Keys to Building a Second-Generation Clinically Integrated Network: Market Positioning and Growth

Clinically integrated networks (CINs) are facing an impending tipping point. In an ongoing blog series, we are readying healthcare organizations for the transition to a second-generation CIN. In our last post,we explored the role of CINs in cultivating innovation in healthcare – which serves as an important contribution to the industry’s collective effort to optimize care, but is also imperative to a network’s survival in a competitive market.

Here we provide guidance on a “formula” of enhanced capabilities needed to progress to a second-generation CIN, starting with market positioning and network growth.

Establishing a Sustainable Competitive Advantage

The industry is rapidly shifting and providers are feeling more pressure than ever to create high-value networks that deliver safe, effective, coordinated care across the continuum. In many markets, the competition is increasing – competition for providers, commercial payers and employer partners, and patients. And broad disruption in the industry — such as the Amazon, JPMorgan and Berkshire Hathaway venture — is largely apparent. Establishing an organization as a steadfast and valuable CIN is crucial to a prosperous future.

First Mover Advantage

Amid this momentum, pace of change and competition in the market place, the CINs that act early and thoughtfully have a significant advantage. Successful early movers have secured a robust and committed network of primary care physicians (PCPs). These networks have been proactive and strategic about expanding their footprint regionally and, in some cases, across entire states. And they’ve successfully navigated how to achieve scale and minimize the burden of investment and operations.

One Premier health system has long been recognized as a leading provider in a state with a dominant payer and limited value-based arrangement activity. They moved early and opportunistically to form a statewide network with strong physician leadership. This decision to create a platform for change has fostered interest from other health system sponsored networks across the state to join as a part of a “Super CIN.”

However, late adopters continue to face an uncertain future. We recently began working with a health system that had been considering forming a CIN for some time. Their delay in forming a CIN allowed a venture capital-backed organization to enter the market with a physician-led (no hospital participants) network two years ago, which resulted in a nearly 10% reduction in Medicare admissions to the hospital with no financial return for the improvements in utilization.

Needless to say, employers and consumers can greatly benefit from higher quality care, lower premiums and a more sustainable regional economy. If they act now, the most significant and successful health systems may lead reform in a region once controlled by a slow-moving payer and get ahead of venture capital-backed organizations that want to take advantage of the market.

Action Steps

Regardless of CIN maturity, positioning your network as a leader in high-value care in your local market is critical.

Six action steps to improve network position and progress to a second generation CIN

1. Know your market.How much and what kind of competition is there? Are your hospital competitors pursuing disruptive strategies with local physicians? Are there non-traditional competitors entering your market? What is the impact of Medicare Shared Savings Program (MSSP) or Medicare Access and CHIP Authorization Act (MACRA) on your timetable for assuming more risk?
2. Be selective in evaluating opportunities with payer partners.Understand, document and communicate your value to commercial payers and employers. Can you successfully manage a portfolio of multiple value-based contracts? Costs need to be favorable and you should have a good track record for utilization and quality outcomes. What is the level of value-based contracting sophistication among payers in your market? Your network might be ready to move full steam ahead, but your payer partners need to be on board, too (in this case, consider internal value-based contracting options, such as Hospital Quality Efficiency Programs or hospital employee health plan management).
3. Solidify your PCP network.In the world of CINs, PCPs represent market share. A robust network of PCPs equates to more attributed lives and cost-sharing across a broader swath of beneficiaries while attracting high-value specialists due to a strong referral network – all appealing assets to payers. CINs should carefully think about how to recruit and retain physician talent through performance bonuses and infrastructure support to alleviate reporting and administrative burdens and optimize care delivery.
4. Recruit high-value specialists.Controlling costs across the care continuum is crucial and therefore your alignment with specialist providers matters immensely. Consider how to leverage available data (e.g., star ratings, patient satisfaction scores) to select quality providers and clearly communicate the value of specialist participation in a CIN.
5. Make patients want to stay in-network.Encourage patients to stay engaged and in-network by making the healthcare experience easy. Consider your use of technology and ways to remove hassles (e.g., same day appointments, Skype and “curbside” consults).
6. Begin expansion.Weigh your options for expansion and move ahead thoughtfully. Contemplate statewide or regional partnerships with other established CINs.

Time is of the essence, but prudent, deliberate decisions and investments are paramount. We urge you to thoroughly and realistically assess your current state and capabilities, your organization’s commitment to change, and your organizational and financial capacity to sustain this change. More risk carries more potential for reward, but if you’re ill-equipped or take a misstep, the consequences can be significant.

For more tips on how to ensure readiness and transition to a second-generation CIN, stay tuned for additional blog posts on requisite capabilities around data, measurement, care delivery, and business operations. We also encourage you to read “Ready, Risk, Reward: Aligning for Success with the Second Generation of Clinically Integrated Networks,” and if you have additional questions, contact us.