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How can eConsults help clinically integrated networks deliver better care and demonstrate value?

Featured in HIT Consultant, June 2020
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CIN strategy

A Clinically Integrated Network (CIN) strategy that leverages eConsult technology can help physicians and health systems deliver better care at lower cost.

Physicians increasingly face pressure to deliver high quality care efficiently while continuing to grow and sustain their practices. But lowering costs while sustaining growth often means giving up autonomy. The percentage of solo physicians in the U.S. fell to 17% in 2014, compared with 41% in 1983. Additionally, hospital ownership of physician practices increased from 24% in 2004 to 49% in 2011.

One way that small physician practices have begun combating this trend is by forming clinically integrated networks (CINs), which are groups of providers that come together to improve quality of patient care, reduce costs, and demonstrate value. A large part of a successful CIN strategy involves the implementation of technologies and procedures that facilitate referral management and improve quality and experience of care. 

What is a CIN?

CINs are legal structures that facilitate healthcare provider collaboration by creating alliances between physicians, independent groups, and the healthcare system. These structures enable small physician groups to jointly negotiate contracts which form the foundation for value-based arrangements but can also help stakeholders with in-network fee-for-service (FFS) models. According to URAC data, there were an estimated 500 CINs in the U.S. as of 2015.

McKinsey defines a CIN as “as a network of interdependent and cooperative providers who continuously evaluate and modify their clinical practices in accordance with agreed-upon protocols to control costs and improve quality.”

Five main elements, as outlined by McKinsey, must be incorporated for a group to be considered a CIN. They are:

  • Responsibility: Physician members need to actively participate in the CIN by serving on committees, participating in training, and adhering to clinical protocols. 

  • Investment: Physicians are required to make monetary and nonmonetary (e.g., time) investments in new tools and infrastructure, such as an eConsult platform.

  • Accountability: A CIN must have a mechanism in place to exclude or discipline physicians who are noncompliant with care protocols or who fail to meet quality measures.

  • Outcome measurements: CINs must have a clear way to measure outcomes through clinical metrics or benchmarks.

  • Non-exclusivity: Physicians who join the CIN should be allowed to contract independently with payors in order to avoid (sometimes dramatic) antitrust risks.

Improving network management can improve quality and cost

Successful network management directly influences steerage from payors, enables the alignment of the most appropriate care, and improves access to providers.

CINs offer a strategic way for health systems to align with solo physicians or small practices to gain market share and offer integrated services to communities where it might otherwise be difficult to compete. Because CINs allow for shared financial responsibility between physicians and health systems, they create a relationship that fosters value-based care by offering alignment incentives that motivate all stakeholders to contribute at-scale care coordination

CINs are not uniquely about value-based contracting. They also benefit stakeholders with in-network FFS structures by requiring them to collaborate and demonstrate results with quality improvement.

The strategic advantages of a successfully formed and managed CIN include supporting steerage to in-network providers, stronger patient retention, and creating greater value by managing spend in areas not under a specific health system’s direct control (e.g., pharmacy).

Likewise, when a CIN strategy aligns the right mix of specialists and primary care physicians, it can be an extremely effective resource for patients. The CIN approach also benefits patients by aligning independent physicians and physician groups with health systems and tools to provide more comprehensive care.

With collaborative care being a key element of a successful CIN strategy, the integration of eConsult technology supports CIN strategy through the delivery of timely specialist support and care via a more efficient, effective communications infrastructure.

How eConsults support  the foundation of the CIN 

Coordination of care between PCPs and the specialists treating their patients is a challenge. CINs aim to mitigate this problem by linking physicians to each other within the network, leading to better communication between all healthcare providers involved in a patient’s care. 

eConsult is a peer-to-peer, or asynchronous telehealth technology, that allows PCPs and specialists to efficiently and effectively share patient information such as provider notes, lab results, diagnostic findings, and other information via a secure, HIPAA-compliant platform prior to or without the need for an in-person patient visit with the specialist.

While one of the strengths of a CIN is its potential to provide better care through improved communication, another benefit is the ability to track and quantify value-based care, two essential elements that affect physician compensation.

An eConsult platform can seamlessly link PCPs to specialists, supporting steerage to in-network specialists and specialty services within the CIN, as well as drive the introduction, adoption and adherence to CIN treatment standards that improve quality and cost of care. eConsults can also provide contracting leverage for CINs when negotiating fees with plans. They do this by supporting improved communication and efficiency in the following ways:

  • eConsults enable physicians to continuously collect and analyze data which can be used to satisfy performance metrics and demonstrate value.  This should lead to greater reimbursement in the value-based care era.
  • CINs can use eConsults to establish chronic disease registries with the goal of lowering costs on prevalent, high-cost chronic illnesses.
  • eConsults can increase specialist capacity by helping higher acuity patients obtain timely specialist appointments and care, while addressing lower acuity patients’ needs quickly.
  • eConsults improve rural access by enabling patients to access high-quality specialty care from their primary care office, often negating the need to travel to specialist offices outside the geographic proximity.

eConsults offer positive net value to CINs

Healthcare organizations are evolving and the role of the CIN within the value-based infrastructure is evolving along with them. These arrangements drive the introduction, adoption and adherence to CIN treatment standards that improve quality and cost of care, ensuring that tests, procedures, medications, and other services are implemented with a focus on quality rather than quantity.  CINs that consist of physicians, hospitals, and post-acute care providers are emerging as a solution that promises to help providers share risks and protocols while improving quality and reducing costs. 

A CIN strategy should aim to align the right combination of specialists and PCPs with an approach that benefits patients by aligning independent physicians and physician groups with health systems and tools to provide more comprehensive care.

eConsult platforms, as a component of your overall CIN strategy, can improve the quality and cost of care and yield contracting leverage for negotiation with plans. eConsults also benefit patients by increasing access to timely, high-quality care and reducing no-shows by appropriately triaging cases. This ensures that patients with specialist appointments have clinical needs requiring a face-to-face specialist visit, while those who do not can have their needs met in some other manner.

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