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What You Need to Know About Clinically Integrated Networks

WHAT OUR PROVIDERS ARE SAYING

Dr. Mike Cascarina 

Our Family Practice

Brick Township, NJ

NJAFP Past President

“Honestly, I joined the Vanguard Partner Network because these are physicians I would send my family members to.  They practice good medicine in a way that maximizes resources for their patients and staff so they can practice even better medicine. The Physicians and support staff of VPN has taught our family practice much of what we know concerning Value Based Contracts over the past 2+ years, and VPN’s contacts within the insurance industry makes them an “insider partner” during negotiations. There is also a comfort level in knowing that physicians own and operate this CIN – it’s much easier to communicate patient and administrative issues to colleagues who have had similar experiences in a similar situation. I actually look forward to our board meetings, as I learn something new at each and every one. Clinically and financially, our membership in VPN has been a win.”

Summary: A clinically integrated network (CIN) is a physician-led health network that provides quality, cost-effective care. In a CIN, providers and healthcare systems collaborate, sharing responsibility for clinical improvement, cost reduction and patient satisfaction. As a leader in value-based care in New Jersey, Vanguard Health Solutions provides expertise to achieve your objectives through our Vanguard Partner Network.

Primary care providers are tasked with delivering high-quality care in an environment that is not always aligned for optimal results. Healthcare is expensive, with costs continuing to rise. Chronic disease continues to be a public health challenge. Healthcare systems and independent physicians aren’t communicating in real time and don’t always share priorities. The current system isn’t as effective as it could be. That’s where value-based care – using a CIN – can help.

 

A CIN helps physicians and health systems collaborate for the benefit of their patients, and helps create the right relationship between physicians and health systems, which share accountability for patient outcomes, patient satisfaction, efficiencies and cost reduction. Importantly, CINs are aligned with the value-based payment model used by Medicare.

 

CIN Basics

 

What Is a CIN?

 

A CIN is a physician-led health network that provides quality, cost-effective care. In a CIN, physicians work together using proven protocols and best practices. The goal is to deliver quality healthcare, improve the patient experience, increase access, develop efficient workflows and decrease costs.

 

There are many ways to structure a CIN. It can be a joint venture between a health system and providers. It can be a partnership between providers only. It can operate as a subsidiary of a health system. An organization is considered to be a CIN if it meets the following criteria:

 

  • Physician-led: You invest in the practice, both in funding and human capital, with the goal of quality, cost-effective care.

  • Clinical guidelines: You create the clinical infrastructure that supports value-based care.

  • Data and technologies: You monitor the use of health services, strategically using data and technology to inform decisions on care.

  • Measurable improvement: You track patient outcomes, healthcare costs and efficiencies based on metrics established for your CIN.

 

Setting Up a CIN

 

In order to work as a CIN, your practice needs to legally establish itself as a care network. Choices include:

 

  • Independent practice association (IPA)

  • Physician-hospital organization (PHO)

  • Health system subsidiary (HSS)

 

A governing board of physicians is necessary to establish a CIN’s goals and to be accountable for outcomes. In addition, all those participating in the CIN must sign agreements to meet the goals of improving health outcomes and patient satisfaction while lowering costs. Financial incentives will be based on meeting performance goals.

 

Data and Technology

Tracking patient health is at the heart of a CIN. The practice has to have a robust information technology system. This includes electronic health records that securely communicate patient information as well as tracking software to assess progress and measure results.

 

Contracting Options

With a network of providers, you have significant leverage in negotiating contracts with payors. If you are working in tandem with a health system as part of your CIN, you have shared goals that also could help in contract negotiations.

 

Benefits of a CIN

 

A CIN aligns your practice with the providers who will have the greatest impact on your patient outcomes. It provides the legal structure to share the accountability for reduced costs, increased efficiencies, and improved clinical outcomes and patient satisfaction. Mutual accountability encourages high-quality care.

 

A CIN offers numerous benefits, both financial and clinical:

 

Financial

  • Negotiate better reimbursement rates in payor contracts.

  • Receive increased incentives as you reach milestones.

  • Expand revenue opportunities.

  • Set up the infrastructure to sustain your practice for the future.

 

Clinical

  • Better manage your patients who have chronic diseases.

  • Make IT improvements and access advanced technologies in managing your patients.

  • Make coordination between health systems and providers increasingly transparent.

  • Align your practice with value-based care.

 

Why Engage Vanguard Health Solutions?

 

Vanguard Health Solutions offers a full spectrum of services to help independent practices create sustainable transformation, including:

 

  • An Operations Team

  • Population Health Management Services

  • Clinically Integrated Network

 

Key Takeaways

 

A CIN in a primary care medical practice will help:

 

  • Identify goals for patient health improvement, increased efficiencies and reduced costs.

  • Streamline communications between your practice and your health system providers.

  • Enable your practice to deliver value-based care.

  • Improve the health outcomes for your most vulnerable patients.

  • Position your practice for growth and sustain it for the future.

 

Contact us to discover how we can help you advance primary care. Request an exploratory call with a Vanguard Health Solutions specialist today by calling 973.559.3701 or emailing info@vanguardhealthsolutions.com to learn more about our Vanguard Partner Network.

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