What is Clinical Integration(CIN)?

In 1996, the DOJ and the FTC defined CI as an active and ongoing program to evaluate and modify practice patterns by the CI network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.  

Generally, the FTC considers a program to be clinically integrated if it performs the following:

1. Establishes tools to monitor and control use of healthcare services that are designed to reduce costs and ensure quality of care
2. Selectively choose CI network physicians who are likely to further these efficiency objectives
3. Utilizes investment of significant capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies. 

Typical CIN Formation Goals

1. To provide a vehicle within the local market to diversify carrier market share via deployment of competitive products.
2. To provide a platform for independent physicians to remain independent while collectively addressing changing market needs, move toward population health, and providing a larger footprint for attributed lives.
3. To develop market tools to redirect appropriate care to participating providers to improve volumes while providing overall value to accessing payers. 

Top 10 Key Success Factors for a CIN

1. The CIN must create a sufficient value proposition for regional health systems, hospitals, physicians, payers, the community, and employers.  If clearly advantageous towards just one or two of these groups will be a turn off for potential members and partners. 
2. Need to develop partnerships outside of CIN entity – Primary care of particular importance, but also others along the Post Acute Care Continuum.  
3. Technology: Maintain systems that can track and monitor clinical and claims data across the continuum of care – ambulatory, acute, post-acute services, home, etc.  Strong data analysis capabilities and resources.
4. Create an effective communication strategy across all stakeholders to increase understanding of the key issues of CI, workgroup activity, provider performance, and peer-to-peer capabilities.
5. Develop a fair, tiered incentive program, with provider participation and agreement. 
6. Continue ongoing discussions / pursuit with payers for value-based contracting.
7. Compliant legal structure at the forefront from the onset of CIN due diligence.  
8. Culture change in the mind set of FFS to FFV practices and needs to get there.
9. Physician Compliance – Rewards as well as disciplinary action if necessary.
10. Physician engagement.  Including workgroups, committee’s, etc.  

Benefits of Clinical Integration

1. Autonomy within collaboration – A CIN enables autonomous medical practices to participate in collaborative care teams and measure comprehensive quality outcomes.
2. Enhanced payer relationships – CIN’s provide a creative value with payers.  As a legal entity, a CIN can contract for enhanced reimbursement through shared savings and/or performance incentives.
3. Population health support – A CIN can provide the technology to track quality outcomes, the organizational structure to integrate patient management with other providers, and the tools to identify and influence the cost of care.  Assists in providing better care to patients in the community.
4. Protection against payment risk – Physicians who align themselves with a CIN will stay on the forefront of opportunities to benefit from new contracting approaches, new reimbursement structures and new ways to maintain accountability for contract performance.
5. As a CIN matures, “leakage” of patients outside of the network should decrease 10% to 15%.  Hospitals should also see a decrease in their utilization.  
6. Payers are beginning to offer complimentary insurance products that leverage population health management.  

What Makes Clinical Integration Distinct?

Unlike closed systems owned by a single hospital, CINs work by building tight-knit communities united in purpose and approach to care. Common goals might include objectives like:

• Investing in integrated IT systems enabling data sharing and communication between participating groups and settings
• Establishing common care protocols backed by analytics measuring cost and quality
• Implementing coordinated treatment programs managing chronic conditions to prevent admissions

United in Vision: Shared Governance Model

CINs aren’t one ruling doctor or hospital calling shots. The best groups build organizational authority and leadership through committee structures balancing input across all participating providers and executives. Though complex, shared governance keeps everyone committed to the overarching goals.

The Bottom Line on CINs

CINs shift perspectives from managing departments to overseeing patients. And the approach works – CIN participation associates with fewer repeat tests, lower hospital readmission rates and controlled costs. As health systems transition from volume to value, clinical integration offers means for coordinating high quality, financially sustainable community care.

Our Approach

There is a due diligence period to assess your organization’s current capabilities. This is to locate the necessary steps to be taken when composing a strategy around becoming a CIN.  For instance, these areas of focus include:

• CIN Legal Transition: Evaluate legal documents and structure to attain a legal advisory opinion.
• Network Management & Operational Infrastructure:
  • Ensure the proper tools are in place to manage the abundance of provider documentation.
  • Assess appropriate governance and committee structure.
  • Create proper documentation and policies and procedures.
• Technological Infrastructure & Reporting: Ensure the necessary tools are in place for providers to gather and submit data, perform clinical and cost analytics. Consequently, these support clinical performance improvement initiatives.
• Clinical Programs: Initiate data-driven programs in correspondence to the needs of your community.
• Strategy: Managed Care and Local Employers.
• Physician Engagement: Physician participation and leadership structure.
• Community Engagement: Information sharing and leading as a voice. Indeed, to drive community health initiatives.