Premier released a new definitive implementation guide to help providers make strategic decisions for continued growth in the new world of value-based care and risk-based contracting.
The Ready, Risk, Reward: Aligning for Success with the Second Generation of Clinically Integrated Networks (CINs), guide summarizes lessons learned from Premier’s experience with health systems forming CINs, and recommends strategies for optimizing performance as these networks move up the continuum to accept two-sided risk, care arrangements for larger patient populations, and participate in advanced alternative payment models with commercial, employer, and government payers.
The CIN guide provides recommended strategies for optimizing CIN performance based on Premier’s experience establishing stand-alone CINs nationwide, as well as optimizing CIN performance through the Population Health Management Collaborative, which helps hundreds of hospitals and thousands of clinicians in more than 80 different markets work together to align, measure and improve population health management.
Premier CINs typically perform 57% better on average in achieving shared savings payments through value-based contracts with Medicare, all while outpacing peers in clinical quality scores.
Beyond these capabilities, the guide recommends 10 additional best-practice steps to enhance performance and prepare for two-side risk contracting, including:
- Conducting a market assessment to determine whether conditions are favorable for moving into two-sided risk contracts;
- Financial modeling to ensure optimal flow of funds and appropriate offsets to make up revenue due to utilization declines;
- Streamlined data assets and data insights with a consistent flow of complete, accurate and timely claims and quality data;
- Consistent measures of cost, utilization and quality that can apply across payers, as well as satisfy professional and regulatory reporting requirements;
- A payer partner strategy with a clear strategy and road map that targets opportunities;
- Unified and coordinated contracting functions and terms that can be leveraged across the network and across payers;
- A strategy for measuring, managing and articulating the value of in-network utilization to minimize referral leakage;
- A clear, data-driven set of evaluation criteria that will be used to determine high-value providers that are asked to join an expanded CIN;
- An expansion strategy that differentiates the high-value network of providers for commercial and employer payers; and
- Coordinated and centralized care management functions across the continuum to spread fixed costs and optimize patient engagement.