For many organizations working to develop clinically integrated networks, connecting all the dots and putting a network in place is still a fairly nascent effort.
This is because the dots keep moving, Rosemary Plorin, president of Lovell Communications, said while moderating a panel at the Becker's Hospital Review 6th Annual Meeting in Chicago May 8.
Panelists Cheryl A. Sadro, CPA, executive vice president and chief business and finance officer at the University of Texas Medical Branch in Galveston, and Heather Foster, senior litigation specialist and assistant vice president at Stanford (Calif.) Health Care, spoke on the issues CINs face in a continuously evolving landscape, including physician-based issues, the role of data and how to structure financial incentives. Ms. Sadro served until last October as a senior executive with Catholic Health Initiatives and as senior vice president for finance and market CFO for CHI's Chattanooga, Tenn.-based Memorial Health Care System, which launched a CIN on Jan. 1, 2015. Ms. Foster said Stanford is also relatively new to the CIN area.
Based on their experiences so far, Ms. Sadro and Ms. Foster highlighted the following three challenges in developing CINs.
1. Getting physicians on board. Establishing a CIN can be a bit of culture shock for physicians. Ms. Foster said Stanford faced big challenges in the beginning stages. The Palo Alto area had physician micro-cultures and small offices that had previously been completely autonomous. They had to get on board with a new brand and culture, implement the Epic EHR, start wearing the Stanford logo on their T-shirts, buy in to the quality department and the risk management department — it wasn't a simple transition, according to Ms. Foster.
Ms. Sadro said it took eight months of selling the CIN to make physicians in Tennessee feel comfortable that it wasn't about coming in and taking over their practices. "One thing that got their attention quickly was that the board was made up equally of hospital executives and physicians," she said. Giving physicians a seat at the table helped align them with the the CIN.
2. The danger of data. Data can be an incredible tool in healthcare, but it can also be a burden. Systems can collect it until they are blue in the face, but it will be useless until systems are able to analyze it to make clinical decisions and coordinate care. For CINs, the issue with data becomes one of ownership: Who will control the data and what data should be used?
Ms. Sadro said the data at CHI was thought of as belonging to and strictly controlled by the physicians. However, she noted there is a great need for a partnership there. Without including the all right people, especially those in finance, the organization risks incorrect data interpretation, she said.
Another issue with data ownership is deciding who will have access, how the data is protected and what the organization will do if there is a breach, Ms. Foster noted.
3. The incentives issue. CINs must also decide on a method for financial incentives for physicians. Especially when you throw Stark and AKS into the mix, "It gets murky," Ms. Foster said. "It's an evolving issue."
In Tennessee, CHI was implementing a bundled payment methodology for Medicaid patients, according to Ms. Sadro. "We wanted physicians to think about the cost and cycle of patient care," she said. "We weren't completely baked, but that was the path we went down." She said the system established a contract with an individual physician group that included robust quality incentives, similar to a co-management model as a step toward a CIN. It was an expensive valuation process, according to Ms. Sadro, but very attractive to physicians.