A Clinical Integration Network or Clinically Integrated Network (CIN) enables alignment of physicians to health systems and helps them adapt themselves to new healthcare business and reimbursement models where there is emphasis on value-based care. The primary focus areas of CINs are improvement in patient care and reduction in costs of care. To effectively deliver on these and to showcase their value to the rapidly evolving healthcare market, they would need secure communication, well established care coordination, robust documentation, high quality performance, and accountability of their physicians.
The U.S. Department of Justice (DOJ) mandates that physicians be part of the CIN’s governance structure and that they must commit to strict adherence to clinical guidelines, while providing coordinated care with continuous improvements by leveraging data and technology – to ensure success of the CIN. An Accountable Care Organization (ACO) is a type of CIN that focuses on patient care improvement while capping overall expenditure by using strong infrastructure. While an ACO consists of healthcare providers collaborating solely to offer improved care to medicare patients, a CIN can have other objectives in this realm. A CIN is the starting point for an ACO, which is a niche, single-goal organization. Other types of CINs include Physician-Hospital Organizations (PHOs) joint ventures, health system subsidiaries, independent practice associations, etc.
Leveraging Technology Solutions
With the CIN’s objectives being quality patient care, reduced healthcare costs, improved population health, and a conscious shift towards value-based reimbursements, it is easy to conclude that just a simple Electronic Health Record (EHR) system will be inadequate to meet the demands of such a high-scale, complex organization. There is an urgent need to go beyond legacy systems and practices and to make investments in technology solutions that ably support these needs. Health Information Technology (HIT) provides a solid foundation to achieve the quality targets defined by CINs. IT solutions including patient dashboards, clinical surveillance, quality analytics, other leading-edge solutions driven by Artificial Intelligence and Machine Learning (AI/ML), automation are helping CINs gain significant improvements in the quality of their offerings.
On the other hand, CINs must also focus on eliminating inefficiencies through clinical protocol compliance and HIE because these integrations enable CIN physicians to reduce unnecessary wastages within the delivery system. These steps will help improve financial margin and reduce the number of hospital admissions/readmissions. CINs also need to adopt evidence-based practice and care coordination through data aggregation platforms. These platforms deliver consolidated data in real-time from various sources and healthcare providers to achieve holistic care for patients. This also drives independence in delivering value-based care.
Considering the size of the population and the amount of data that gets accumulated, CINs must invest in a system that offers data control, care management, data analytics, and patient engagement. CINs must leverage the right data solutions that would promote optimal utilization of resources and data-driven decision making through data insights and advanced data analytics.
Must-Have Capabilities for CINs
For CINs to succeed in their endeavor to offer enhanced care while being cost-efficient, they need access to data and resources, for which they must have the following capabilities:
- Successful Interdependence – Since CINs are built on seamless communication among various health professionals, physicians need to be empowered to coordinate effectively with others to offer value-based care. With the availability of multiple communication channels and EHR systems, a platform that supports robust and secure two-way transmission of data is critical.
- Referral System – With the goals of CINs in mind, a referral system must be created between specialists and primary care physicians while creating a closed-loop within patient care. This can be based on criteria like location, cost, patient preference, etc.
- Risk Analysis based on Patient History – With rising costs of care, there is always the likelihood of expensive episodes of care for most patients. To reduce the incidence of such expensive episodes CINs must include predictive methods to analyze risks based on patient health history. This analysis can be used to improve patient care in CINs. Some of the common methods include the NYU algorithm, HCC (Hierarchical Condition Category) coding, etc.
- Unified Care Practice – The lack of unified care management can result in higher costs and poorer health outcomes. So, CINs need to track different treatment plans from within a single system for better compliance. This helps draw more attention to care plans, enables making suitable changes to planned approaches, and closes any gaps in care that might have crept in.
- Population Health Management – A unified view of patient data consolidated from clinical and claims systems, that provides 360-degree visibility of the patient, is critical. This can be achieved only through the use of the right technology solutions. Implementing electronic Health Information Exchange (HIE) will allow medical practitioners and other healthcare providers to electronically share patient medical information. Although EHRs contain all the relevant details of a patient, the information could be dispersed.
It is now evident that the right healthcare data solutions is key for the success of CINs. Data frameworks that utilize the core tenants of blockchain help create a single version of truth for all stakeholders, facilitate de-centralized ownership of smart contracts, and offer the ability to provide transaction traceability throughout the value chain. Such data frameworks help with master patient index, patient consent management, practitioner directory and credentialing, and Fraud, Wastage and Abuse (FWA). The success of CINs is important for the healthcare industry as it will enable the move towards value-based care.
References
https://www.definitivehc.com/resources/glossary/clinically-integrated-network
https://lightbeamhealth.com/necessary-requirements-of-clinically-integrated-networks/
https://www.premierinc.com/downloads/CIN-whitepaper-v5.pdf
https://www.gavstech.com/healthcare/platforms/rhodium/
Back to blogsSHARE
