In response to mass consolidation and federally mandated payment reform, health systems and physicians across the country are forming or joining clinically integrated networks to share meaningful patient data, collaborate on clinical outcomes, and bargain with payers.
In the last few years, clinically integrated networks have grown synonymous with the formation of value-based contracts and involvement in Medicare Shared Savings Program ACOs, while partnerships with convenient care access points such as retail clinics and telemedicine could be an emerging trend.
The nationwide shift to value-based payments is perhaps the main driver in the formation of clinically integrated networks. With the onset of the Centers for Medicare & Medicaid Services’ advanced payment models in October 2017, health systems and physicians are looking to maximize financial and clinical efficiencies to improve value and drive down costs. Soon, their payments will depend on it.
Many providers have opted to get their feet wet in value-based payments via contracts with commercial carriers. Payers are more likely to form value-based contracts with physicians and hospitals if those providers can furnish the financial, technical and administrative resources needed to succeed. The governance structure of CINs helps participants combine these resources to streamline clinical protocol development, measure physician performance, and implement supportive technologies, such as shared electronic medical records, to improve care coordination and patient outcomes.
HealthChoice Trilogy in Memphis, Tennessee, is an example of the value proposition of CINs; this network has recently formed value-based contracts with two of Memphis’ largest insurers, Cigna and UnitedHealthcare, and intends to evolve these partnerships to risk-based payments in the future.
Aside from forming commercial value-based contracts with payers, some CINs have also launched formal accountable care organizations with CMS, again to capitalize on the shared resources of multiple providers and hospitals. The incentive to launch a Medicare ACO is a large one: Providers are increasingly burdened by rising healthcare costs and insufficient Medicare/Medicaid reimbursements that lead to a high level of uncompensated care. If providers can develop strategies through the formal governance of the CIN and ACO that improve the health of vulnerable populations, they can be eligible for shared savings and increase the likelihood of success in CMS’ impending advanced payment models.
While CIN-focused ACOs such as Baptist Physician Alliance MSSP ACO in Birmingham, Alabama, and Arizona Care Network Next Generation ACO are fairly new (having launched in January 2016 and January 2017, respectively), older ACOs such as BayCare Physician Partners MSSP ACO in Tampa, Florida (launched in January 2015) and Chicago’s Advocate Physician Partners MSSP ACO (launched in July 2012) have demonstrated success. In the most recent performance period of 2015, BayCare Physician Partners received $5.9 million in shared savings and Advocate Physician Partners received $33.5 million.
Patient access is key in driving savings for both value-based contracts and these ACOs. Retail clinics and telemedicine are easily accessible and inexpensive points of care, so much so that payers have begun turning to them to help cut costs. CINs that partner with retail clinics and telemedicine providers could realize a healthier population, one that improves a CIN’s negotiating power with payers in value-based contracts.
To the extent that many CINs are connected to health systems and that health systems are ready and willing partners in both telemedicine and retail clinics, these care avenues already play—and will continue to play—an important role in CIN success. Hospital-employed and -affiliated physicians who participate in a CIN automatically benefit from the relationship that hospital has with telehealth venues such as Teladoc and American Well or retail clinics such as The Little Clinic and CVS/minuteclinic.
For example, Arizona Care Network, through a collaboration between parent company Dignity Health and CVS/minuteclinic, provides care at CVS/minuteclinic locations in Arizona, while Cleveland Clinic Tampa’s BayCare Physician Partners will likely play an integral role in BayCare Health System’s new telehealth collaboration with Publix. This collaboration involves BayCare-branded telehealth kiosks in Publix stores across Florida’s Hillsborough, Pasco, Pinellas, and Polk counties.
Emory Healthcare Network in Atlanta is a CIN that has taken a more direct partnership approach. In October 2016, Emory Healthcare Network partnered with two urgent-care companies in the metro Atlanta market and expanded a collaboration with CVS/minuteclinic that syncs Emory’s electronic medical records (DRG Atlanta, Georgia, Market Overview Report, May 2017). Through these partnerships, Emory Healthcare Network physicians can track and manage patient care and help improve patient outcomes.
Overall, CINs are promising in their delivery of high-quality, coordinated care that spans multiple patient, and payer, populations. As consolidation among health system heavyweights continues to chip away power from independent physicians, we are likely to see a spike in physician participation in these networks, as well as an associated increase in the formation of value-based contracts, ACOs, and convenient care partnerships.
For more information on the CINs profiled in this blog, refer to the Decision Resources Group Market Overview and Health Plan Analysis reports. In addition, stay tuned for new products from Decision Resources Group in 2017 that profile integrated delivery networks and associated clinically integrated networks. Find out more: Health Plan Analysis. Market Overviews.
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