Becker's Hospital Review

127 Executive Briefing: 7 Steps to a Clinically Integrated Network: A Roadmap for Success O ne of the key aspects of successfully transitioning to value-based care is the implementation of a clinically integrated network. A CIN is a healthcare network of hospitals, physician organizations and non-acute providers across a market using established governance, measurements and defined incentives to create a virtually integrated delivery system that will enhance patient care and reduce cost. A successful CIN not only enhances access to quality care for consumers, but also improves clinicians' and physicians' access to insights into the health of populations and how to better manage patients across the continuum of care. Developing a CIN requires identifying participating provid- er organizations, recruiting physicians and ultimately, engaging payers — all of which takes time and commitment. Hospitals and other stakeholder organizations' values and goals must be thoroughly considered while creating the CIN. Although there is no silver bullet to success, health systems can follow seven steps to ensure their CIN is properly planned, implemented and measured. Step One Identify Potential Participants A CIN involves bringing together separate and distinct or- ganizations. Therefore, hospitals and health systems, physician organizations and independent physicians must find a way to work as one whole fluid network. A number of factors, including market position and each entity's leadership, are considered in determining which groups would work best as potential partners. More practical factors must be examined as well, such as geography and pos- sible facilitators in the marketplace. On a more specific level, core competencies are determin- ing factors. Each group must bring value to the network and complement one another. Here are a few questions that must be asked when considering potential participants: • What services do they offer to complement or bridge gaps in the care continuum? • Which physician specialists are they considering bringing in? • Does the entity represent what the network desires to stand for (i.e. quality, cost) Step Two Develop a Shared Vision and Value Proposition Once the CIN founders identify other participants for the CIN, they must create value propositions for the network and for each stakeholder. The visioning sessions with stakeholders should occur to not only develop the value propositions but to help pare down the barriers between stakeholders to reach common ground. It is during these meetings when each participant sees what the others are trying to accomplish. In addition, they're able to see the benefits of helping each other. The visioning sessions give participating organizations the opportunity to see the CIN's goals from a broader and more varied perspective. While each participant has specific desires regarding value propositions, the aim of visioning sessions is to ensure all parties involved adhere to the same strategy. CIN participants cannot have competing interests — they must instead have aligned and coordinated incentives. However, the target audience isn't left out of the value proposition process. "We create value propositions not only for the stakeholders, but also for the patients and consumers that will bring [the CIN] together," says Mark Martinez, associate vice president of network operations for Conifer Health. The value propositions for the CIN determine its value to the market. Many common themes are convenience, quality, cost and keeping the community healthy. Step Three Develop the Governance Framework and Participation Agree- ments After value propositions are developed, stakeholders must draw up the governance framework and participation agree- ments. A successful governance framework includes leaders from each of the participating organizations who work together as a singular entity. The stronger governance structures are exceedingly inclusive and see to it that each of the stakehold- ers has a voice. "Governance structures should be organized to ensure that all participating organizations have a seat at the table, under- stand the shared vision and have the information required to drive performance. However, spend the most time recruiting strong physician leadership because the best governance structures give credence to reality that physician buy-in and participation is one of the most important elements for CIN success," says Megan North, president of value-based care for Conifer Health. Detailed participation agreements should ultimately define what will determine a CIN's success, including the governance structure, quality measures, the rewards (or penalties) to drive performance and how either of these will be shared among the participants. There is no secret methodology for the process: It often involves sitting at a table with stakeholders and working through the details that make sense for each individual orga- nization. Once an agreement is created, the members of the governance team take it back to their organizations for approv- al. Overall, a good agreement will: • Clearly define what is required of each participant • Outline the measures that drive quality outcomes and cost savings • Articulate incentives and how good performance will be rewarded • Establish a means for fair and balanced conflict resolution Step Four Select Quality Measures Selecting quality measures is critical to establishing a high-quality network. Using industry-standard quality mea- sures, clinician and physician representatives view performance Sponsored by: 7 Steps to a Clinically Integrated Network

• Cover