There is a ton of confusion around what clinically integrated networks (CINs) are and what they are not. It's easy to find various definitions of CINs online, but they are often far from specific and may leave those considering forming a CIN with misconceptions.
This can lead to the decision to not form a CIN at all, which could mean missing out on the benefits of a CIN, or forming one for the wrong reasons, or trying to force your CIN to fit some preconceived mold that isn't really necessary.
The Myth of the CIN
In our blog, we've often covered what a CIN is, the benefits of CINs, and how they can be leveraged to cut costs, increase revenues and provide better patient care. Now we're going to take a look at what a CIN isn't, and get rid of some of the myths surrounding CINs, including what they require and what they allow.
1. Myth: CINS require a hospital
Fact: Many CINs do include a hospital, but it isn't required.
A CIN is at its core a formal group of healthcare providers who have chosen to begin working together in order to deliver efficient, affordable, coordinated patient care. There are three different types of clinically integrated networks:
Joint Venture Physician-Hospital Organizations (PHOs)
PHOs are CINs which are made up of both physician and hospital partners. In some cases, physicians may band together then find a hospital to partner with. In others, a hospital may form the CIN and seek physician partners. In this case, a hospital is indeed an integral part of the CIN.
Health System Subsidiaries
Health system subsidiaries are CINs operated as part of an integrated delivery network (IDN). The IDN is an organization that owns and operates a network of one or more healthcare facilities. There are often hospitals involved, but not always; facilities can include:
- Ambulatory Surgery Centers
- Health Clinics
- Hospitals
- Imaging Centers
- Physician Groups
These health systems are designed to provide a wide variety of care services from different types of inpatient and outpatient care facilities. That can mean they have one of several different integrations:
- Horizontal integration of facilities that offer care across a region, like many government, state and investor-run hospital networks
- Vertical integration of facilities that offer care from women's health through infants to adult primary and specialty care to elder care and nursing facilities (cradle to grave), like many community health networks
- Strategic integration of any types of facilities with a focus on internal organization to coordinate better care and keep costs under control, from supply chain negotiations to care reimbursement optimization
Independent Practice Associations
Independent practice associations are made up of only physician partners, working together to help provide a broad spectrum of care to patients and improve outcomes across the board. No hospital is required.
2. Myth: CINs only allow referrals within their own network
Fact: While much of the value of a CIN comes from internal referrals, it's not an exclusive setup.
A CIN is not a health insurance plan, set up to enforce patient adherence to a set list of providers based on whether they are participants in that plan, or rating other doctors as in or out of network. Instead, CINs work to facilitate patient care wherever it is delivered.
That's not to say it isn't to the benefit of CINs to refer within their own network. However, it's always the patient's choice to see the doctor they prefer, and CIN members should be aware of the ethics involved in making referrals and strive to help achieve best patient outcomes regardless of referral preferences.
3. Myth: CINs and ACOs (Accountable Care Organizations) are the same thing.
Fact: A CIN can act as a platform or framework upon which to build an ACO, but the reverse isn't true.
CINs do share many similarities with accountable care organizations (ACOs). Both are generally recognizable as a network of physicians, hospitals, and other healthcare providers who choose to voluntarily work together to achieve two key goals: improving patient care and reducing costs.
ACOs and other systems can certainly be described using phrases like "clinically integrated" in the respect that they do strive to achieve care coordination and interoperability. However, the term "clinically integrated network" means a distinct legal entity.
CINs are the specific organizing structures that providers join when they form an ACO. Without a CIN, an ACO won't exist. However, a CIN can exist without an ACO as substructure.
4. Myth: CIN and IPAs (Independent Practice Associations) are the same.
Fact: Independent Practice Associations (IPAs)are more connected to an HMO rather than a CIN.
An IPA is a very loosely constructed group of (typically) independent physicians for the purpose of payer contracting while a CIN is a much more complex infrastructure focused on quality and cost of care. IPAs include phsyycians who usually all see patients from a health maintenance organization (HMO) but also see patients privately, and may refer to these patients within the IPA.
Many IPAs are transforming into CINs due to changes in reimbursements from fee-for-service to value-based. Physicians who choose to be part of an IPA rather than a CIN can't as effectively negotiate payer contracts.
What a CIN can do for you
Benefits of CINs for physicians and practices as well as other healthcare organizations include:
- Improved opportunities for team-based patient care
- Better communication between healthcare providers
- Increased connections between physicians and a shift toward team-based care
- Enhanced access to resources for patients
- Negotiating power for improved reimbursement rates
- Creation of data that can be used to satisfy performance metrics and demonstrate value
- Ability for independent physicians to maintain their individual practice
- Positioning of physicians to make informed decisions on best practices
- Lowered costs on frequently encountered high-cost chronic illnesses.
How Tangible can help
We can help you decide if a CIN is right for you and enhance results through connectivity, data transformation and reporting. To learn more about how our solutions can help you start your own CIN, contact Tangible today.
