In this blog post
Healthcare Data Solutions for Clinically Integrated Networks
A Clinical Integration Network (CIN), sometimes called a Clinically Integrated Network, is a structure for physicians to align with health systems and adapt themselves to new reimbursement trends that emphasize value-based payments. A CIN collaborates to improve patient care, decrease care cost, and showcase their value to the rapidly changing market. As CINs are focused on communication and care coordination, it leads to improvements in documentation, physician accountability, and quality performance.
According to the U.S. Department of Justice, physicians must be part of a Clinical Integration Network’s governance structure. The members must also commit to complying with clinical guidelines while providing coordinated care to patients by leveraging data and technology and continually improving the service throughout the tenure. This also helps in the success of a CIN. There are various types of CINs including Physician-Hospital Organizations (PHOs) joint venture, health system subsidiaries, independent practice associations, etc. An Accountable Care Organizations (ACO) is also a type of CIN that focuses on improving patient care while capping overall expenditure through the use of strong infrastructure. While an ACO consists of physicians, hospitals, and other healthcare providers collaborating solely to offer improved care to medicare patients, CIN can have any number of objectives in the realm of higher quality patient care. Simply put, CIN is the starting point to build an ACO, which is a niche, single-goal-specific organization.
Healthcare Data Solutions for Value-based Care
The main objectives of CIN are to offer quality patient care, lower healthcare costs, and improve population health. With a conscious shift towards value-based reimbursements, CINs are very well received where high-quality care in an efficient manner forms the crux of the service offering. Considering the objectives of these clinically integrated networks, it suffices to say a simple electronic health record (EHR) system will be inadequate to meet the demands of such a high-scale, complex organization. These organizations must take a step beyond and invest in technology that supports and meets the healthcare industry’s growing need.
It is observed that Health Information Technology (HIT) creates the foundation for clinically integrated networks. With a network of physicians, CINs define quality targets coupled with incentive payments for better service. In recent times, a number of IT solutions, including patient dashboards, clinical surveillance, quality analytics, have helped achieve quality care.
CINs must focus on resolving operational inefficiencies through clinical protocol compliance and HIE to lower healthcare costs. These integrations allow physicians part of CINs to eliminate unnecessary wastage within the delivery system. Focusing on resolving inefficiencies helps improve financial margin, reduce the number of referrals, and hospital admissions.
In an effort to sustain independence in value-based care, CINs have adopted the evidence-based practice and care coordination through data aggregation platforms. This helps collect data in real-time from various sources and healthcare providers to achieve better care for patients.
Utilization of resources is one of the highest priorities for CINs. Considering the size of the population and the amount of data that gets accumulated, CINs must invest in a system that offers data control, care management, data analytics, and patient engagement.
Components of Clinically Integrated Networks
For CINs to succeed in their endeavor to offer enhanced care while being cost-efficient, they need access to data and resources. To that end, CINs must have the following capabilities met.
- Effective Population Health Management – Proper infrastructure is essential to create a 360-degree view of patient data from clinical and claims systems. Implementing electronic health information exchange (HIE) will allow medical practitioners and other healthcare providers to electronically share patients’ medical information. Although Electronic Health Record (EHR) contains all the relevant details of a patient, the information can be dispersed.
- Support System for Successful Interdependence – A network built on communication among various health professionals needs physicians to coordinate with others to offer value-based care. Due to the presence of multiple channels of communication and EHR systems, a robust platform that supports two-way transmission of data is imperative that also supports physician affinity with the CIN.
- Referral System – Keeping in line with the goals of CINs, a referral system must be created between specialists and primary care while creating a closed-loop within patient care. This system can be based on location, cost, patient preference, and other criteria.
- Patient History-based Risk Analysis – As there is a likelihood for expensive episodes of care, CINs must include predictive methods to analyze risk based on the patient’s history. This analysis can be used to improve patient care in CINs. Some of the common methods include hierarchical condition category (HCC) coding, the NYU algorithm, among others.
- Unified Care Practice – The ultimate aim of CIN is to create unified care management, a lack of which can result in higher utilization costs and poorer care outcomes. To that end, organized CINs must track different styles of treatment from within a single system to ensure compliance. This helps draw attention to care plans, make modifications to the medical approach, and close prevailing care gaps.
GAVS’ Rhodium Framework
GAVS Rhodium Framework allows the healthcare industry to move towards creating value-based care such as CINs. The framework utilizes the core tenants of blockchain to create a single version of truth for all stakeholders, facilitates de-centralized ownership of smart contracts, and offers the ability to provide transaction traceability throughout the value chain. The framework helps with master patient index, patient consent management, practitioner directory and credentialing, and Fraud, Wastage and Abuse (FWA). To learn more, please visit https://www.gavstech.com/healthcare/platforms/rhodium/.
References
https://www.definitivehc.com/resources/glossary/clinically-integrated-network
https://lightbeamhealth.com/necessary-requirements-of-clinically-integrated-networks/
