Population Health Services
What is Population Health? As defined by the Center for Disease Control (CDC), Population Health “brings significant health concerns into focus and addresses ways that resources can be allocated to overcome the problems that drive poor health conditions in the population.” The goal of population health is to help coordinate health systems, physicians, post-acute facilities, employers, insurance payors, and other organizations to work together to improve the health outcomes of the communities we serve.
LBMC utilizes a robust team of Population Health advisors who can help you learn how to improve the quality of care provided to your employees and patients in your community, and how to qualify for additional value-based contracting reimbursement and incentives.
Readiness Assessments & Strategy
- Completion of Clinically Integrated Network (CIN) Readiness Assessments
- Maturity Frameworks
- Strategy & Roadmap Design
Design & Implementation
- Completion of Accountable Care Organization (ACO) / CIN Network Design
- Implementation of Roadmap
- Standing Up Capabilities & Network Functions
Population Health Management
- Facilitating Transitions of Care and Post-Acute Management
- Value-Based Contracting Reimbursement
- Care Management Program Development
Network Development & Agreements
- Supporting Development of Health System & Provider ACO/CIN Networks
- Development of Governance Structure, Participation Agreements, Committees, & Task Forces
- Supporting Existing Networks with Selection of Key Vendors to Support Population Health Initiatives
- IT Infrastructure
- Collaborating with Existing ASO/TPAs and Broker-Consultant Partners
- Care Management Workflow Tools
Frequently Asked Questions
- What is a Clinical Integration Organization (CIN)?
A CIN is a partnership between physicians and a hospital to provide medical and health care and wellness services to a defined population. The governance is usually a Board of Directors made up of equal representation from the two partners. The Board Chairperson is usually a physician.
The CIN is formed to take financial and quality performance upside only risk for a defined population of patients. Gains (savings) are shared among the members and sometimes the members can take risks with insurers to cover potential losses.
- Why do health systems and physician leadership form a CIN?
Health Systems and community physicians want to optimize their ability to succeed with current and future value-based reimbursement. An organized CIN is the preferred vehicle to achieve this. Although presently, the reimbursement model is still primarily fee for service, the new reimbursement model includes additional reimbursement that is based on cost effectiveness and quality outcomes. A CIN can bring resources to its physician and hospital members to help them individually and collectively succeed at value-based care and reimbursement.
- How is the CIN structured? Will Physicians really have a voice in how it organized and operated?
The legal structure for the CIN is usually a Limited Liability Company (LLC) with the Hospital as the sole member. The governance of the CIN is usually a Board of Directors with a majority of Physicians and a minority of Hospital representation.
- How is a CIN funded and who shares in any profit?
The CIN operations are generally supported by the hospital funding, but also includes a physician investment opportunity, as well as a physician membership application fee and dues.
- How will the Medicare thresholds be used in the CIN?
Technically, the Medicare performance thresholds will not be used in the CIN. The CIN is designed for value-based reimbursement agreements with Employers and Commercial Payors. Medicare thresholds come into play for Standard Medicare “accountable care programs”. However, the CIN may want to adopt some of the Medicare Performance measures as its core measures.
- How do “value added” payments figure into the CIN?
Unlike a Medicare down-side risk sharing arrangement, the CIN negotiates contracts that reimburse providers for achieving low costs and higher quality, without the risk of paying for cost increases. However, gain sharing will only occur when there is both a cost savings, and successful achievement of the quality measures.
- What are potential future opportunities for a CIN beyond contracting with the hospital employee population health plan?
The CIN can market its population management approach to providing health care to all insurers, and large self-insured community employers, and Medicare Advantage programs. The Hospital employee population is an excellent starting point to learn population management with little risk. The CIN then has an opportunity to also form an Accountable Care Organization to contract with the Centers for Medicare and Medicaid Services.
- What are the differences between ACO and CIN?
A CIN is a commercial and private payor form of an Accountable Care Organization (ACO). The CIN and the ACO both sign up a network of providers that make up the CIN clinical team, and will include community physicians and hospital-employed physicians. CIN initiatives are selected by local providers, whereas ACO initiatives are selected by CMS and the government. CINs are generally upside risk only while ACOs will assume downside financial risk in later years of their contract with CMS.
- Would a provider be required to change their EMR to be a part of the CIN?
No, but if a physician’s EMR needs major upgrading or is antiquated, the CIN may encourage changing to a preferred system that is more compatible with the needs of the CIN.
- What providers are invited to participate in the CIN?
Any and all physicians who can meet the credentialing requirements of the affiliated hospital, and are willing to commit to participate along the guidelines and expectations spelled out in the CIN Physician Participation Agreement, the compacts, and Guiding Principles, will be invited to participate.