A 2007 article in the New England Journal of Medicine found that the average Medicare patient saw a median of two primary care physicians (PCPs) and five specialist physicians per year. These numbers illustrate the consequences of poor communication between providers, and the resulting excessive costs seen in medicine.
Because of this increasing cost of care, many payers decreased reimbursement of fee-for-service and increased value-based payments, illustrating a focus on delivering better healthcare at lower costs (Strilesky), (Krivopal). An increasingly popular approach to meet this goal is the establishment of clinically integrated networks (CINs). Compared to other physician organizations, CINs can provide unique benefits to the physicians involved, as well as patients under their care.
CINs are networks of providers that share information via EHRs to improve quality of patient care, reduce costs, and demonstrate value in the healthcare marketplace (Pofeldt). Typically physician-led, CINs can be composed of employed and/or independent physicians and can also include partnerships with healthcare systems. Leadership within a CIN will establish clear goals and objectives, as well as participation guidelines for members to meet the demands of the ever-changing healthcare landscape.
Benefits of a CIN
Many benefits of CINs are linked to the improved opportunities for team-based patient care. Because of the increased prevalence of the hospitalist model, the current healthcare landscape makes it difficult for PCPs to interact with specialists who share their patients. CINs help mitigate this problem by connecting these physicians to each other, leading to better communication between healthcare providers. This increase in connections between physicians and a shift toward team-based care can also translate into enhanced access to resources for patients. For example, some CINs have implemented alert systems that will notify PCPs if one of their patients visits the emergency department, allowing for faster follow-up care.
Another major advantage of CINs is that they can negotiate with payers on the physician’s behalf, potentially improving reimbursement rates. By continuously collecting and analyzing data, CINs allow for the creation of tangible data that can be utilized to satisfy performance metrics and demonstrate their value in the market. CINs also allow independent physicians to maintain their individual practice while gaining access to resources and pooled data that would otherwise be unavailable to them. This positions physicians to make informed decisions on best practices to improve patient outcomes, which should lead to greater reimbursement in the value-based care era. Some CINs have even established chronic disease registries that collect data in an effort to lower costs on frequently encountered high-cost chronic illnesses.