How Do CINs Reward Providers?

How Do CINs Reward Providers?

How Do CINs Reward Providers?

How Do CINs Reward Providers?

How Do CINs Reward Providers?

There are many ways to approach the CIN distribution reward for providers. First, the sponsoring system agreed on how much money was saved. We then split that amount 50/50 with the healthplan, then the remainder of that with the hospital system, again 50/50. We then made a payment towards the start up costs for the CIN, as we had a contractual arrangement with our sponsor. Our current year to year expenses were also deducted. We had saved so much money we accelerated the debt reduction and paid off the hospital system in three years, rather than the planned for ten. Under our arrangement, the providers got paid last. Our systems leadership was quite skeptical of the providers ability to lower the spend of the healthplan. They aren’t anymore.

There is a distribution of funds that remains to the providers. The leadership and board of the Network then needs to make some decisions about who gets paid, and how much gets paid, understanding that Fair Market Value tests and an independent third party will have to sign off on the distribution.  Our accounting on what each provider did (and therefore deserved) was meticulous and defensible. We went through each provider, line by line, measure by measure to ensure the funds flow were for results, rather than the overall performance of the group.

In the ten years of our organization’s life, national trends for risk based payment, and therefor compliances’ willingness to be flexible have made the change to value based care more realistic, and generous in the compensation allowed.  In some physician compensation arrangements, the “at risk” portion can be 30% or more of their total compensation. The provider work force needs to understand the compensation is considerable and worth the attention as Fee for Service begins to lessen its grip.

Some Risk Based Arrangements have compensation in excess of $100k per provider, and these have been in provider networks who are tethered to a hospital system. Independent provider networks or non-hospital affiliated Clinically Integrated Networks don’t have to satisfy Fair Market Value tests, and subsequently, their compensation could be much higher.