Physician engagement is critical to CIN success. True engagement, however, takes vigilance and a long-term commitment; having physicians join your network is just the beginning of the process. Our experience has shown that, despite their best intentions, many CINs lose touch with their physician membership at some point along the road. Effectively engaging physicians in […]
Many hospitals and health systems have made significant investments in physician practice acquisitions and employment. Often, this has been a defensive strategy, pursued without an expectation of direct profits. Instead, their new employers anticipated that these physicians would “pay for themselves” through downstream inpatient and ancillary service revenues once employed. As healthcare reform has progressed, […]
Today’s provider efforts to form clinically integrated networks (CINs) suggest clinical integration is gaining traction. Providers are starting to address the array of opportunities to improve care, lower cost, and receive the associated rewards. We have seen significant movement in five pillars of clinical integration. Payer Engagement Payers are focusing additional funds on value-based arrangements […]
As a Zen master might say, “Change must come from within.” Everybody can point to fundamental problems with healthcare delivery, especially for low-income populations. But managed-care rewards and penalties and other efforts have not been enough to transform the delivery system. New York State is working to encourage “change from within” through its Delivery […]
The number of physician-led ACOs is growing faster than the number of hospital-physician ACOs. Increasing numbers of physician groups are evaluating bundled payment arrangements. Payers are working directly with physicians on patient-centered medical homes (PCMHs). It appears that physician-led accountable care initiatives are here to stay. In some markets, physician-led networks may compete successfully by […]
Of the 41,000 physicians in the 2013 MGMA Physician Compensation and Production Survey, 56 percent are employed by hospitals or health systems, compared with 42 percent in the 2010 survey. Conventional wisdom is that the remaining physicians will rapidly join the ranks of the employed. However, hospitals and physicians can explore many types of relationships […]
Clinically Integrated Networks (CINs) and Accountable Care Organizations (ACOs) are vehicles for evolved forms of capitation that include value-based and risk sharing performance incentives, unlike past reimbursement models which focused primarily on utilization (see Figure below). Both aggregate and align providers, but differ in types of payors. ACOs are paid by Medicare and/or Medicaid, while CINs have commercial insurers. […]
A health system’s efforts in deploying strategic network initiatives will be effective only if its leaders understand the unique factors affecting multi-provider networks.