Jackie serves as the vice president for network development for a large, midwestern healthcare system. She has worked with many rural and semirural hospitals to improve efficiency by offering shared services, consulting, and purchasing. She also develops in-house hospital management abilities, and her system currently provides contracted management services for three rural hospitals.

As part of her network development, she invites 15–20 rural and semirural hospitals quarterly to a network dinner and brainstorming session. Generally, 8–10 attend, but the information and suggestions they made were always helpful.

In an earlier meeting, most of the attendees wanted Jackie to explore the possibility of setting up a clinically integrated network (CIN) that could encompass the smaller, networked hospitals. Her hospital had been working on establishing aspects of a CIN within its own system, and she knew that it had spent many years and significant resources on the project. However, given the interest expressed by the attendees, she agreed to present more information at the next meeting.

When the next quarter arrived, Jackie presented how CINs work and what their desired outcomes are. CINs seek to improve patient care while reducing costs and existing redundancies. These networks should develop a team of primary care and specialty physicians to work together to streamline their care delivery model. CINs also allow both employed and affiliated physicians to partner and negotiate with insurers for contracts. Generally, a CIN should do the following:

• Establish a network of providers that enhances coordination of care.

• Create a partnership model with hospitals and their employed and independent physicians.

• Define roles for physician leadership.

• Clearly establish performance improvement initiatives to provide demonstrated value.

• Provide a structure for joint contracting to support care redesign and performance improvement initiatives.

• Negotiate with businesses and insurers for risk-based contracts.

• Implement consistent clinical protocols across the network to achieve patient care.

• Collectively own a reporting system.

Health systems have used many structures to implement CINs. Jackie presented various options that would work best in different circumstances. These ranged from a joint venture to a pooled-service alliance to a network outsource alliance.

During the subsequent discussion, almost all attendees concurred that they would like to pursue this together. They felt that critical aspects included involving their physicians, improving patient care, lowering costs, and providing a mechanism to negotiate joint contracts.

Questions

1. Given what the leaders want to accomplish, what structure would you suggest? Why?

2. What are the advantages and disadvantages of using each of the three structures to establish a CIN?

3. What other structures could they use?