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CIN: A new and improved recipe for success

Over the past few decades, industry thought leaders have displayed a voracious appetite for new and improved ways to fix health care—and embraced an “alphabet soup” of  acronyms to describe them: HMO, IPA, PHO, VBC, ACO, PCMH, to name a few.

And now they’re dishing up CINs: clinical integration networks (aka clinically integrated networks).

The difference is that CINs build on what we’ve learned from predecessor models that were only partially successful and add elements that promise to help the industry achieve the goals of reform.

3 shortcomings characteristic of earlier models

While well-intentioned, previous attempts to address the challenges facing health care met with only limited success for three primary reasons:

1) Incentives intended to motivate stakeholders were rarely aligned. Often, community-wide healthcare networks were driven by hospitals, looking to build loyalty among referring physicians. Local providers, however, were often suspicious and wondered what was in it for them (and typically never found out).

2) The ostensive goal was cost-cutting. But leaders promoting these efforts neglected to consider the larger issue of quality, which offers a significant opportunity to control the cost of care for both individual patients and populations of patients. Plus, measures to reduce expenses typically benefited the hospital, but the rewards seldom trickled down to community physicians.

3) Healthcare organizations lacked the technology necessary to access pertinent information and apply meaningful analytics. Patient information—as we all know—has historically been siloed. Providers who wanted to analyze care and outcomes had to gather data (often inadequate or of poor quality) manually. Or, if they had adopted health information technology (HIT), they needed to synchronize the data so it could be used meaningfully. (Side note: And even those organizations who were ahead of the curve when it came to analytics often focused on the wrong things—such as, I believe, mammography rates. Research on the value of mammography offers only controversial data on outcomes and cost benefit.)

CINs represent new approach

But, unlike the solutions du jour of the past, CINs address and mitigate many of these obstacles.

Briefly put, CINs are legal entities, governed by Federal Trade Commission (FTC) regulations, which have been established by collaborating hospitals and physicians. CINs do not entail hospital acquisition of medical practices or the transfer of assets among participants. All parties retain their independence.

They are designed to meet specific objectives that might range from enhanced care coordination, to elevated quality objectives, to collective negotiation and management of payer contracts. CINs are physician-led (a critically important attribute), promote evidence-based medicine, require participants to meet performance criteria and advance data sharing via HIT systems.

Physician-led, focused on evidence-based medicine

These details are significant. Because CINs are physician-driven—rather than being controlled by hospital or payer administrators—clinicians across the continuum are fully engaged and reap the benefits of success. At the same time, this model makes clinicians fully accountable for achieving quality and cost-containment goals based on scientifically proven metrics.

In the past, for example, quality programs addressing patients with congestive heart failure (CHF) might require the patient be treated with ACE inhibitors and have an echocardiogram every six months. But these “measures” represent only the most basic care for CHF; it would be unthinkable for any provider NOT to treat in this manner.

CINs, with performance criteria based on evidence-based medicine and tied to financial incentives, will up the ante and refocus quality efforts on measures that truly matter—like examining factors that impact CHF hospital readmission risk such as patient engagement, the effects of co-morbidities and social influences.

HIT critical to CIN infrastructure

The final ingredient foreshadowing success with the CIN model is its focus on HIT. These networks require connectivity among participants so information can be readily shared. The availability of up-to-date, comprehensive, high-quality patient information allows providers to improve care delivered in the exam room and at the bedside.

In addition, providers are able to coordinate care between settings to eliminate gaps and proactively address emerging problems. And, access to comprehensive data enables CINs to leverage analytics to identify risk and opportunity with the goal of improving quality and outcomes.

For an industry hungry for change and improvement, CINs offer great potential. It’s time to dig in!

Editor’s Note: Dr. Diamond’s next blog post will look more closely at this focus on HIT and at the solutions which promote success with CINs.

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About the author

Joel Diamond, MD, serves as Chief Medical Officer for Allscripts dbMotion Solution. Previously, he held positions as Chief Medical Information Officer and Chairman of the Physician Advisory Board at UPMC/St. Margaret Memorial Hospital, where he helped achieve 100% adoption of CPOE. Dr. Diamond graduated from medical school at the State University of New York, Health Science Center at Syracuse in 1988, and completed his residency in Family Medicine at UPMC/St. Margaret Memorial Hospital in 1991. In addition to his position with Allscripts, Dr. Diamond is an active partner at Handelsman Family Practice in Pittsburgh, PA.

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