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 mission of population health is to improve the health outcomes of the communities we serve. The associated reimbursement from value-based contracting is the vehicle used most often to fund this mission.
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 optimize your value-based contracting reimbursement and incentives.
Readiness Assessments & Strategy
- Value-based Contracting and Reimbursement Assessment
- Clinically Integrated Network (CIN) and ACO Readiness Assessments
- Strategy & Roadmap Design
Design & Implementation
- 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
- Data Analytics Program Development
- Care Management Program Development
Physician Network Development & Agreements
- Supporting Development of Health System & Provider ACO/CIN Networks
- ACO and CIN Governance Structure, Participation Agreements, Committees, & Task Forces
Frequently Asked Questions
- Do I have to sacrifice my fee for service reimbursement to get involved with value-based reimbursement?
- What channels (types) of value-based reimbursement programs do I pursue?
- Do I have to invest in additional resources to optimize my value-based reimbursement?
- Is there an eventual return on investment in value-based contracting? How long before the return on investment becomes positive?
- 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 do “value added” reimbursement 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 services to all insurers, and large self-insured community employers, and Medicare Advantage programs and also form an Accountable Care Organization to contract with the Centers for Medicare and Medicaid Services. 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.