Developing a CIN for an Academic Medical Center
Client/Profile
A Midwestern academic medical center hospital with 800 employed physicians, which had recently acquired a community hospital with its own PHO.
Challenge/Situation
To develop a Clinically Integrated Network that would be very attractive to independent physicians, including those from the acquired hospital, allowing the Medical Center to respond effectively to payer initiatives. Other health systems and hospitals in the region had a head start in responding to value-based payment initiatives.
Process
Veralon and the Medical Center established a CIN planning task force composed of hospital administrators and an even number of employed and independent physicians. We explored the type of opportunities to be pursued, and the decision was made to pursue a Medicare ACO and the state’s Medicaid equivalent. Then, together, we:
- Considered alternative organizational structures and selected one
- Chose to form separate legal entities for Medicare and other payers to increase physician participation options
- Determined staffing requirements and costs
- Identified IT requirements and costs
- Modelled the financial impact, including incentives that would flow through to physicians
- Planned and supported the communications program to achieve physician participation
Results
The CIN was established successfully, and ultimately developed a Medicaid ACO contract, with about 30% of the lives assigned based on participating independent/affiliated physicians. In addition, the CIN launched a Medicare ACO with 20,000 lives.