Don’t underestimate the importance of these six key design and due diligence efforts as you develop your clinically integrated network (CIN):
- Vision & Purpose: Defining the vision upfront provides ongoing guidance and direction as you think through complex issues. Periodically step back and reflect on the overarching strategic purpose behind your efforts.
- Market Dynamics: Understanding your local market and the key drivers accelerating the transition to value will help you determine how quickly you need to develop and implement your Value-Based Care strategy. Your transition must align with the market’s transition. Too fast, and you risk not having the proper organizational structure and supporting capabilities in place. Too slow, and competitors and payers will impose their strategies on you, resulting in lost market share and an inability to maintain your margin.
- Financial Modeling: In addition to modeling anticipated revenues and expenses, you must evaluate the financial implications of transitioning existing fee-for-service contracts to risk/ value-based contracts. You must understand the financial risk for the organization and whether it’s feasible.
- Incentive Distribution: Developing your incentive distribution methodology in advance saves time and energy down the road. You need a methodology detailing how gains and losses from risk/value-based contracts (and other revenue sources) will flow from the payers and employers to the network and how they will be distributed among participating providers. Determine:
• The percentage of funds (if any) that will be held within the organization to cover operating expenses, strategic investments, and/or anticipated future losses;
• The percentage of gains/losses that will be distributed between hospital members and participating physicians;
• The percentage of gains/losses that will be made available to primary care physicians and specialists, respectively; and
• The criteria participating providers must meet to participate in any shared savings/gains. - Communications & Messaging: You can’t communicate too early or often. Inform stakeholders of your plans to develop the organization. Provide updates as key decisions and milestones are reached. Obtain buy-in by customizing communications to each stakeholder group (i.e. patients, independent physicians, employed physicians, payers and internal management and staff) with the unique value proposition and WIIFMs (What’s In It For Me).
- Provider Network Development: To effectively manage population health, a network of primary care and specialist physicians is not enough. You must align with post-acute care providers, as well. Early on, determine which physician and non-physician entities are needed to realize the organization’s vision and strategic objectives. When creating the participating provider agreement, use objective criteria based on:
• quality,
• technical capabilities, and
• commitment to success of the organization’s vision.