A CIN is an arrangement that allows hospitals and physicians to collaborate with the objective of improving the quality and cost-effectiveness of patient care while remaining independent entities. A CIN is usually a separate legal entity that enters into contracts with insurers to reward providers for improvements in the quality and cost-effectiveness of care. Clinical integration aims to coordinate care across settings and providers by implementing policies, procedures and protocols to deliver high-quality, cost-efficient care.
Loyola's Clinically Integrated Network
Loyola University Health System is forming a Clinically Integrated Network. The CIN is a physician-led collaboration to improve patient care and reward performance.
Our integrated group, Loyola Physician Partners (LPP), will allow all physicians -- both employed and independent -- to respond to new health reforms by improving the quality and controlling the cost of patient care. Together, we will seek contracts and incentives with payors that will position our network for success under new payment and care models.
Enrollment in the clinically integrated network will close July 15, 2014.
Frequently Asked Questions about Loyola's CIN
LUHS is developing LPP to collaborate with independent providers and to become clinically integrated. Clinical integration takes time and effort to ensure a care model is in place, quality and performance is tracked, and data and information are shared. LPP’s network of physicians will manage the quality and costs of care and seek rewards from payers for such efforts. This arrangement allows hospitals and physicians to work together to improve the quality and cost-effectiveness of patient care while remaining independent entities.
In light of health reform, payment pressures and increasing demands on providers, LUHS identified the need for an effective way to work with physicians and payers. As reimbursement models shift from fee-for-service reimbursement to performance- and value-based payment models, LPP can help providers better coordinate care and bring value to patients, payers, and physicians. The ability to manage population health and coordinate care typically involve adding new care-management and data-sharing capabilities. By proactively developing these new capabilities, LPP can help its participants succeed in the new era of value-based care.
LPP welcomes participation from all physicians who want to be accountable and improve the quality of care. This will include independent community physicians, physicians employed by LUHS, and those who contract with LUHS to provide services, such as emergency care, radiology, anesthesiology, and pathology.
The Physician Participation Agreement outlines the eligibility and participation requirements. Physicians are not required to be members of LUHS hospital’s medical staff, but must meet certain eligibility requirements.
There are no fees to participate in LPP. And, LPP is not exclusive and welcomes participation from all physicians interested in improving quality and cost-effectiveness. LPP participation itself does not restrict physicians from signing on to other arrangements or networks.
However, note that some payer arrangements may have certain restrictions.
While it may be beneficial to keep patients within the network to allow for optimized coordination and care management, there are no requirements or standards in terms of referral patterns. Patients should be referred to the highest quality and most cost-effective facilities and physicians. While some other networks may have expectations for referrals which impact physician-incentive payments, this is not the case with LPP.
Physician participants can leave LPP with 120-day written notice, or as otherwise specified in payer contracts.
Physicians may already be involved in efforts to control costs and improve the quality of care. These benefits currently accrue to payers.
LPP will enter into contracts with payers that will reward participants for improving the quality and cost-efficiency of patient care.
Additionally, physicians will be supported by care-management resources provided by LPP, best practices and care protocols, and better coordinated care for their patients.
Currently, there is only one solicitation period planned — now through July 15.
Participants who join during this period will ensure that they are eligible to participate in payer arrangements that are planned for 2014 and 2015.
The board will decide on the frequency of future enrollment periods, if any. Physicians who enroll during the initial enrollment period may be candidates for board position and have the opportunity to vote for the board of directors.
LPP will be structured as a wholly owned subsidiary of the health system, which will provide all funds required to develop and launch the entity. This decision was made through a collaborative process in which a physician steering committee weighed the pros and cons and decided this model was the best for the following reasons.
Physicians do not need to invest their own funds in LPP infrastructure or operations, but do need to invest time and effort to promote clinical integration, or to attend to matters related to the ongoing operations of LPP.
The only income that LPP will receive are the rewards and incentive payments it earns from payers — and all of this income will be distributed to participating physicians and LUHS based on quality and cost-effectiveness, after covering operating expenses. There is limited benefit to being an owner because there will be no "dividends" to distribute
Physicians are given a strong governance role to ensure their oversight of operations; and LPP will likely garner a larger network of physician participants and can start more quickly if financial investment is not required.
The LPP board will consist of 13 directors made up of two classes: physician directors and hospital directors. The decisions of the board will require approval of a majority of both classes of directors, ensuring that only decisions and initiatives that are agreed upon by both classes are pursued. The board will be comprised primarily of physician directors, as follows:
Physician Directors — eight physicians: four LUHS faculty or employed physicians (2 PCPs and 2 specialists) and four independent physicians (2 PCPs and 2 specialists).
Hospital Directors — five LUHS-designated representatives
Additionally, LPP will have several committees that offer additional opportunities for physicians to be involved in the leadership of the organization. The committee structure will be determined by the initial board, but likely will include:
- Quality & Care Management
- Credentialing & Standards
The CIN's key activities will be to:
- Develop and implement clinical integration guidelines and protocols.
- Manage IT infrastructure implementation and operations.
- Gather and analyze data.
- Design and implement care-management initiatives.
- Develop and manage arrangements with payers for payment of bonuses, care-management fees, or other incentive compensation.
- Align with additional providers across the continuum of care.
- Measure performance and distribute incentive funds based on performance.