There is a genuine art to creating a cohesive Clinically Integrated Network (CIN). The purpose of forming CINs is to engage physicians, connect healthcare providers and hospitals, share data, improve patient care, and decrease utilization for their patient population. It begs the question of what exactly goes into the formula, and what tools do population health professionals know to make for a successful CIN and work to achieve value-based care goals?
Amid a new year, many healthcare providers might be wondering if it is time to take the leap or entertain contracting arrangements. There are a lot of moving parts within these networks, and a CIN that aims to succeed under value-based reimbursement requires several tools to support the operational changes to members’ day to day and technology-based resources.
A Holistic Patient Record
A CIN needs to create a holistic view of their patients using data from clinical and claims systems. The comprehensive data creates a foundation for effective population health management. Since a single electronic health record (EHR) does not offer the data necessary, CINs need to put the infrastructure in place to not only capture data from disparate sources but normalize it as well. The infrastructure can be deployed through an enterprise data warehouse or a health information exchange (HIE). With these solutions in place, CINs can begin the journey of analyzing and stratifying data to share key insights with providers within their network. Such insights might include gaps in care, coding opportunities, or alerts for when patients within their network are admitted or discharged from hospitals.
Bi-Directional Data Integration to Support a Physician Affinity Strategy
A physician affinity strategy unites physicians and other members of the CIN to maximize efficiency in their practices. An example of a comprehensive physician affinity strategy is combining the available data on a single platform and creating a common way to view and analyze it, depending on the network’s underlying adoption strategies. One of the ways to support this is through bi-directional data integration, meaning that the vendor of the CIN’s platform does not only pull data from the EHR systems but pushes data back into them as well. That vendor’s data will appear in the existing EHR, so the physicians within the CIN do not have to use another system to share insights between members.
Bi-directional integration allows data to move directly into provider workflows and other population health management tools, allowing for more scalable interoperability. The capability supports an airtight physician affinity strategy that meets beneficiary needs and creates a holistic record for them from the beginning to end of their care journey.
Analytics to Stratify Risk
To accurately stratify risk, it is important to utilize different predictive methods to discern a patient’s likelihood of becoming high-risk, becoming comorbid, going to the emergency room, unnecessary utilization costs, and other insights. The process is simplified further when they are performed within the unified platform. Some of these measurements include hierarchical condition category (HCC) coding, the Johns Hopkins ACG® System, the Elder Risk Assessment (ERA), the Charlson Comorbidity Index, the NYU Algorithm, and Milliman Advanced Risk Adjusters (MARA).
A Referral Management Solution
Using a built-in referral solution to match and manage patient referrals helps maintain strong CINs. These solutions support closing the loop between patients and specialists; they should enable physicians to create preferred and provider networks and match specialists based on factors like quality outcomes, costs, location, and patient preferences. It is important for CINs to steer patients back to contracted providers if they visit a specialist outside the network; the CIN will have to make up for the loss if a patient continues to visit out-of-network providers. Costs can compound if a patient is high-risk or already considered high-cost and continually returns to these providers.
A Single Care Management Approach
Operations should remain unified throughout, but especially when it comes to care management. CINs are made up of many different providers with different styles of treatment; organized CINs should rely on one means to track compliance to care plans, approach intervention, and close care gaps in populations. The need for unified care management intensifies if they are thinking of contracting for risk. Without access to a patient’s health information to deploy immediate care, providers in a CIN may find themselves at a disadvantage, facing higher utilization costs and potentially poorer outcomes.
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Alex Gorman is Lightbeam’s Associate Vice President of Business Development.