By Dr. Dave Levin

This is a continuation of Part 1 and Part 2 of the Edge of CIN.

The transition from fee-for-service to value-based care (VBC) continues to accelerate. Some studies predict that VBC will represent 50% of all reimbursement to providers by 2018. Linking medical outcomes to payment aligns incentives in ways that reward providers for pursuing higher levels of efficiency, clinical efficacy and patient satisfaction. 


Clinically integrated provider networks

In a clinically integrated network (CIN), a group of healthcare providers come together in a purposeful and carefully orchestrated way to take economic responsibility for delivering care that is better, cheaper and provides a more satisfying experience for patients. For example, a group of orthopedic surgeons, a hospital, a rehab facility and a home health company might all join together to form a CIN that focuses on joint replacement. The insurance company would negotiate a set price for the entire episode of care and standards to ensure the quality of care is not diminished. It’s up to the CIN to figure out how best to care for the patient “on a budget” while still hitting the quality targets.


The edge of CIN

CINs succeed or fail largely on their ability to (1) collect, analyze and share data and (2) collaborate as a team. Data supports the analytics needed to successfully take on and manage medical and economic risk. The free flow of data is essential if providers are going to manage care efficiently and effectively.

Frequently, organizations attempt to meet these needs by getting everyone onto the same electronic medical record (EMR). The “Borg” strategy (“You will be assimilated!”) can make it easier to collaborate, coordinate care and collect data. It’s a sound strategy as far as it goes. The problem is, it only goes so far.

Despite widespread deployment of EMRs, there are many large information silos that do not readily connect. Organizations frequently find their single platform approach falters when they reach the “edge” of their CIN. At the edge, there are key players who must be part of the CIN for it to succeed, as well as others that would be “nice to have” if there were a feasible way to include them.


Not all EMRs are created equal

While the trend to consolidate isn’t over, there are strong counter-trends that limit the Borg strategy. It turns out that resistance may not be futile after all.

Not all provider groups want to be assimilated. Perhaps they want to maintain their independence. Or maybe they like their current EMR and don’t want to deal with the cost and hassle of making a switch. Or there’s more than one orthopedic group involved. If you are building a CIN for joint replacement with an orthopedic group that doesn’t want to be acquired by the health system and/or won’t adopt their EMR, it’s unlikely your CIN will succeed.

There is also the “onsie-twosie” problem: Buying a group and replacing their EMR system is expensive. It is tough to justify the cost of doing this for small medical practices with only a few providers. This is especially common for small primary care practices.

A whole new set of issues arise when attempting to link the disparate systems used by rehab facilities, pharmacies, home health providers and other providers. Linking contrasting EMR systems typically leads to an exponential nightmare of interfaces, complexity and cost. And don’t forget the importance and challenges of bringing patients and families into the loop.


Let’s think of healthcare IT like it’s 2017

Glance at the rest of the digital economy and you will see an obvious alternative to the single platform approach: application programing interfaces (APIs). It seems everyone has adopted APIs to connect, share and collaborate.

APIs are the underlying technology that lets both you and Amazon know exactly where that UPS package is at any moment. UPS and Amazon aren’t on a single platform, but they have opened up to each other using APIs. They don’t care which platform the other is utilizing as long as they are able to work together. Healthcare technology can and should work the same way.


Connecting, collaborating and spurring innovation  

We know that APIs work in healthcare IT because we do it every day here at Sansoro Health. Our solution, Emissary, has a robust suite of API web services that provide deep integration between EMRs and other applications. Emissary is secure, reliable, flexible and scalable.

In addition to the obvious benefits of fostering collaboration, APIs are a catalyst for rapid innovation. Make it easier for innovators to build, test and integrate into a healthcare IT “ecosystem,” and there will be an explosion of new ideas, products and services.


To the “edge” and beyond!

Now we can imagine a very different life at the “edge” of a CIN:

  • It no longer matters which EMR platform CIN members utilize. They can collaborate without having to merge or switch platforms – just like Amazon and UPS.
  •  It becomes more feasible to include “marginal value” providers – the smaller “onesie-twosie” groups – in a CIN
  • Data can be easily collected and shared in real time between CIN members for patient care, performance improvement and research

This is a CIN with no “edge” and more opportunities to introduce innovative products and services as new players more easily get into the game. New kinds of support services and devices can be developed and integrated more rapidly driving greater value at an even faster pace.

In summary, value-based care gives us the opportunity to redesign our healthcare system to achieve better outcomes at lower cost and with greater satisfaction for patients and providers. Data management and innovative applications are essential ingredients for success. APIs can remove technical barriers to EMR interoperability and reduce “edge of CIN” challenges.

It’s past time to set the Borg strategy aside. We don’t need to be assimilated when we can collaborate in an open manner with APIs!


Download our white paper to learn how leveraging APIs can make health IT disappear

Download the white paper

Dave Levin, MD is the Chief Medical Officer for Sansoro Health where he focuses on bringing true interoperability to healthcare. Dave is a nationally recognized speaker, author and the former CMIO for the Cleveland Clinic. He has served in a variety of leadership and advisory roles for healthcare IT companies, health systems and investors. You can follow him @DaveLevinMD or email


Talk with one of our experts today.