Population Health Services

What is Population Health? As defined by the Center for Disease Control (CDC), Population Health “brings significant health concerns into focus and addresses ways that resources can be allocated to overcome the problems that drive poor health conditions in the population.” The mission of population health is to improve the health outcomes of the communities we serve. The associated reimbursement from value-based contracting is the vehicle used most often to fund this mission.

金沙乐娱app下载 utilizes a robust team of Population Health advisors who can help you learn how to improve the quality of care provided to your employees and patients in your community, and how to optimize your value-based contracting reimbursement and incentives.

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Readiness Assessments & Strategy

Value-based Contracting and Reimbursement Assessment
Clinically Integrated Network (CIN) and ACO Readiness Assessments
Strategy & Roadmap Design

Design & Implementation

Accountable Care Organization (ACO) / CIN Network Design
Implementation of Roadmap
Standing Up Capabilities & Network Functions

Population Health Management

Facilitating Transitions of Care and Post-Acute Management
Data Analytics Program Development
Care Management Program Development

Physician Network Development & Agreements

Supporting Development of Health System & Provider ACO/CIN Networks
ACO and CIN Governance Structure, Participation Agreements, Committees, & Task Forces

Testimonials

“It’s difficult to measure money not spent on healthcare, but the Clinically Integrated Network team has shown us each and every quarter how interventions have positively impacted the lives of our employees. The care managers seek out and intervene personally to help our employees solve their complex medical issues which reduces costs but more importantly improves their quality of life and their regard for us as an employer who cares.”

VP of Human Resources at a large regional health system

“Words can’t adequately express my gratitude for the Clinically Integrated Network group. I work daily with them, specifically the care management team. The care managers go out of their way to help our employees navigate care for their medical issues. They not only help reduce the employee’s and employer’s cost, they also help with the stress an employee feels when faced with a medical obstacle. The team truly cares and it shows by the quality of their work.”

HR Generalist at a southeastern medical center

Frequently Asked Questions

Do I have to sacrifice my fee for service reimbursement to get involved with value-based reimbursement?

No. Value-based contracting reimbursement is usually provided as an additional incentive payment over and above the fee-for-service reimbursement.

What channels (types) of value-based reimbursement programs do I pursue?

The easiest value-based program to start with is the Health System Employee Health Plan. Afterwards, other Large Self-insured Employer programs make sense to pursue. Medicare Advantage programs are also very popular, as well as the Medicare Shared Savings Program with CMS.

Do I have to invest in additional resources to optimize my value-based reimbursement?

Yes, an investment in care management resources and data analytics personnel are required to optimize your value-based reimbursement. Leadership and governance resources are also required.

Is there an eventual return on investment in value-based contracting? How long before the return on investment becomes positive?

The return on investment for value-based contracting and programs has historically had mixed results. However, when the proper strategy and governance structure is put in place, the return on investment is generally very positive after 2 years.

What is a Clinical Integration Organization (CIN)?

A CIN is a partnership between physicians and a hospital to provide medical and health care and wellness services to a defined population. The governance is usually a Board of Directors made up of equal representation from the two partners. The Board Chairperson is usually a physician.

The CIN is formed to take financial and quality performance upside only risk for a defined population of patients. Gains (savings) are shared among the members and sometimes the members can take risks with insurers to cover potential losses.

Why do health systems and physician leadership form a CIN?

Health Systems and community physicians want to optimize their ability to succeed with current and future value-based reimbursement. An organized CIN is the preferred vehicle to achieve this. Although presently, the reimbursement model is still primarily fee for service, the new reimbursement model includes additional reimbursement that is based on cost effectiveness and quality outcomes. A CIN can bring resources to its physician and hospital members to help them individually and collectively succeed at value-based care and reimbursement.

How is the CIN structured? Will Physicians really have a voice in how it organized and operated?

The legal structure for the CIN is usually a Limited Liability Company (LLC) with the Hospital as the sole member. The governance of the CIN is usually a Board of Directors with a majority of Physicians and a minority of Hospital representation.

How do “value added” reimbursement payments figure into the CIN?

Unlike a Medicare down-side risk sharing arrangement, the CIN negotiates contracts that reimburse providers for achieving low costs and higher quality, without the risk of paying for cost increases. However, gain sharing will only occur when there is both a cost savings, and successful achievement of the quality measures.

What are potential future opportunities for a CIN beyond contracting with the hospital employee population health plan?

The CIN can market its services to all insurers, and large self-insured community employers, and Medicare Advantage programs and also form an Accountable Care Organization to contract with the Centers for Medicare and Medicaid Services. The Hospital employee population is an excellent starting point to learn population management with little risk. The CIN then has an opportunity to also form an Accountable Care Organization to contract with the Centers for Medicare and Medicaid Services.

What are the differences between ACO and CIN?

A CIN is a commercial and private payor form of an Accountable Care Organization (ACO). The CIN and the ACO both sign up a network of providers that make up the CIN clinical team, and will include community physicians and hospital-employed physicians. CIN initiatives are selected by local providers, whereas ACO initiatives are selected by CMS and the government. CINs are generally upside risk only while ACOs will assume downside financial risk in later years of their contract with CMS.