In this podcast, we speak with Geeta Nayyar, M.D., M.B.A. about her experiences as the Chief Healthcare & Innovation Officer for Femwell Group Health, a management services organization (MSO).
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.
In a previous post, we explored the shift in healthcare reimbursement from traditional Fee-for-Service to a Value-based Care model. These new models of paying providers are making it possible to focus on both quality and quantity of care, and for providers to come together to design new and creative ways of delivering healthcare. In some cases, they are forming Clinically Integrated Networks (CINs) to organize and orchestrate care of specific problems or patient populations. For example, a group of orthopedic surgeons, a hospital, and a rehabilitation facility might all form a CIN to care for patients who need a hip or knee replacement. Key to the success of these CINs is the ability to connect their IT systems to share patient data. It also turns out to be one of the major barriers to overcome – especially when everyone is not on the same Electronic Medical Record (EMR) platform.
The way we pay for healthcare services is transitioning from the old Fee-for-Service model, to a new model often referred to as Value-Based Care. Under the traditional model, healthcare providers were paid for “doing stuff” with little regard for the actual result. I do not mean to imply that providers didn’t care about results but rather, at least when it came to compensation, outcomes weren’t much of a factor. Augment this with a lack of transparency in pricing and you have a good recipe for rapidly rising healthcare costs. And that’s just what we got.