases that require a more skilled level of expertise.

2. Sync the practice schedule to patient demand

Many practices are open from 8:30 a.m. to 4:30 p.m. (and closed over the lunch hour) Monday to Friday, but many patients prefer early-morning, evening or weekend appointments. Adjusting practice office hours to match patient demand will accommodate more volume, even if the total hours of patient appointments remain the same. Monday is typically the busiest day of the week in doctors’ offices; therefore, the greatest number of physician appointment hours should be provided on Monday. Similarly, patient demand is usually greatest during the winter flu season, so limit adult care providers vacations during this time. Similarly, pediatricians should be most available during school physical season.

3. Simplify appointment types and frequency

Practices create many different appointment types—well visits, sick visits, physicals, pap visits, follow-ups, etc. To better manage patient flow, reduce the number of appointment types to two: 15 minutes and 30 minutes (or any base appointment length and one twice as long). You can determine what kind of patient is best suited to each of these two types, rather than letting the name of the appointment determine whether a patient fits in that slot. Providers should also reconsider the interval at which they recommend follow-up appointments. Some physicians routinely tell their hypertensive or diabetic patients to return every three months. This clogs their schedules unnecessarily so they have inadequate appointments for those that are acutely ill. A better practice is to tailor the follow up interval to the specific patient. If they are well-controlled and self-monitored, certain patients may only need to be seen twice a year. Some patients should be seen more frequently than quarterly to keep them out of the hospital. 

4. Fix practice bottlenecks

All practices can stand to improve patient throughput and efficiency by identifying bottlenecks. Conduct a time-flow study on a sample of patients as they move through each phase of their visit. Reduce delays by redesigning processes and redeploying staff. For example, give patients a clipboard to fill out while they are in the waiting room, so they can list their concerns for the day and verify the medications they are currently taking. Better yet, let them do this through an advanced patient portal. Better patient flow can increase patient access without extending the workday.

5. Create standing orders

Staff members often ask physicians questions for which the answer is always the same. When this is the case, everyone would benefit from standing orders. An example would be a nurse waiting for a doctor’s signature on an order for a mammogram or diabetic retinal exam when it is documented that the patient is due for one of these tests. The physician can designate that they always approve under certain circumstances by creating standing orders. Rooming protocols can also improve throughput. For instance, assistants should always have diabetic patients remove their shoes and socks while rooming the patient, so the doctor can examine the patient’s feet without delay.

6. Break the “face to face” pattern

Clinical integration aims to reward physicians for improving patient outcomes. In the fee-for-service world, physicians are rewarded only for face-to-face encounters, so they have become accustomed to having patients come in to the office when it is not actually necessary. To succeed in new systems of payment, physicians must become comfortable with managing low-risk patients outside of the face-to-face visit, so they are available to see the high-risk patient who truly needs to be seen. In many cases, diagnosis and treatment over the phone is entirely appropriate.

What about patient satisfaction?

Implementing these strategies can help physicians increase their availability to patients. A more efficiently run office can actually expand that amount of “face time” a patient has with their doctor. This also opens up appointments when patients actually want to be seen, which is a big satisfier.

About the Author

William K. Faber, Primary Care AccessDr. Faber is a vice president with The Camden Group. As a physician executive, he specializes in the development of accountable care organizations and clinically integrated networks, physician engagement, and health information technology. Prior to joining The Camden Group, Dr. Faber served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s clinical integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an electronic health records system. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

Clinically Integrated Networks, CIN, Clinical Integration, The Camden Group

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Care, Primary Care Access, The Camden Group

New Download: Clinically Integrated Networks Overview--Attributes for Success

Posted by Matthew Smith on Jan 21, 2015 12:02:00 PM

Download, The Camden Group, Population Health, Clinically Integrated Networks, CIN, Clinical IntegrationHospitals and health systems face continued pressures to reduce healthcare costs and reimbursements (volume-based model). This necessitates a shift to accountable care and value-based reimbursement tied to performance of services.

This new download from Daniel J. Marino, Senior Vice President at The Camden Group, shares concepts tied to such a shift, including:

  • Challenges for health systems and providers
  • Enterprise transition to risk timing
  • Overview of clinically integrated networks
  • Attributes of clinically integrated care
  • Evolution of clinical integration
  • Risk vs. capabilities
  • Financial opportunities for clinically integrated networks
  • Building the clinical integration value proposition

To download this PDF, simply click the button below, complete the short form, and press the "Click for Download" button. Your file will appear and will be available for you to save to your device.

Clinically Integrated Networks, CIN, Clinical Integration, The Camden Group

Topics: Clinical Integration, CIN, Clinically Integrated Networks, Daniel J. Marino, The Camden Group

Clinically Integrated Networks: You Can’t Stop Change, But You Can Control Your Momentum

Posted by Matthew Smith on Jan 20, 2015 4:30:00 PM

By Daniel J. Marino, MBA, MHA
Senior Vice President, The Camden Group

Clinically Integrated Network, CINThe shift from volume to value in healthcare will pick up steam in 2015. The question for hospital leaders is not whether to embrace change, but how quickly.

Many hospital leaders fear the consequences of moving too fast. Last year, we talked to healthcare leaders nationwide about preparing for value-based payment. For many, the biggest fear is reducing their hospital revenues. What will happen if you transition care to lower-reimbursement ambulatory settings faster than you can grow value-based revenue? How do you increase volume to cover the shift in revenue from acute to ambulatory or post acute? Others are concerned about investment costs. Value-based care is new territory. That means many big upfront investments could end up being unnecessary.

Yet moving too slowly carries significant risks. Hospitals that fail to act now could soon lose market share to value-driven competitors. Lagging organizations will be forced to accept lower reimbursement on their remaining volume. They will not be in a position to accept value-based contracts from payers and will also be unable to offset utilization reductions with new revenue streams.

The ultimate penalty of inaction is that you will allow others to dictate your future.
How do you find the right pace in transitioning your hospital to value-based care? The key to establishing the right momentum is to clinically integrate with other providers. A well calibrated clinical integration strategy will allow you to maximize value for your organization while minimizing risk.

The Basic Framework

A clinically integrated network (“CIN”) is a group of provider organizations that come together to form an organized system of care. The network can include one or more hospitals, their employed physicians, independent community physicians, post acute providers, and other provider organizations. Member organizations remain independent but are aligned contractually. The entire network is physician-led and incorporates a multi-stakeholder governance body that oversees quality initiatives, financial goals, and other strategic issues.

Leading clinically integrated networks share a handful of key attributes and capabilities:

  • Physician-led organization with a focus on quality of care within a patient-centric model.
  • Care management capabilities to help improve quality and outcomes while reducing costs.
  • Clinical programs that optimize services for specific diseases and patient groups.
  • Advanced technology that is leveraged to improve electronic interoperability, standardize optimal care, and improve services at the point of care.
  • Population health capabilities that allow the CIN to aggregate data and manage the high-level factors that influence health outcomes.

The ultimate goal of a CIN is to secure value-based payment contracts. Providers receive financial rewards for superior quality and outcomes along with successfully managing cost trends. Value-based contracts align provider incentives with the needs of payers, employers, and patients.

Plan to Evolve

While clinical integration is complex and challenging, it is also a versatile strategy. CINs can develop infrastructure and capabilities step-by-step. Member organizations are able to assume risk at a steady pace while achieving powerful forward momentum.
Here is a simplified pathway for transitioning your organization from traditional volume-based payment to robust value-based care:

Phase 1: Lay the CIN foundation. Start by assembling the building blocks of a clinically integrated network. The risk is low, and potential gains are moderate. Key activities include establishing the appropriate governance structure and building the provider network. Establish the desired care model and the focus of quality programs with the ability to track outcomes. Network leaders should begin negotiating limited risk-based contracts that include provider quality and cost management incentives. Emphasize referral management strategies to keep patients within the CIN and the organized system of care. CINs that properly execute on the foundational elements and establish an organized system of care can create opportunities to increase revenue five to ten percent.

Phase 2: Develop a clinically integrated collaborative. As a CIN begins to experience success in creating an organized system of care, the next step is to assume additional risk, but target bigger rewards, by expanding the network regionally. Move strategically into other markets by partnering with providers that can benefit from your CIN’s provider network, technology, and care management infrastructure. At the same time, refine the network’s ability to manage costs, expand clinical guidelines, and support risk-based contracts. Hone capabilities for managing the entire enterprise through monitoring, analytics, and reporting. Explore opportunities to partner with payers in narrow-network health plans.

Phase 3: Transition to full-risk contracts. The most advanced CINs are creating provider-sponsored health plans that offer compelling revenue opportunities. This phase carries the most risk, but it can be mitigated substantially through strong care delivery, cost management, and utilization management capabilities. Networks at this stage can function as full-service ACOs, including organizations acting as provider sponsored health plans assuming full-risk contracts, similar to Geisinger Health System, Intermountain Healthcare, or Northshore Long Island Jewish Health System. Another strategic option is to offer insurance products directly to the market, either alone or in partnership with a payer. Direct employer contracting allows the CIN to “commoditize” its services, potentially increasing revenue 10 to 15 percent over traditional contracts. In order for this to be achieved, provider-sponsored health plans would need to be in place accompanied by a large provider network and organized systems of care. If “payer dependencies” are removed or limited, the healthcare spend decrease translates into revenue opportunities for the CIN.

Target Financial Opportunities to Mitigate Risk

One key to reducing the risk of value-based care is to take full advantage of its unique financial opportunities. Pay attention to four categories:

  • Infrastructure cost savings. Creating a strong shared administrative and care management infrastructure can allow a CIN to reduce per-member per-month (“PMPM”) costs 20 to 30 percent within 5 to 10 years.
  • Increased volume. Entering into narrow-network contracts with payers and employers can drive strong membership growth and patient volumes.
  • Increased domestic utilization. Minimizing patient leakage allows the CIN to maximize influence over care transitions and quality, a key to controlling costs.
  • Advanced care programs. Hospitals have the opportunity to develop advanced clinical programs and centers of excellence. Offering these programs to other network providers will increase revenue while further leveraging network effects.

The Starting Point

As you plan and launch a CIN, keep in mind one absolute necessity. Your organization must offer a strong value proposition to participating providers, payers, and patients.

For physicians, participation in your network must be an opportunity to improve patient care through access to care management, as well as clinical program and technology resources. Your CIN should also provide a management infrastructure that eases the challenges of practicing medicine today. It must facilitate care redesign to enhance care efficiency and patient focus, and optimize clinical resources.

For payers, your network must provide higher quality care, better patient outcomes, and better patient access, all while reducing the cost of care.

For patients, your network must provide access, affordability, and tools to facilitate care coordination and engagement.

A strong value proposition is key to finding the right “change momentum” for your organization. Focusing on providing value helps make sure you do not embrace change too quickly for your market. It also ensures your organization can maintain a steady forward pace by balancing appropriate risk with solid potential for clinical and financial gains.

Daniel J. Marino, The Camden GroupMr. Marino is a senior vice president with The Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. He may be reached at dmarino@thecamdengroup.com or 312-775-1701.
 
Clinically Integrated Networks, CIN, Clinical Integration, The Camden Group

Topics: Clinical Integration, CIN, Clinically Integrated Networks, Daniel J. Marino, The Camden Group

Health Directions Acquired by The Camden Group

Posted by Matthew Smith on Jan 12, 2015 11:08:00 AM

Two National Healthcare Consulting Firms Combine to Address Increased Demand for Population Health and Physician Advisory Services

The Camden GroupAs you are aware, Health Directions has been growing rapidly as we help our clients navigate through their strategic, operational, and financial challenges. Because of our growth, we felt that the time was right to look to outside partners to help facilitate and accelerate our firm’s development.

We are happy to announce that after a thorough and comprehensive consideration, Health Directions agreed to be acquired by The Camden Group effective January 1, 2015. 

This move will be especially beneficial to our clients in that a greater wealth of resources is now in place to strategically support their needs. One key component to the acquisition was the cultural fit and industry expertise each firm brings to the relationship. We will continue to build our existing footprint in the Chicago area while creating a new Camden Group presence in Texas via our Austin office.

Visit The Camden Group's leadership page to meet the senior leaders on The Camden Group team!

The Insights Blog will remain in tact and will be published and delivered in the same manner in which you are accustomed. If you have any questions, please email Matthew Smith at msmith@thecamdengroup.com.

The full press release may be accessed here or by reading below.

The Camden Group, one of the nation's largest healthcare business advisory firms, today announced it has acquired Health Directions, LLC. Health Directions is a national consulting firm that provides business solutions for healthcare organizations, helping medical groups and hospitals improve their financial performance, enhance physician satisfaction, take full advantage of health IT, and strengthen their strategic position. The merger results in an enhancement of the depth of services and expertise of both firms, providing additional advantages for clients in developing clinical integration programs, accountable care organizations, improving the performance of their physician enterprise, and implementing other population health solutions involving innovation to care delivery and payment models.

MarinoQuote"Health Directions is a highly respected and well-regarded national healthcare consulting firm, dedicated to assisting healthcare systems and physician groups," says Steven T. Valentine, president of The Camden Group. "The firm is a great cultural fit, and given the evolving needs of our clients and our commitment to assist in their successful transformation, this acquisition strengthens our capabilities to provide the best solutions that fit the broad range of client needs for migrating this change, as well as expand our footprint in Chicago and establish our presence in the Texas market." Additionally, clients will benefit from Health Directions' data analytics and expertise in HIT selection and implementation.

"By teaming up with one the largest healthcare consulting firms in the country, we are now better able to assist clients as they navigate a post-healthcare reform world and transition into value-based care," said Daniel Marino, president, Health Directions. "As a full-service firm, The Camden Group's ability to provide a broad array of advisory services delivers distinct advantages to our clients." Offices in Chicago and Austin, Texas, will now operate under The Camden Group banner.

About The Camden Group

With offices across the country, The Camden Group is one of the nation's leading healthcare business advisory firms. Since 1970, the firm has been providing management and consulting services to the healthcare industry exclusively, assisting more than 2,000 healthcare organizations nationwide. Its multidisciplinary team of industry experts and clinical leaders is nationally recognized for its thought leadership, results-oriented approach, and personalized service. The Camden Group has extensive, hands-on experience in many facets of healthcare, including hospitals, health systems, medical groups, health plans, and a wide array of business advisory services to accelerate success with population health, clinical integration,bundled paymenttransactions, and performance improvement. For more insights from the team and information on The Camden Group's services, please visit www.thecamdengroup.com.

Topics: Health Directions, Population Health, The Camden Group, Physician Advisory Services

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