By Lea Vlacos
TOPIC: Business Process Optimization, Change Management, Health Care Leadership, Strategic and Advisory Services
As the U.S. health care system increasingly turns to a value-based structure, more providers and health care organizations are forming clinical integration networks (CIN) to collaborate on improving the quality and efficiency of care, while allowing themselves to continue to operate independently.
A CIN, sometimes also called a clinically integrated network, allows physicians to more closely align with health systems (yet maintain their independence) and adapt to new reimbursement trends that emphasize value-based payments. CINs can help participants reduce their costs, maintain margins and more effectively manage utilization and population health.
Launching a quality CIN can be complicated, as it is a specific type of legal arrangement that includes meeting multiple legal, regulatory and quality-related requirements to execute properly. Because of these high standards, establishing a CIN requires participants to adhere to multiple quality-related sequential steps, including identifying and analyzing evidence-based clinical guidelines.
In addition to gaining counsel from an attorney well-versed in establishing a CIN, as well as involving all pertinent clinical stakeholders, here are six fundamental quality-related steps to consider when launching a CIN:
- Identify evidence-based guidelines and associated quality measures – CIN regulations will require you to adopt a set of standard, evidence-based guidelines and associated quality measures. This is to indicate participating CIN physicians’ adherence to evidence-based clinical protocols, reduce care variations and demonstrate clinical integration. Based on an analysis of high prevalence/high cost conditions treated by the proposed CIN participants, plan to identify and develop corresponding quality measures, particularly those which improve care quality and/or affordability.
- Plan to present measures for internal review and approval – As part of vetting your proposed quality measures, plan to first have them reviewed and approved by your participating health care system’s physician-led governance mechanisms. These might include, for example, a clinical initiatives committee and accountable care organization board. You will want to update your quality measures based on the input you gain from such governing bodies.
- Develop your quality measure requirements – Next, plan to develop requirements documentation for each approved quality measure. Your requirements documents should contain detailed quality measure criteria and specifications to guide developing new and modified EHR workflows and required reporting. Be sure that all other pertinent departments in the CIN have a thorough understanding of your quality measure specifications.
- Plan to report quality measure results – You will next need a plan to prioritize and manage all relevant training and workflow changes, including new work plans and schedules, required for reporting your quality measure results. You will also need to design, build and test discrete data capture for quality measure components and develop associated training materials for physicians and clinical staff.
- Prepare for an annual CIN review process – Again, as part of the CIN regulatory process, you should plan to have an annual CIN review process. This might include developing specific benefit and feasibility criteria to support your CIN physicians’ annual quality measure review. This will also help you determine if a quality measure should be maintained, changed or retired for the next measurement year.
- Develop an internal communications plan – All CIN participants and stakeholders need to be kept informed throughout the quality measure development process. Think “no surprises.” Plan to develop an internal communications plan, sent to all pertinent audiences, that includes whatever tactics are necessary to maintain communications including FAQs, weekly articles, monthly newsletters, and quarterly webinars and CME offerings.
Work such as analyzing prevalent population conditions and approving and adopting new quality measures can be grueling and time-consuming. You may wish to consider engaging an external consultant to assist you with this process. In addition, you will need to develop all new CIN quality measure requirements documentation for electronic record design and development, scoring criteria for an annual review of quality measures, as well as an internal communications plan. Once you have completed these steps, you should be well on your way toward achieving the quality, efficiency and cost-reduction goals you envisioned when seeking to establish your CIN.