3 ways data fuels growth and performance for clinically integrated networks

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In contemporary health care, clinically integrated networks (CINs) are an increasingly appealing model for clinical alignment and network growth for health systems. As the industry experiences significant disruptions catalyzed by rising costs, diminished revenues, payment reform, digital health transformation, and competition from the entry of national, nontraditional health care entities, CINs represent a viable way for health systems to strengthen. In addition, the collaborative nature of a CIN provides its members access to more resources and information collectively than each individual practice would have otherwise in an increasingly difficult health care environment. The shared expertise in population health best practices and data-fueled performance of all contributors makes every participant stronger in value-based care, financial outcomes, and, importantly, patient care.

Kate Behan, MD, FACP
_Arcadia

Additionally, with infrastructure and systems for standardization, CINs provide a foundation for the Accountable Care Organization (ACO) model and other value-based care arrangements. With the U.S. Centers for Medicare & Medicaid Services (CMS) aiming for 100% of Medicare recipients receiving accountable care by 2030, CINs are an important inroad for health care groups seeking to support this goal. In short: CIN expansion is a way to remain on the cutting edge in a competitive environment, while broadening a health care group’s offerings and allowing them to provide better care to patients.

But forming or expanding a CIN alone is not enough. To execute this model successfully, data at the point of care that provides meaningful insights is paramount. In my role as chief medical officer at Arcadia, I often help CINs build strong data foundations, and I’ve observed three key components to success:

1. Connecting the network and providing support

Aggregated data for a CIN can enable smarter and more effective negotiations with payers on value-based care arrangements, resulting in better reimbursement for CIN members. In addition, data enables CINs to measure and monitor how each provider, practice, or groups of practices are performing on quality goals and medical cost management, then adjust programming accordingly. Data illuminates both successes and failures, providing insights into the opportunities that could elevate a CIN to be high performing and preferred by patients, providers, and payers. At the point of care, data should be curated to provide meaningful insight and decrease the administrative burden for providers.

2. Measuring and optimizing performance and access to care

Data can also help administrators identify potential opportunities. For example, data could point to geographic areas where a CIN might expand its reach, engaging more patients, broadening their network of services, and covering more lives, thereby fortifying the economic model.

Data also enables CINs to better meet the specific needs of the communities they serve. For example, are there access issues and perhaps a shortage of primary care providers in a particular ZIP code? This might point to establishing a new practice, partnering with an existing independent practice, or shifting existing resources so they’re balanced across the population. The integration of health-related social needs and social index data with clinical and claims data is integral to a CIN’s ability to identify health disparities and create and develop programs focused on health equity.

With increasingly more focus on ambulatory care and the shift in service sites from inpatient to outpatient, data can help target sites of service for health care resource investment. This proactive approach to delivery system reorganization can ensure that services are more accessible to patients. In turn, a more broadly distributed care delivery network can promote preventive care that keeps patients healthier and better served, with data highlighting actionable opportunities.

Critically, data also powers network integrity. Keeping patients engaged and within the system is a major driver of success in value-based care. Referring them within a CIN’s broad spectrum of specialists and offerings improves continuity of care, enables more streamlined communication between providers and patients, and decreases fragmented care – all of which leads to more efficient and effective care. The more patients a CIN can serve, the stronger the economic model and reinvestment back into the delivery system, and the higher the likelihood of positively impacting population health at scale.

3. Improving finances and meeting objectives

Whether driven by a specific contract or created internally, financial goals are a key piece of sustaining a CIN. Without data, it’s difficult (or impossible) to gauge whether or not a CIN is on track. An excellent data platform allows leaders to track progress in value-based care programs and participating practices to monitor their own performance, capture and report the true disease burden of their population, and identify and engage their higher risk patients. This means the network can not only improve care, but better achieve financial objectives through value-based contracts and other payment models the CIN may have in place.

With a great data platform, CINs can pool resources, access a vast store of knowledge, scale their efforts, and grow their bottom lines. In a highly competitive environment, partnership distributes costs for powerful technology that many individual practices may not be able to afford alone, and it allows its members to weather changes with the support of a wide, highly resourced network. As competition and costs both soar, a CIN is a viable alternative to building expensive networks or specialty facilities from scratch.

With powerful data analytics as a foundation, CINs point towards a more collaborative health care future where costs are contained and patients’ needs are met – sustainably, efficiently, and competitively.

Kate Behan, MD, FACP, is the chief medical officer at Arcadia, a leading data analytics platform for healthcare, where she applies a clinical perspective to the design and implementation of strategies that enable health care organizations to succeed in value-based care. In addition to serving as a strategic advisor to physician leaders at Arcadia’s clients, she provides clinical input into the development of Arcadia’s technology and service programs.