Common CIN Pitfalls to Avoid

Mistaking Inaction for Action

Hesitant leaders can easily raise the red flag at any one of the many unclear pathways to success, that Clinically Integrated Network (CIN) conversationalists claim when discussing the ability to cultivate true innovation capable of both increasing care quality and reducing costs while simultaneously benefiting the bottom line for those putting in the work. The bar for successfully achieving the triple aim while operating a physician practice with fiscal responsibility may be high, however delaying clinical integration is allowing employment models to infiltrate markets with far less consideration for local autonomy and independence. Clinically Integrating locally, or regionally, significantly bolsters network position and market knowledge / IQ, promoting effective partnerships with the right payers and employers to build a portfolio of value-based contrasts that make sense to you. Delaying CIN formation decreases the likelihood of fostering a sophisticated arrangement of value-based contracts that can otherwise quickly introduce a barrage of conflicting quality measures and reporting nuances amongst your payers, wasting both time and money.

Innovators and Early Adopters Leaving Laggards Behind

In Diffusion of Innovations, Everett Rogers categorizes adopters of any market changes as a bell curve equally distributing innovators (2.5%) and early adopters (13.5%) who blaze new trails, early and late majority (34% each) who hesitantly adopt new marketplace realities, and finally laggards (16%) who represent true traditionalists in times of change. In healthcare, physicians and administrators alike can promptly identify themselves and their peers as representatives of one of those categories when it comes to clinically integrating financial incentives, intertwined with quality performance improvement. It is natural for physician champions to sway the opinions of the early and late majority, but completely neglecting the nay-sayers often sprouts problems down the line. The traditionalists have strong opinions for a reason, and their reasoning often can prevent the innovators from blindly leading the blind into complicated contracts structured with little chance of success. Discussing the depths of the included performance or outcomes measures, shared savings contingencies, and governance arrangements with those in opposition can cultivate a more thorough decision-making process and ultimately build better sense of trust within the organization down the road.

Expecting Early Results

Anticipating engagement from physician members, contracting partners, or local employer groups within a few years of clinically integrating, is an ambitious goal in it of itself. Though everyone knows change takes time, and change takes an even slower pace in healthcare, CINs often target unrealistic goals that often underestimate the lift required for many disparate initiatives. In the early days, each individual step of the clinical integration journey, as mundane as it may be, deserves celebration. Whether it’s merely defining governance responsibilities, stipulating the flow of funds, or implementing a data registry, each individual milestone is a short step towards a distant goal of contracting options with tangible financial benefit. Many CINs erroneously over-predict the number of contracts they will offer their members within a short period of time, causing frustration when physician members come to understand the slowly evolving nature of managed care contracting in 2018.

External Focus Instead of Inward Insight

The main objective of CIN members may, and should, be contracting activity, fair enough. However, it is easy for CINs to spend an excessive amount of meeting minutes, phone calls, and administrative effort in seeking external recognitions of palatable contracting offers when those offers would be more plentiful if the CIN built their internal brand first. CIN governance boards should be cognizant of the percentage time spent seeking outward recognition vs. bolstering internal capabilities. For example, payers and local employers, like everyone else in 2018, demand data. A successfully established population health product offering from a CIN requires internal focus to connect disparate data sources, develop and successfully implement interventions, determine and dissipate workflow adjustments or care redesign pathways to their broader membership, along with a laundry list of other tasks. CINs churning measurable population health initiatives onto their resume build stronger portfolios for negotiations than CINs waiting for payers to call back with their predetermined list of quality-based contract offerings.

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