If you’ve been paying attention to MIPS and MACRA over the last couple of years, you know that the government is rewarding providers for participating in alternative practice models (APMs). There are many models that go beyond fee-for-service, and they all seek to improve quality and efficiency while reducing costs and increasing patient satisfaction. Clinically Integrated Networks (CINs) are one of them.
Clinically Integrated Networks help small practices join forces with other providers while allowing each individual provider to retain ownership of their practice. The clinical integration part helps the group of providers take advantage of data sharing to improve patient care and reduce inefficiencies. A subset of this type of APM is Clinically Integrated Eye Care Networks (CIENs).
Why CIENs, and Why Now?
As healthcare reform began to take shape, there wasn’t a real understanding of the role of eye care was in organizations like ACOs, which are more focused on primary care. That was understandable, because the healthcare system has traditionally considered PCPs to be the “gatekeepers” of patients. It became clear early on that eye care was not really connected and that there was an opportunity in eye care for a new role in the healthcare ecosystem.
Now, the healthcare community understands more that specialists must participate in that ecosystem. They are the higher-cost providers relative to value-based care. There is also a growing appreciation of the role of eye care providers in capturing new patients and bringing them into the healthcare system. Many patients don’t have an annual physical, but they see their ECP regularly due to vision issues that affect their lifestyle. It’s an opportunity to identify underlying conditions, understand their overall needs, and assess their medical history.
ECPs help patients connect or reconnect with their PCP. They identify and treat patients with chronic conditions, and manage those same conditions. ECPs are also instrumental in avoiding large events that are detrimental to the patient and costly to the system. Many times, those events are preventable. This includes not only diabetes but hypertension, high cholesterol, rheumatoid arthritis, multiple sclerosis, and more. These drivers are leading organizations to want to partner with eye care providers.
Interested in Clinically Integrated Networks? Here’s How to Get Started.
First, I suggest seeking information from your industry groups (AAO, ASCRS, etc). You can also talk to colleagues in your market, and local health systems and hospitals to see what kind of network options are already in place.
There are also networks of groups and consultants that can help you with strategic development and planning. They will come into your practice and help you assess whether staying independent is the right strategy. Beyond that, they’ll help you determine the right approach within that strategy. That could be a CIEN, an ACO, or another arrangement.
If you go that route, realize that many consultants operate in just one area. It might be revenue cycle solutions, practice management, or staffing. But that’s not the strategic type of approach you need to be successful—there are a lot of dots to connect. You need a more macro vision to achieve clinical integration, care coordination partnerships, and value-based care transitions.
There’s also tactical execution involved, and a lot of that takes place at the granular level. Your strategic partner must have the expertise to develop your practice’s internal processes and capabilities to implement your strategy. You may need to adopt a new ophthalmology EMR, so your systems are interoperable. There’s a lot involved in a CIEN – but a lot to gain, as well.