What is a Clinically Integrated Network?
Simply, a CIN is a group of providers who, in partnership with a hospital, make a collective commitment to performance improvement with a focus on improving the quality and efficiency of care for the patients they serve. To support these population health efforts, they are able to contract together to help achieve their goals without the risk of violating antitrust laws.
Connected Care, LLC, d/b/a Connected Care Partners (CCP)is a CIN partnership between North Mississippi Health Services (NMHS), the physicians and other providers employed by NMHS, and independent physicians and other advanced practice clinicians. the legal definition of acceptable Clinical Integration provided by the Federal Trade Commission (FTC) and U.S. Department of Justice in 1996 the statements of Antitrust Enforcement Policy in Health Care states: “Clinical Integration is an active and ongoing program to evaluate and modify practice patterns by the network’s provider participants and create a high degree of interdependence and cooperation among the providers to control costs and ensure quality.
This program may include:
- establishing mechanisms to monitor and control utilization of health care services that are designed to control costs and assure quality of care
- selectively choosing network providers who are likely to further these efficiency objectives
- the significant investment of capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies."
Is the CIN the same as an ACO?
The CIN is the over-arching term for the network of providers, hospitals and other providers of care that is committed to improving the quality and efficiency of care for patients.
An accountable care organization (or ACO) is a group of providers who come together to manage the cost, quality and utilization of services for a given population of patients such as Medicare patients. Typically, the term ACO is used to refer to the Medicare Shared Savings and Pioneer programs currently being piloted to improve care. ACOs, by specific waivers, are exempt from several federal laws (eg. certain Stark regulations). CINs are not exempt.
What is the difference between Health Link PPO and Connected Care Partners?
Health Link is a preferred provider organization (PPO). A PPO is a network of providers that agree to provide services on a fee for service basis. Health Link PPO has been awarded credentialing certification from the National
Committee for Quality Assurance (NCQA), an independent, not-for-profit organization dedicated to measuring the quality of America’s health care. Health Link’s certification is based on a voluntary review of the preferred
provider organization, which ensures that its members are receiving high quality care.
Connected Care Partners will have fewer members than the Health Link PPO and will be more exclusive for certain independent and NMHS-employed providers who have made a collective commitment to collaborate, with the goal of improving the quality and lowering the costs of care will be included.
Initiatives that will help with this goal include:
- developing a set of common clinical protocols
- defining and collecting data on quality measures
- and implementing additional programs and initiatives to assist providers in delivering the best care possible to the patients they serve.
Will Connected Care Partners apply to become a Medicare ACO?
At present, Connected Care Partners is not and has no immediate plans to be an Accountable Care Organization (ACO). Connected Care Partners’ immediate focus will be insurers and employers in Mississippi. This focus does not preclude Connected Care Partners’ involvement in Medicare Advantage Programs. A Connected Care Partners membership does not preclude the individual member’s involvement in federal programs.