Clinically Integrated Networks vs Accountable Care Organizations

Clinically Integrated Networks vs Accountable Care Organizations

Clinically Integrated Networks vs Accountable Care Organizations

Clinically Integrated Networks vs Accountable Care Organizations

What’s the difference between a CIN and an ACO?

Clinically Integrated Networks vs Accountable Care Organizations… They have similar goals, though they are structured in different ways. This doesn’t mean they are mutually exclusive, however. In fact, Advisory Board noted that a CIN often serves as the physician network arm of a larger ACO.

Here’s a quick briefing on the two types of structures:

Clinically integrated networks:

  • A group of independent physicians come together to identify and improve the quality of their offerings.
  • A CIN grants the group a safe harbor against antitrust laws to collectively negotiate for better payment rates with insurers.
  • Savings, when realized, can be distributed to the participating providers. The amounts depend on the total amount saved, the number of participating providers, and Fair Market Value tests.

Accountable care organizations:

  • Physicians, hospitals and other healthcare providers join together voluntarily to provide improved care to Medicare patients.
  • The Centers for Medicare and Medicaid (CMS) defines and provides rules for ACOs. This makes them more rule based, expensive and cumbersome to start.
  • This type of organization can cover the entire continuum of care.

Often a clinically integrated network is the platform upon which physicians can build an accountable care organization. The Advisory Board explained the CIN provides a legal framework around which physicians can set goals for standardization, efficiency and coordination.

ACOs participation and success remain in flux.

With the introduction of the Medicare Shared Savings Program (MSSP), the number of active ACOs in the U.S. has increased sharply. According to Modern Healthcare, there were just 64 ACOs in the U.S. in 2011. By early 2016, that number had risen to 838. In 2022 there are 483 ACOs currently operating with a Medicare contract. Structural requirements, inability to participate in MSSP (as of 2021) , and the riskiness of the contracts have all contributed to the decrease. CMMS continues to iterate their way through the ACO vehicle in the pursuit of value-based care.

CINs and ACOs can complement each other. With proper technical support, these types of organizations stand to win big by improving quality of care, lowering costs for patients and getting better payment rates from insurers. However, most CINs and ACOs haven’t made much money (if any), and thus have had little or no distribution to the partners.

A Clinically Integrated Network (CIN) is a separate legal entity, oftentimes set up by a sponsoring hospital or system. This allows savings to be distributed to participating providers who have contributed to the result. The physicians and advanced practice providers are taught to identify and manage patients who are high cost, and then how to reduce the cost while improving the outcomes.