Care Transformation Center Blog

CI networks: Are you letting your physicians down?

by Sarah O'Hara

When it comes to navigating the transition to population management readiness, why reinvent the wheel? Newly launched clinical integration (CI) networks can learn a lot from their more advanced counterparts and how they've shifted from basic performance management to greater patient accountability.

A CI network’s ability to execute against its performance goals depends not just on which physicians participate, but also on the infrastructure built to support those physicians. Every CI network will need to make some investment in leadership, information technology, and care management staff to support network activities, even if those activities are basic.

On Oct. 17, I'm hosting a webconference to review how advanced CI networks are tailoring physician membership criteria and building infrastructure to meet new imperatives for care management, cross-continuum coordination, and total cost reduction. I hope you'll join me.



Design program activities, network membership to achieve promised value

Once the CI network starts to secure risk-based contracts, it must begin developing a strategy to successfully manage the specific populations it has now agreed to serve.

Ask yourself: How will we bend the cost curve for this population? Do we have the right physicians in place?

First, the network and its physicians must determine how best to reduce total care costs for the population. For many CI networks, this will likely require a more direct focus on care “value” than they have taken in the past, directly managing not just quality but cost of care. Leaders must ensure that physicians are ready for this shift, then develop strategies to quickly and effectively identify the best cost management opportunities.

Second, CI leaders must consider whether the network is appropriately configured to serve contracted populations. Leaders must ensure that the network has physicians in the right distribution across specialties and geographies to meet patient needs, and that all participating physicians are capable of executing against new population management goals.



Strengthen infrastructure support for physician-led population management

Finally, the CI network must recognize that its ability to succeed in a population management environment is not dependent on physician capabilities alone. Many elements of improved care management are impossible for physicians to do by themselves.

The network must build a robust infrastructure to support physicians across the populations they serve. CI programs are well positioned to offer support at scale in ways that individual practices cannot.



For new networks, build for population accountability from the start

While the shift toward population management as often positioned as an evolution, CI networks that are early in the development process don't need to start at the basic performance improvement phase.

Most experienced CI networks agree that you need at least two years to develop baseline capabilities for managing population health.

Instead, networks can build for population accountability from the beginning. While some aspects of network development are difficult to accelerate, others—such as investing in care management resources or requiring that physicians prepare to implement an ambulatory electronic medical record—can be fast-tracked.

By viewing population management as a near-term goal rather than a long-term possibility, networks can begin to factor population health imperatives into current strategies, and avoid making decisions that are appropriate for managing in a fee-for-service environment but less effective in a paradigm with greater reimbursement risk.

  • Explore 12 imperatives for designing a clinical integration network capable of successfully managing under total cost risk. Read the study.

Move From Quality Improvement to Population Accountability

Last week, I explored how these networks are working with purchasers to design and execute on contracts that reward for total cost management. Missed the session? Catch it on demand.

Then, come back on Oct. 17 to examine how they are tailoring physician membership criteria and structuring infrastructure to meet new imperatives for care management, cross-continuum coordination, and total cost reduction.

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How Advanced Networks Build Infrastructure for Care Transformation

Learn how advanced CI networks are tailoring physician membership criteria and structuring infrastructure to meet new imperatives for care management, cross-continuum coordination, and total cost reduction. Register for the webconference.


 

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Meet the Author

Sarah O'HaraSarah O'Hara
Senior Consultant
Health Care Advisory Board