In the healthcare industry, there is an increasing demand for higher quality of care and lower costs. Clinically Integrated Networks (CINs) are gaining traction as a collaboration model and a leading solution, offering potential 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.
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 integrated relationship between payor and provider enables coordinated 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.
A Clinically Integrated Network is an arrangement in which like-minded hospitals and/or independent providers share performance improvement, 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.
A CIN and an accountable care organization (ACO) are both provider-led programs with very similar goals: optimizing patient care and improving revenue. However, they are typically structured in different ways.
CIN structure includes:
- A group of doctors, hospitals, and other healthcare providers that work together to coordinate patient care and improve outcomes at a lower cost.
- Adherence to guidelines allowing "safe harbor" from antitrust laws, so that the group can collectively negotiate for better payment rates with insurers.
- Documentation and agreements provide the legal framework around which the hospitals and healthcare providers can set goals and standards. Robust data analytics and shared records are a key component to accurately track results and gauge improvements.
- Incentives are aligned with the payor, with shared upside and downside risk scenarios.
ACO structure includes:
- Doctors, hospitals and other healthcare providers working together to provide better coordinated and improved care to patients.
- Medicare is an ACO's primary payor, with the patient population mostly consisting of Medicare beneficiaries.
- The Centers for Medicare and Medicaid (CMS) defines and provides rules for ACOs.
- This type of organization often uses alternative payment models, such as capitation.
Both ACOs and CINs can be effective ways to organize healthcare entities and respond to today's challenges, and they are growing in popularity throughout the U.S. CINs can provide unique benefits for improved performance and value to the participating parties. First Choice Health is excited to be a part of the expanding use of CINs, and the shift toward a lower-cost, more accessible model of care.
Within this fundamental structure, 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 help to control medical 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 narrow 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.
From Seattle and the Puget Sound region, our CIN partnerships extend as far east as South Dakota, and our network helps fill in the gaps for care. We select and partner with the leading health systems in these communities. Our shared success is measured on a number of outcomes, including areas identified as opportunities for the improved health of the population.
At First Choice Health, we work with self insured employer groups to design and administer flexible medical plans that are configured to meet their specific needs. All plans include customized multi-tier network design with lower copays and cost shares for members utilizing the CIN. Our innovative direct-to-consumer network and contracting model provide favorable reimbursement rates and additional negotiated discounts to employers. Find out more about our direct contracting advantage.
- We have an exclusive partnership with Eastside Health Network that provides direct access to high-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 and Praxis Health in Central Oregon, called Central Oregon Select.
- Supporting both Western Washington and Eastern Washington in the Spokane Valley area, we're collaborating with MultiCare Connected Care and Embright networks.
- Puget Sound High-Value Network connects 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.
- Employer groups located in the Plains states are supported through our partnerships with the leading clinically integrated networks in South Dakota (Monument Health) and Nebraska (Nebraska Health Network).