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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, and Tina Wardrop, MHA, MSSW, Senior Manager, GE Healthcare Camden Group 

super clinically integrated networksClinically 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


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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.

WardropT.jpgMs. Wardrop is a senior manager with GE Healthcare Camden Group. She has over 30 years of experience working in the healthcare provider sector. She has worked with a wide range of hospitals, healthcare systems, and independent and employed physician groups. Her key areas of expertise include strategic planning, medical staff development, physician recruitment and employment, electronic health record selections, hospital/physician integration, and population health. With a diverse background in hospital and physician arenas, Ms. Wardrop has in-depth knowledge of the political and economic factors and implementation processes that determine the success of strategic and operational turnaround initiatives. She may be reached at tina.wardrop@ge.com.

 


 

 

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

Are Health Systems Positioned to Efficiently Manage the Newly Eligible Medicaid Population?

Posted by Matthew Smith on Feb 18, 2015 3:50:00 PM
By William K. Faber, M.D., Vice President and Tina Wardrop, Vice President, The Camden Group

Population Health, Medicaid PopulationAs more states begin to take on newly eligible Medicaid populations, there are a number of lessons that can be learned from health systems that have already begun managing these patients. These lessons include:

  • Not taking on too many recipients at one time without understanding the costs
  • Not taking on a large value-based population without prior managed care experience
  • Creating financial incentives to build a provider network so there is sufficient access to care for this population
  • Providing adequate technology and connectivity to measure utilization and outcomes
  • Coordinating outreach services between providers and institutions
  • Using telemedicine to facilitate care

It should also be recognized that all institutions within a state will not be equally prepared to manage the newly eligible population due to organizational, information technology, and provider network constraints. Some of this depends on whether organizations have developed an ACO or ACO-type structure to manage other commercial or Medicare populations because these infrastructures can be modified to manage Medicaid patients as well.

Key questions healthcare systems should ask themselves include:

  • Is the organization’s leadership prepared to make the necessary investments to address the unique needs of this population, including time and financial resources?
  • Is the provider network sufficient to support this population? Typically this population has significant psycho-social, economic, and logistical issues that challenge care delivery capabilities.
  • Are the key payers aligned with the interests of the hospitals and ambulatory providers? Are they willing to fund the development of care delivery models and share in financial savings if improvements are accomplished?
  • Is there sufficient technology in place to integrate clinical data among providers and track individuals across a continuum of care? Typically this includes integrated EMRs, data registries and warehousing, and health information exchanges (HIEs) across areas within the state.
  • What quality metrics are put in place to monitor patient outcomes?
  • Are there care management programs in place to manage patients across the continuum with a focus on preventative and post acute care, behavioral health issues, and other psycho-social needs?

Once this assessment has been completed, health systems can determine the priority of key capabilities that should be implemented and what their optimal role should be in serving the Medicaid population. It takes significant time and resources to build value-based patient care models. Most important is the amount of cultural change that is needed among all stakeholders to make this initiative successful.

Taking on the challenges of health management for this population is not for the risk averse, but it may be a necessary skill for many health systems as Medicaid expands and grows in importance as a major segment of the market.

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.

 

Tina Wardrop, The Camden Group, Medicaid, Population HealthMs. Wardrop is a vice president with The Camden Group. She has over 30 years of experience working in the healthcare provider sector. She has worked with a wide range of hospitals, healthcare systems, and independent and employed physician groups. Her key areas of expertise include strategic planning, medical staff development, physician recruitment and employment, electronic health record selections, hospital/physician integration, and population health. With a diverse background in hospital and physician arenas, Ms. Wardrop has in-depth knowledge of the political and economic factors and implementation processes that determine the success of strategic and operational turnaround initiatives. She may be reached at twardrop@thecamdengroup.com or 312-775-1714.

Medicaid Population, The Camden Group, Population Health

Topics: Population Health, William K. Faber MD, Medicaid, Managed Care, Tina Wardrop

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