From mergers and acquisitions to research agreements and technology partnerships, the healthcare industry is full of information exchanges. Collaboration is common in U.S. healthcare, all in efforts to refine or reform the nation's existing healthcare system. Costs are rising, services are shrinking and high-quality care is falling off. The status quo must change, but how?
Clinically Integrated Networks (CINs) are gaining traction as a collaboration model, offering potential solutions and innovative, value-based disruptions to our current healthcare system. First Choice Health's network of providers operates as a CIN and more, filling in gaps where traditional care teams are not necessarily able to help patients, and providing additional support to help navigate healthcare plans' complexities.
What is a Clinically Integrated Network?
A Clinically Integrated Network is an arrangement in which like-minded hospitals and/or independent providers share performance, quality, value, and efficiency goals that result in improved quality and coordinated care at a lower cost.
Successful CINs operate with some key elements, including coordination, which ensures active communication among health systems, administrators, brokers, and employers. CINs also employ integration between health systems and benefits administrators to help members properly navigate and manage their care. And due to the variation of different healthcare organizations, CINs offer unique flexibility that allows for differences in the delivery and development products. Proactive use of analytics helps CINs tie everything together across their networks and more seamlessly manage population health, as well.
Benefits of Clinically Integrated Networks
With these fundamental foundations, CINs offer a model of high-quality clinical care, coupled with benefit navigation and appropriate incentives. From what we've seen within First Choice Health's network, CINs in turn boost access to care and help drive healthcare savings in some major ways.
- CINs avoid unnecessarily high costs.
By encouraging prescription of generic medicines, CINs are able to offer treatments and necessary medicines to prevent or slow the progression of diseases at lower costs. As an additional benefit, lower cost treatment or prevention options boost care access for many people who may not be able to afford high-cost treatments.
- CINs allow for site of care optimization.
The location or quality of healthcare facilities can impact the costs, and the current fee-for-service healthcare model in the U.S. incentivizes use of higher-cost locations and facilities. The broad network and range of location, facility, and even preferred provider options presented by CINs reduce that incentive, meaning higher-cost locations and facilities are only used to care for patients when appropriate.
- CINs deliver robust clinical outcomes.
With a focus on high-value, coordinated care, CINs focus on lower readmissions and timely access to care. Additionally, participating employer groups will receive comprehensive access to healthcare professionals, along with market leading network discounts. CINs bring together regional providers and healthcare organizations that are celebrated for high-quality care and service and exceptional patient experiences.
- CINs provide pricing stability.
CINs have the wide network and resources to offer members ongoing management of high-cost claimants, proactive engagement with rising-risk, and underwriting stability.
Guiding Principles for Clinically Integrated Networks
At First Choice Health, we work with employer groups to design and administer health plans and CINs optimized for their unique needs, while reducing costs and keeping their members healthy. Though our headquarters are located in Seattle, our reach extends as far east as South Dakota, and our network helps fill in the gaps for care.
- We have an exclusive partnership with Eastside Health Network that provides direct access to higher-quality, comprehensive care for self-funded employers throughout the Puget Sound region's Eastside, including Bellevue, Kirkland, Redmond, Issaquah, Bothell and more.
- We've built a similar program with St. Charles Health System in Central Oregon, called Central Oregon Select, as well as one with MultiCare Connected Care throughout Washington State.
- Puget Sound High-Value Network has been a leading network since 2016, connecting the Puget Sound region, from Tacoma and Puyallup to Everett and Marysville, with regional providers and healthcare organizations that are celebrated for high-quality care and service.
We are excited to be a part of the expanding use of CINs, and the shift toward a lower-cost, more accessible model of care. Through these networks, payors serve as enablers of access rather than as barriers to care, making it simple for members to receive care that drives better outcomes. The relationship between payor and provider seamlessly enables care for patients, allows for more focus on appropriate clinical care, and supports real-time information sharing that assists the member along their journey. Members trust their doctors for clinical advice and have convenient access to care rather than the burden of complex administrative hurdles.
These are the types of outcomes we're proud to work toward at First Choice Health. If you have any questions about Clinically Integrated Networks or the value they can provide to your organization and members, please reach out to us today; we're always happy to help navigate!