A recent white paper from Coker Group describes five possible arrangements for clinically integrated networks, depending on the entity that is driving the model — at least in the beginning of the CIN's existence.
CINs are networks of interdependent facilities and providers that collaborate to develop and sustain clinical initiatives. All participants adhere to evidence-based clinical protocols, ensure patient treatment information is readily available throughout the network and collaborate in the development of a prescribed set of quality and performance measures. Additionally, the ability to participate within a payor contracting network is an important prerequisite of being within a CIN.
1. Independent physician association-directed CIN. In this arrangement, a grouping of independent physician practices leads the CIN. Allied healthcare providers might also be included in the CIN. Since IPAs are physician-led, hospitals and health systems often assume a subordinate position in this CIN arrangement. This model would also consider a patient-centered medical home structure as a foundation.
2. Multispecialty group-directed CIN. A multispecialty physician group leads the development of the CIN, which may then go to a hospital or health system and contract for inpatient services. Usually the multispecialty group that heads the CIN is quite large and has a combination of primary care and specialists.
3. Physician hospital organization-directed CIN. In this model, the more traditional physician-hospital organization creates relationships with physician practices and a hospital system. The PHO is at the center of the CIN, but generally, the hospital takes the leadership role in the CIN's development.
4. Integrated delivery network-directed CIN. The IDN is at the center of the involvement and ownership of the CIN in this model. The IDN may employ and/or contract with its physicians and is usually led by a health system or hospital.
5. Payor-directed CIN. In this model, a private payor forms direct partnerships with physicians and creates a physician-only CIN that subcontracts for hospital and health system services. This CIN could also be formed between IPAs and/or PHOs or multispecialty group models. The idea is for the payor to be the partner that provides financial support for infrastructure, including IT and aggregation.
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CINs are networks of interdependent facilities and providers that collaborate to develop and sustain clinical initiatives. All participants adhere to evidence-based clinical protocols, ensure patient treatment information is readily available throughout the network and collaborate in the development of a prescribed set of quality and performance measures. Additionally, the ability to participate within a payor contracting network is an important prerequisite of being within a CIN.
1. Independent physician association-directed CIN. In this arrangement, a grouping of independent physician practices leads the CIN. Allied healthcare providers might also be included in the CIN. Since IPAs are physician-led, hospitals and health systems often assume a subordinate position in this CIN arrangement. This model would also consider a patient-centered medical home structure as a foundation.
2. Multispecialty group-directed CIN. A multispecialty physician group leads the development of the CIN, which may then go to a hospital or health system and contract for inpatient services. Usually the multispecialty group that heads the CIN is quite large and has a combination of primary care and specialists.
3. Physician hospital organization-directed CIN. In this model, the more traditional physician-hospital organization creates relationships with physician practices and a hospital system. The PHO is at the center of the CIN, but generally, the hospital takes the leadership role in the CIN's development.
4. Integrated delivery network-directed CIN. The IDN is at the center of the involvement and ownership of the CIN in this model. The IDN may employ and/or contract with its physicians and is usually led by a health system or hospital.
5. Payor-directed CIN. In this model, a private payor forms direct partnerships with physicians and creates a physician-only CIN that subcontracts for hospital and health system services. This CIN could also be formed between IPAs and/or PHOs or multispecialty group models. The idea is for the payor to be the partner that provides financial support for infrastructure, including IT and aggregation.
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