Sha cin orientation final
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CINs (Clinically Integrated Networks) are groups of healthcare providers that work to improve care, reduce costs, and maintain quality standards. They create structures to manage value-based contracts, allow providers to demonstrate value, and integrate physicians and health systems. Key elements of CINs include collaborative physician governance, a focus on population health through data sharing and care management, health IT infrastructure, and aligning provider incentives through value-based contracts and shared savings. Providers commit to engaging with the network, focusing on quality metrics, and using resources to standardize care. In return, CINs provide opportunities for shared savings contracts and support providers through committees and performance feedback.
Sha cin orientation final
- 1. © Seton Healthcare Family Orientation to Clinically Integrated Networks
- 2. © Seton Healthcare Family What is a Clinically Integrated Network? CINs are legal entities with specific, FTC-recognized features that differentiate such affiliations from monopolies and price-fixing arrangements “... an active and ongoing program to evaluate and modify practice patterns by the network's physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality” CINs must actually improve care, reduce unnecessary cost and maintain quality standards for participation Source: 1996 Joint Statements of Antitrust Enforcement Policy in Health Care by the Federal Trade Commission and U.S. Department of Justice
- 3. © Seton Healthcare Family Why Build ClNs? Challenges •Lack of integration leads to poor clinical outcomes and unnecessarily high healthcare costs CIN Solutions •Create structure to manage value-oriented contracts •Allow providers to define and objectively show value •Integrate physicians with systems without employment 3 CINs are a major health system strategy in 2014 in response to market demand for value. According to Health Affairs, there were over 600 public and private ACOs as of January 2014.
- 4. © Seton Healthcare Family Four Key CIN Elements 1. Collaborative, Physician-Oriented Governance Structure 2. Population Health Focus 3. Health Information Technology Infrastructure 4. Alignment of Provider Financial Incentives
- 5. © Seton Healthcare Family Four Key CIN Elements 1.Collaborative, Physician-Oriented Governance Structure • Board has physicians in majority and physician in chair role • Roles and Responsibilities: • Membership: sets criteria for participation, monitors compliance • Finance and Contracting: evaluates contractual opportunities • Clinical Integration Committee • Roles and Responsibilities: • Quality: selects/approves quality metrics and oversees overall network improvement efforts • Clinical Subcommittees (Primary Care, Cardiology, Post-Acute, Spine, Oncology) • Roles and Responsibilities: • Develop clinical pathways • Identify quality measures to drive improvement • Leverage analytics resources to identify areas for quality improvement
- 6. © Seton Healthcare Family Four Key CIN Elements 2. Population Health Focus • Quality measurement • Provides group, clinic, and provider-level performance reports • Develops clinical programs to support metric achievement through care gap identification and management • Patient management across the care continuum • Development of Care Management infrastructure • Develop an algorithmic approach to identification of patients who may benefit from outreach • Develop partnerships with community organizations and payer programs
- 7. © Seton Healthcare Family Four Key CIN Elements 3. Health Information Technology Infrastructure • Aggregation of claims and clinical data to support quality measurement • Harmonizes data from multiple EMR platforms • Use of analytics to develop insights into utilization and population health • Utilization and financial reports • Communication tools to alert providers to patient status and movement between care settings • Support for HIE connectivity, EMR optimization, and documentation/data collection aligned with quality goals
- 8. © Seton Healthcare Family Four Key CIN Elements 4. Alignment of Provider Financial Incentives • Develop value-based contracts that create opportunities for shared savings after attainment of quality and cost targets • Distribute shared savings to physicians based on quality performance
- 9. © Seton Healthcare Family Provider Commitments to CIN Engage with Provider Community •Cooperate and communicate with others in the optimal care of patients •Participate in quality committees and governance •Share best practices, success stories, barriers, concerns •Use other network providers for referrals to maximize coordination of care
- 10. © Seton Healthcare Family Provider Commitments to CIN Focus on Quality •Participate in data sharing to enable measurement of peer-chosen quality metrics • Clarify any perceived data inaccuracies to improve reliability and validity of performance reports • Providers focus on clinical metrics for their specialty • Analyze workflows and practices to achieve performance targets and addressing opportunities identified in care gap reports •Use resources such as clinical subcommittees and care pathways to standardize care, improve outcomes, and control costs
- 11. © Seton Healthcare Family CIN Commitments to Providers • Access to value-oriented contracts and opportunity for shared savings based on performance • Governance support through physician-led committees • Regular feedback on performance measures (scorecards) • Fully-funded care management programs • New patients through payer contracts which direct patients exclusively to Alliance providers
- 12. © Seton Healthcare Family Attestation Statement Please follow the below link to attest that you have reviewed the SHA CIN Orientation.
- 13. © Seton Healthcare Family Questions or Comments? Meredith Duncan Vice President mdDuncan@seton.org Hayli Baldridge Manager, Seton Health Alliance Physician Engagement hbaldridge@seton.org Gemma Borja Manager, Clinical Integration gborja@seton.org