Clinically integrated networks could improve healthcare quality and costs for employers
To combat the inequity this can cause within their communities, some hospitals and providers are pushing for more standardized care through clinically integrated networks.
Deanna Cuadra, Employee Benefit News (EBN)
Healthcare in the U.S. varies from zip code to zip code, with mere blocks potentially making the difference in costs and quality of care. To combat the inequity this can cause within their communities, some hospitals and providers are pushing for more standardized care through clinically integrated networks.
Clinically integrated networks are an arrangement of hospitals and providers that share protocols, patient information and performance goals in an effort to bring coordinated, quality care to members at a lower cost. Unlike other networks, such as a preferred provider organization or a health maintenance organization, CINs operate in collaboration with different hospitals and providers of various medical disciplines to communicate and coordinate with each other on behalf of the patient.
“There’s a reasonable degree of predictability and consistency in the care our patients are going to experience, regardless of where they access care in our network,” says Dr. Christopher Kodama, president and CEO of Embright, a clinically integrated network in Washington. “We ensure that providers are empowered with the information they need to coordinate across the aisle so that care is following the member.”
Established in 2019, Embright brings together three independent health systems in Washington: UW Medicine, MultiCare Health System and LifePoint Health. These hospital systems share data and similar approaches to patient concerns and conditions. If a patient is receiving care for diabetes, they can expect similar costs and treatments across the network, explains Dr. Kodama. Additionally, patients will not have to re-explain their condition every time they see a new doctor within their CIN — providers are already on the same page.
“One of the biggest issues in healthcare is that there's no coordination between providers, so you get duplication of services and people telling their story all over,” says Dr. Shawn West, Chief Executive Officer at Embright. “But in our CIN, we actually know what has happened to our members over the last two years and we can create a strategy as a network.”
“One of the biggest issues in healthcare is that there's no coordination between providers, so you get duplication of services and people telling their story all over,” says Dr. Shawn West, chief executive officer at Embright. “But in our CIN, we actually know what has happened to our members over the last two years and we can create a strategy as a network.”
Dr. Kodama recalls working at a children’s hospital and watching children sent for follow-up appointments with their primary care provider after being discharged. The primary care physician would often repeat tests and recreate action plans with the families, driving the cost of care up while leaving patients confused.
“There was a significant amount of wasted activity and the inappropriate utilization of services,” says Dr. Kodama. “In a CIN, it's less expensive to access care because you're only getting the care that you need in the most appropriate modality.”
As a CIN, Embright is under a value-based care model, which means providers are reimbursed for clinical outcomes rather than their volume of care or services provided. So, financial incentives are tied to patients getting better — an incentive Dr. West believes many healthcare professionals prefer.
“What I hear from physicians is that they want to spend more time with their patients,” he says. “Shifting the pay models allows providers to get that time with their patients and do what we consider is at the top of their license.”
“There was a significant amount of wasted activity and the inappropriate utilization of services,” says Dr. Kodama. “In a CIN, it's less expensive to access care because you're only getting the care that you need in the most appropriate modality.”
Since Embright’s providers work with care teams that include other diverse disciplines, such as behavioral health specialists and pharmacists, they can focus on their specializations in relation to the patient’s needs. Dr. West also notes that this ensures doctors do not charge patients and their insurance plans for unnecessary tests or treatments.
According to The American Journal of Managed Care, coordinated care decreased hospitalization by 12% for adults and 23% for children and decreased emergency services by 11% for adults and 17% for children. This lowered overall costs and pointed to improved long-term health.
CINs could be good news for self-insured employers who are looking to work against the rising tide of healthcare costs. Embright collaborates with employers who have self-funded plans and creates a plan unique to that particular workforce’s health problems, be it diabetes or musculoskeletal pain.
“We can partner directly with the employer to understand the local needs of their population,” says Dr. Kodama. “As a result, employees will be happier, healthier and more engaged in their work. It will also help you address several pain points in your working population.”
Between 2019 and 2020, healthcare spending increased by nearly 10% as COVID became a threat to public health. Employers can expect healthcare prices to continue to rise, as COVID variants and long-term symptoms of the virus prevail. Dr. Kodama admits that CINs may not be for every employer, but neither is the miscommunication and waste that comes with other networks.
“A lot of the time, you’re reliant on intermediaries in healthcare, and like a game of telephone, stuff is going to get lost in translation,” says Dr. Kodama. “So having a streamlined and coordinated process with various components in our healthcare ecosystem is really important.”
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