Clinically Integrated Networks

Overview

The clinically integrated network (CIN) is an increasingly preferred alignment option. First, it allows employed and independent physicians to develop and implement a full range of coordinated approaches. Second, it allows combinations into larger groups—for example, one health system’s CIN can work with another system’s CIN, or with a larger independent CIN—creating a still larger group that will be more cost effective in achieving population health management.

The underlying principle of the CIN is that it enables more effective, coordinated care, and that this is better for the patient. One of the strongest appeals of the CIN is its flexibility. CINs can include many forms of hospital-physician models—academic practice plans, employed physician groups, independent physician groups—as long as they adhere to legal requirements of a CIN. CINs increasingly include the full range of care options, including pre- and post-acute services. In order to fulfill the legal requirements of a CIN, the network must develop and follow common approaches to delivering care (for example, for chronically ill patient populations). A discussion of the legal requirements for CINs is available in HFMA’s Acquisition and Affiliation Strategies Value Project report.

Organizing services within a CIN

Many CINs begin by organizing care into major service areas. Teams are organized under the CIN’s governing body. These are typically comprised primarily of physicians and advanced practice clinicians, but also may also include the broader care continuum (including pre-and post-acute care services). They are often under the management of a dyad leadership—the chief medical officer for the CIN, for example, will be paired with an administrative leader.

Tool: Organizing a CIN by Service Area

Common quality and cost emphases for CINs

High cost points in care transitions include readmissions to hospitals and leakage from the CIN. Special task forces or teams are often assigned to address these issues.
After the CIN has been in place for a time, the network often identifies selected populations that are disproportionately expensive and could benefit from targeted approaches. 

Example segments that are being targeted for special approaches include:

• Chronic or intensive care groups, such as cancer and cardiac patients that benefit from targeted multi-disciplinary teams in a specialized setting
• The sickest of the sick, who can benefit from targeted care through specialized extensivist or ambulatory intensivist services that provide better care and help avoid inappropriate hospitalization
• Multiple diagnosis patients, such as patients with six or more diagnoses who also may be treated best by a multidisciplinary team in an ambulatory setting
• Homebound and nursing home patients, who may benefit from mobile care.

The precision with which these populations are identified and cared for on an ongoing basis is improving through techniques such as predictive modeling.