By Katie Tsui
The movement away from fee-for-service has brought to life a range of new healthcare delivery models, each with varying degrees of risk sharing, that support the implementation of value-based care. One model that is increasingly being used is the clinically integrated network (CIN). CINs consist of a group of independent physicians that formally congregate to identify and improve quality metrics of care. Systems have developed CINs to assist in care coordination alignment, financial accountability sharing via legal entities, integrated care management, quality improvement demonstration, and negotiation of payer contracts.
In upcoming years, CINs will grow as prominent players in refining health care delivery, as 66% of organizations in one study placed high priority on development of CIN strategies[1]. In 2012, 100 times more CINs were in existence compared to the parallel statistic in 2008[2]. Today, over 500 CINs exist in the United States[3].
This growth can largely be attributed to the two primary benefits that stakeholders receive for joining CINs:
- Independent physicians are able to preserve their private practice models by aligning with health system physicians as both parties collaborate toward care improvement.
- CINs combine evidence-based best practices with data analytics and negotiate with health plans on behalf of its participants to seek contracts with payers that recognize and more generously reimburse for value.
CINs are protected against antitrust laws to collectively negotiate for better payment rates with insurance, but the Department of Justice and Federal Trade Commission threaten to prosecute networks that seek only to obtain reimbursement without integrating greater value into care practices[4].
The establishment of a CIN within a health system is a strong indicator that a system prioritizes value-based care and reimbursement. A CIN’s interest aligns with that of an ACO, so systems with CINs may also be good candidates for ACO platforms (and vice versa). The assembly of a CIN varies, but it is usually structured as a joint venture or subsidiary Physician Hospital Organization (PHO), or an Independent Practice Association (IPA). The establishment of these aforementioned groups in a health system suggests that it may be a worthwhile entity to partner with in value-based care delivery and reimbursement initiatives.
What does this mean for pharma?
The establishment of a CIN in a system may be a useful metric for pharma stakeholders to include in their targeting and segmentation strategies. Looking deeper into entities with similar qualities, structures, and interests as CINs and matching them with corresponding health systems can be a component of account planning in determining possible collaboration opportunities, particularly around value-based initiatives.
Pharma is uniquely positioned to support CINs in addressing total cost of care metrics. But account management teams must demonstrate product value propositions to health system decision makers through a value-based lens by emphasizing patient outcomes, comparative cost analyses, impact analysis models, and pharmacy benefits when working with health systems and CINs.
After all, a CIN is not simply a form of physician employment or a hospital-led program to gain leverage over payers. It is instead a deliberate physician-led initiative that collaborates with larger health organizations with the goal of demonstrating value to the market. Pharma leaders too must demonstrate their value to the market by showing that they understand the priorities of health systems and corresponding entities like CINs.
[1] https://www.shsmd.org/resources/conference/clinically-integrated-networks-acos-physician-alignment.pdf
[2] https://www.advisory.com/research/health-care-advisory-board/studies/2012/next-generation-clinical-integration/an-evolving-mandate/an-explosion-of-interest-in-the-clinical-integration-model
[3] https://www.healthitoutcomes.com/doc/clinically-integrated-networks-and-population-health-0001
[4] https://www.ftc.gov/sites/default/files/documents/public_statements/clinical-integration-changing-policy-climate-and-what-it-means-care-coordination/090427ahaclinicalintegration.pdf