Issue link: https://beckershealthcare.uberflip.com/i/112775
32 were consistent across contracts. Individual metrics were then reevaluated and updated on an annual basis to help ensure that the initiatives continued to demonstrate the value of the network. Performance improvement initiatives are typically developed in the following categories: • ariance and cost reduction — Improving operational efficiencies. V • linical efficiency — Reducing avoidable, unproductive and duplicaC tive services. • are redesign — Ensuring treatment in the most optimal setting and C by the right provider. • ystem optimization — Shifting focus to preventive care and populaS tion health. • atient experience —Objective and meaningful comparisons beP tween providers of care. 5. Information technology. If you do not measure it, you cannot improve it. IT is the backbone of the CI network's value proposition and is critical to improving coordination and connectivity between providers of care. Early adopters of CI would manually input data and transfer information by Excel template report cards. Today the industry is inundated with tools to assist with monitoring and reporting the care provided to a patient. Since providers will be affected most by a change in technology, they must be heavily involved in choosing the correct vendor. Two types of data sharing sources being used most by hospitals are electronic health records and patient registries. However, health information exchanges are becoming more popular and could eventually become robust enough to support clinically integrated initiatives. An EHR is a medical record for a patient in a physician office, hospital, ancillary care facility or ambulatory care facility. The EHR is intended to replace paper-based patient records for recording encounter-based information on each patient who receives care from the provider entity and includes electronic: data entry, order entry, prescribing and transcription. A patient registry is a repository that holds clinical information specific to a disease, disease process, implant, drug, etc. A cancer registry is an example of a disease-specific database. The registry is intended to track (1) patients and their compliance with specific chronic disease- (or wellness-)based guidelines across populations, (2) physician compliance with those guidelines and (3) outcomes for specific interventions. A data registry differentiates itself by interfaces with multiple data sources to provide sufficient data at the point of care provided to a patient, which is why many CI networks are utilizing data registries as opposed to the electronic medical records approach. 6. Contracting options. The purpose of CI is to provide higher quality care. Creating a CI network for the sole purpose of negotiating better rates is not the purpose of CI. However, CI networks are rewarded for demonstrated value, which is defined as the highest quality care at the lowest cost. The CI network can contract with payors, employers or health systems. These contracts can range from a specific procedure to a population of patients. Many hospital systems have reported that payors are not requiring that CI contracts include downside risk for the network. A six-hospital system in the Southeast reported that a major payor has approached them with a contracting model that would reward their network for demonstrated performance in the following ways: • remium base rates — Increased fee-for-service rates based on exP pected performance. • erformance incentives — Incentive payments made for perforP mance improvement initiatives. • hared savings — Savings shared based on a reduction in the cost S of care. Physician-Hospital Relationships & ACO Some hospitals have also contracted with their own CI network to realize cost saving opportunities and to more effectively manage cost within their own health plan. A hospital system in the Southwest has implemented this strategy. The savings that are generated by the network are shared to fund the CI program and to make distributions to member physicians. 7. Flow of funds. Calculation and distribution of CI incentives to physicians and to the health system occur after performance is achieved. A distribution of funds will typically be realized through cost savings, quality and efficiency programs negotiated by the CI network and its partners. Funds are distributed based on meeting performance objectives and performance can be defined in a variety of ways. For example, some CI networks reward simply for global network compliance of the CI agreement while other CI networks reward based on site (multiple hospital systems), specialty and individual performance. Regardless of how the funds flow to the members of the CI network, the methodology should be transparent and easy to understand. Key considerations for CI network distribution methodologies include: • istribute rewards based on measurable performance. D • educe complexity of distribution methodology. R • ncrease transparency across the network. I Conclusion Health systems and physicians are implementing CI networks across the nation to respond to changing healthcare dynamics that are holding providers more accountable for quality and outcomes. Each CI network needs to create a disciplined approach to assessing and developing the key components of their network to create a sufficient value proposition for the health system, physicians, payors and employers. As CI becomes a strategic imperative in most markets, organizations should keep the following critical success factors in mind to accelerate the implementation of a successful and sustainable CI network: • lign your health system objectives with the CI vision and strategy to A avoid conflicting messages in your market. • nvolve physician leaders in the CI development process to gain phyI sician buy-in for program objectives. • xpress a willingness to create a new partnership model with emE ployed and independent physicians that includes defined roles for physician leadership. • aintain systems that can track and monitor clinical data across the M continuum of ambulatory, acute and post-acute services. • tilize a scaled approach to develop a comprehensive list of metrics U that provide value to multiple stakeholders and positions the CI network for greater levels of accountability. • reate an effective communication strategy across all stakeholders to C increase understanding of the key issues of CI. • ommit to approach payors in the market as a combined network. n C Dennis Butts is a manager with Dixon Hughes Goodman, where he designs and implements strategic business solutions for hospitals and large physician practices. Mr. Butts can be reached at dennis.butts@dhgllp.com. Michael Strilesky is a manager with Dixon Hughes Goodman, where he develops strategic and operational solutions for healthcare clients. Mr. Strilesky can be reached at michael.strilesky@dhgllp.com. Matthew Fadel is a senior associate with Dixon Hughes Goodman, where he assists hospitals and physicians with alignment strategies and strategic planning initiatives. Mr. Fadel can be reached at matt.fadel@dhgllp.com.