Clinically Integrated Networks vs Accountable Care Organizations

Moving Toward Fee-for-Value? Let’s Walk before We Run.


Moving Toward Fee-for-Value? Let’s Walk before We Run.

We lead you in the right Fee-for-Value (FFV) direction

Let’s face it, Fee-for-Service is not completely going away. Shifting toward risk-based agreements for specific populations will become more prevalent in both the commercial and government payor space. We can show you how to succeed at this. The transition to fee-for-value-based care revolves around a recalibration of how healthcare is measured and how payments are reimbursed. The traditional model, known as fee-for-service, simply assigns reimbursements based on what services a healthcare organization provides. But in value-based care, reimbursement is contingent upon the quality of the care provided and it comes tethered to patient outcomes. This seemingly simple pivot of emphasis requires major changes on the part of healthcare providers.

We help you walk before you run with a Clinically Integrated Network

The fee-for-service model encourages healthcare providers to fill as many beds and perform as many high-tech procedures, as possible. That succeeds in driving up the cost of healthcare, but it doesn’t improve patient outcomes.

Value-based care, on the other hand, puts the quality of outcomes first, and by tethering reimbursement to this metric, incentivizes healthcare providers to prioritize patients. Both Medicare and private insurers have begun to adopt value-based models and providers have had to rethink how they can conform to the new system while meeting budgetary limitations. The incentive for more “stuff”, more procedures, more ER visits, more hospitalizations, goes away with a value-based approach. The patient comes first.

Start with a Clinically Integrated Network and manage the spend of your health plan for your employees and their dependents.

  • Cheaper to set up, less cumbersome to operate, the objectives are simpler than an ACO.
  • Health Systems can focus on better financial and clinical outcomes for their employees and their dependents—the results are immediate.
  • The financial risk is minimal-upside is considerable.
  • A percentage of the savings are distributed to the providers—clinicians are engaged like never before.

We are physician run and physician led in Fee-for-Value strategies

The encounter between the clinicians and the patients, whether in the exam room or phone/video call, is where the “rubber meets the road.” Success happens when clinicians welcome and adapt to FFV strategies, creating a win-win for providers and patients. That is the focus of our physician leadership team. Clinician to Clinician.

We get your entire organization ready

The challenges of making changes and creating a new shared vision may seem formidable. We can help your organization transform. We start with HR, Legal, Case Management, and Payor Relations, then use our experience with all facets of the organization to create a smooth, easy-to-understand transition that is embraced and accepted as the way forward.

We have one of the best track records in the US for creating Clinically Integrated Networks

For almost a decade, we have saved our clients money, provided a distribution to their provider network and improved clinical outcomes – every single year – all while using existing IT infrastructure. We are confident we can show you how to begin the Fee-for-Value journey through Clinically Integrated Networks in a way that produces immediate benefits to the bottom line and prepares the organization for success in risk-based contracts. 

Contact the Redington Group to see how your health system can benefit from this integrated approach