Becker's Hospital Review

95 Executive Briefing Sponsored by: W hether physicians and hospitals are looking to create a new clinically integrated network or strengthen the efficiency of an existing CIN, many CIN administrators find vetting processes, like URAC's Clinical Integration Accreditation, can provide a framework for financial, operational and legal success, and ultimately serve as a mark of quality in the industry. A CIN is a physician-led legal entity consisting of independent providers within a community who commit to sharing clinical practice guidelines to improve care, develop ways to measure and share performance, and invest in data infrastructure that supports these activities. CINs allow physicians to jointly negotiate contracts, and they often form the basis of other value-based care arrangements, like accountable care organizations. As of 2015, there were an estimated 500 CINs in the U.S., according to data analytics firm Caradigm. This number is expected to rise as interest in value-based care grows, particularly under MACRA. Establishing a CIN, though, poses challenges for physicians and administrators. Although CINs provide a safe harbor from antitrust laws when set up properly, they put physicians at risk in an incredibly complex regulatory environment. Moreover, a CIN's ability to improve quality and cost depends on active engagement from clinician partners, who can be difficult to gain without strong communication, governance and management structures. And while CINs have potential to leverage collective negotiating power, this is only possible if the networks can demonstrate population health management and cost control. To address these challenges, many CIN stakeholders see value in using accreditation programs to best position their organization for success. URAC's Clinical Integration Accreditation — the only program of its kind — can help streamline CIN operations, ensure legal and regulatory compliance and improve market value, enabling physicians to provide better, more valuable care to patients. Based on the testimony of three administrators whose CINs sought accreditation through URAC, this article explores three major advantages of accreditation and provides six tips for successful accreditation. The accreditation advantage 1. Compliance integrity. Bridgeport, Conn.-based St. Vincent's Health Partners was the nation's first CINs to earn URAC accreditation. It sought this status right from the start. "We needed to create an organization that would give us the structure and flexibility that would allow us to meaningfully participate in healthcare reform," says Kyle Lanning, JD, associate director of operations and administration and in- house counsel for SVHP. SVHP's founders used accreditation as a tool to ensure they were playing by the rules to eliminate the need for antitrust scrutiny. "Connecticut has a rich history of transgressions by physician groups in terms of antitrust," says Mr. Lanning. The URAC Clinical Integration accreditation was created to align with Federal Trade Commission, Department of Justice and state-level antitrust requirements. Thus, when SVHP achieved accreditation, the network's leadership team gained confidence that the organization was compliant, even in Connecticut's stringent antitrust environment. 2. Operational efficiency. Phoenix Children's Care Network established itself as CIN in 2013 when Phoenix Children's Hospital and the area's community physicians came together to improve care continuity and help keep children out of the hospital. "We wanted to make it easier to navigate our system, easier to access and easier for physicians to engage specialists," says Casey Osborne, vice president of PCCN. About three years into its clinical integration journey, PCCN sought accreditation from URAC, becoming the first pediatric CIN to do so. Even after three years as a CIN, one of the greatest benefits of the accreditation process was streamlining PCCN's operations, according to Mr. Osborne. By going through each of the 35 URAC standards for accreditation and documenting their processes, PCCN was able to identify and streamline their best practices, thereby improving efficiency. "It was really the No. 1 thing we could have done to fully stand up our operations," he says. "I cannot overstate the importance we found in becoming accredited." This newfound efficiency has increased PCCN's reach. In one year, it has doubled its patient panel to 100,000 lives from 50,000 lives. Accreditation also helped PCCN achieve significant cost savings by deploying a fully self-sustaining care model staffed by case managers and care coordinators. "In January 2017, we were only lightly working in engaging patients and members, and now at any given point we have hundreds of members being engaged," says Mr. Osborne. 3. Enhanced market value. Similar to PCCN, Seattle Children's Care Network began as a model to create a pediatric primary care network integrated with specialty providers. Somewhat uniquely from other pediatric CINs, however, SCCN to date has served the commercially insured market and supports several CIN accreditation: A framework for financial, legal and operational success

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