Imagine this scenario: Your health system has made a strategic commitment to new quality and cost containment targets, and reaching those goals relies heavily on partnering more closely with providers within the clinically integrated network. Your team is tasked with making sure that providers across the health system are aligned with the new strategy.
Right now, information about your increasingly complex clinical network is spread across disconnected databases and static reports, with no single source of truth. And it is almost impossible to coordinate various provider outreach activities. This isn’t an unusual scene. We’re seeing this challenge unfold at health systems across the country.
To successfully transition your provider network to new models of care, cost containment programs and payer risk models, you need a governance model, starting at the enterprise level. This is a key role for the clinically integrated network and the mechanism to share and accelerate best practices across the network.
The clinically integrated network is responsible for operations, payer negotiations, risk stratification and analytics, performance monitoring, and compliance. The providers within the network deliver care management, drive practice performance, outreach and engage patients, provide the staffing and contribute to capital and funds flow.
What is a clinically integrated network?
A Clinically Integrated Network (CIN) is a group of health care providers that have agreed to work together to improve the quality and coordination of care for their patients.
The organization’s goals include lower cost of care, improved patient outcomes, and a demonstration of value to the marketplace. In addition, the members of a CIN agree to enhance the patient experience and quality of care.
The benefits of a CIN
A CIN benefits physicians, hospitals, and patients.
Physicians can preserve their private practice and benefit from the services a provider network can offer, such as payer negotiations and enhanced reimbursements.
Under a “safe harbor” from antitrust law, physicians can jointly negotiate for commercial payer contracts that reward them for cost and quality improvement.
Hospitals can align independent and employed primary care physicians and specialists within a single organization. Hospitals can also receive increased reimbursements for implementing a Quality Improvement Strategy (QIS).
Patients experience better coordination and efficiency of care. In addition, they are better informed and have more control of their care.
CINs have improved the quality of care for patients with chronic conditions such as heart failure, diabetes, and asthma. For example, an Atlanta-area CIN facilitated community distribution of asthma-related educational materials so patients could better manage asthma and reduce ER visits.
CINs vs. ACOs
People often ask what the difference is between a CIN and an ACO (Accountable Care Organization).
Both address the issue of rising costs and quality of care. However, a CIN is a contracted entity of providers while an ACO is a group of providers defined by their relationship to a population of Medicare or commercial plan patients. A CIN holds both Medicare and commercial contracts while an ACO is related to a single contract. In other words, an ACO is a subset of a CIN.
Reducing the complexity and costs of network management
Many CINs have similar operational pain points. These include manual processes, lack of quality data, and the inability to integrate systems in a meaningful way for the provider network. The relationships with providers are impaired. Managers may lack analytics for fully-informed decision-making.
One of the fundamental principles of a CIN is to make efforts to meet quality standardization and cost efficiencies. This includes investment in information technology, more efficient network participants, and clinical improvements such as better care management.
For non-clinical data and relationship management needs, Salesforce Health Cloud is the healthcare industry’s leading platform.
Since Salesforce is a platform, it can be adapted to address many different requirements within healthcare organizations. Below are ways Health Cloud can lead to greater efficiencies and cost savings within an integrated network.
Provider recruiting and management
Health system analysts and other staff can use Health Cloud for the following functions.
- View detailed information about current providers
- Manage a list of prospective providers
- Determine where there are gaps
- Recruit providers (outreach)
- Retain providers
Health Cloud users benefit from Salesforce’s foundational contact management, activity management, and email marketing for building and maintaining a physician network.
If a health system has already deployed Salesforce Health Cloud for Provider Relationship Management and other operational needs, the physician recruiting and retention functions for a CIN can be added to the existing Salesforce org.
Salesforce Health Cloud can facilitate an end-to-end onboarding process. Steps can include:
- Credential checking
Salesforce’s OmniStudio is used to streamline processes within many industries including healthcare. Within OmniStudio, OmniScripts (guided flows) can be created to facilitate user navigation and progress through the steps listed above.
Since CINs are best off taking a “crawl, walk, run” approach to deploying technology, OmniScripts are often implemented at a later stage.
Provider directory management
CINs have traditionally managed provider directories with spreadsheets. However, spreadsheets are prone to inconsistency and errors compared to the structured data schema behind Health Cloud.
When a directory contains the wrong locations for doctors or out-of-network providers who should not be listed, this can be upsetting to a patient. In addition, because of the No Surprises Act, patient visits to out-of-network doctors can be costly to the CIN. Additionally, provider directory errors can be subject to CMS fines — as much as $25,000 per beneficiary.
Salesforce Experience Cloud works alongside Health Cloud as a self-service and collaboration portal for providers, removing annoying red tape and ensuring that the CIN has the most current data for its provider list.
CINs that leverage Salesforce Health Cloud and Experience Cloud with integration to a unified care record and analytics now bring financial and quality performance metrics to the fingertips of their providers. As CIN performance management becomes more automated and less one-off, CINs will have the confidence to move into more aggressive risk arrangements knowing that they have their finger on the pulse of the network and can use that data to inform payer strategy.