Clinically Integrated Network
A clinically integrated network is a specific organizing structure that providers join when they form an accountable care organization (ACO) and meets specific standards that allow the clinicians in the network to jointly negotiate with payers without violating anti-trust laws.
What is a Clinically Integrated Network?
A clinically integrated network is a distinct legal entity and an organizing structure that providers join when forming an accountable care organization (ACO). It encourages health systems and community-based providers to deliver high-quality care efficiently and effectively by creating mutual accountability. CINs allow practices to remain independent while leveraging a broader community of experts.
A clinically integrated network may also include establishing mechanisms to monitor and control the utilization of healthcare services, designed to control costs and assure quality of care. These networks selectively choose network providers who are likely to further these efficiency objectives. There are different types of CINs, such as Joint Venture Physician-Hospital Organizations (PHOs) and Health System Subsidiaries.
What is the difference between a Clinically Integrated Network and HMO?
While both Clinically Integrated Networks (CINs) and Health Maintenance Organizations (HMOs) aim to improve care and manage costs, they differ significantly in their structure and operational focus. CINs are provider-driven entities that foster collaboration and accountability among independent providers, whereas HMOs are typically insurance-driven models with a more controlled network and payment structure.
Structure: A CIN is a distinct legal entity formed by providers to coordinate care and create mutual accountability, often for forming an ACO. An HMO is typically organized by insurance companies or health plans.
Provider Independence: CINs allow practices to remain independent while leveraging a broader community of experts. HMOs often have a more limited network of providers, and patients typically choose a primary care physician (PCP) who acts as a gatekeeper.
Focus: CINs focus on encouraging health systems and community-based providers to deliver high-quality care efficiently and effectively, including mechanisms to monitor utilization and assure quality. HMOs often involve capitated payments, where providers receive a fixed amount per patient regardless of services provided, and may have a stronger emphasis on managing utilization through their restricted network.
Contracting: CINs coordinate care across affiliated caregivers and develop contracts with payors, including value-based contracting. HMOs are a type of health insurance plan that contracts with providers to offer services to members at a fixed rate.
Control: CINs selectively choose network providers to further efficiency objectives. HMOs often require patients to seek care within their network and may require referrals for specialized services.
What are examples of a Clinically Integrated Network?
OhioHealth Clinically Integrated Network (Columbus, OH)
Novant Health Clinically Integrated Network (Winston Salem, NC)
Mayo Clinic Care Network (Rochester, MN)
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