Expert explains how to succeed with a clinically integrated network

PHILADELPHIA – Despite their challenges, clinically integrated networks offer physicians an opportunity to succeed in a crowded health care marketplace, according to a presentation given at the American College of Gastroenterology Annual Meeting.

Frank J. Chapman, chief operating officer of Ohio Gastroenterology Group, said in a landscape with seemingly endless mergers and acquisitions, the future of private practices can seem bleak. However, clinically integrated networks (CINs) can offer physicians a chance to stay in private practice while reaping some of the benefits of larger networks.

“The fact is we need to try and recognize that every physician is unique, every group is unique, every setting is unique, every metropolitan or geographical competition you face is unique,” he said in his presentation.

By forming a CIN, Chapman said physicians are seeking to achieve several goals:

Leverage greater size to reduce costs.

Negotiate better contracts using a “messenger model.”

Show payers that membership in the network provides patients with higher quality of care.

Allow private groups to stay private.

Case study: Tennessee Gastro

Chapman focused on Tennessee Gastro, an example of a single-specialty CIN, which has coverage throughout all the metropolitan areas in the state. He interviewed several members of the group to learn more about their experience and found they had the same goals that most CINs do.

First, they wanted to leverage their size to reduce the costs of supplies.

“As they were developing this,” Chapman said. “Another entity put together a huge CIN, and their negotiating power was smaller than something that had just come online.”

Second, they wanted to use their high quality of care to increase reimbursement. However, because of differences in what each individual doctor charged, the state’s largest payer would have only offered to reimburse for the average cost.

“The price for some would have gone down while the price for some would go up,” Chapman said. “What they were hoping for was to have the highest price and raise everybody up to that, and the payer refused.”

They had similar difficulty with their third goal of negotiating better contracts. Because of variances in payment rates, they found that helping some members of the network, they might be hurting others.

“Some had good contracts and some bad contracts,” Chapman said. “It’s going to be very difficult to raise the bad up without lowering the good.”

The end result

Even though they failed to reach all three of these goals, Chapman said the members he talked to would absolutely make the decision to join the CIN again.

After demonstrating overall improvement to quality of care across the network, the CIN got an unexpected boost from the same payer that they previously tried to work with to get better reimbursement. It turned out that the payer had a surplus of patients that needed screening colonoscopies.

He said that by delivering quality results, they were able to develop a new relationship with the payer and gave them a statewide platform to approach large employers to provide a one-stop shop for colonoscopy screenings.

“While they weren’t paying them more, they actually gave them a huge bonus of patients and they were able to stay with those patients,” Chapman said. “Now they’re taking that model to other large payers and saying ‘this is what we did and how we helped this other payer. Can we help you?’ Your payer might need you, but you might not even know that. The outcome was unexpected, but they continue to leverage it for continued business.” – by Alex Young

Reference : Chapman, F. “Are Clinically Integrate Networks the Answer?” Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.