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Core building blocks for a mutually beneficial ACO and CIN partnership

By Signify Health Team on 7/5/23 9:23 AM

A webinar recap; Payers, Providers, & Patients The Impact of ACOs on Accelerating Clinical Integration

With the transition to value-based care, healthcare providers are increasingly tasked with decisions about how to improve patient care outcomes while controlling costs. With the right scale, support, and resources in place, Accountable Care Organizations (ACOs) have demonstrated the ability to help providers improve outcomes while lowering or minimizing costs. Clinically Integrated Network (CIN) participation offers the added benefit of collaboration between providers of a range of specialties and organizations of varied sizes and patient demographics, in both rural and urban communities. Many ACOs operate as CINs but not all CINs are (or are required to be) part of an ACO. However, when these two models work together, the foundation for a successful collaborative partnership is achieved.

ACOs and CINs: A shared structure

While there are different components that distinguish an ACO from a CIN, the two bodies share a common structure which consists of three elements. First, there is the willingness to approach healthcare in a new way, accepting the need for change and adequately communicating with the organization’s shareholders. Second, understanding the patient’s needs by identifying ways to bridge gaps in patient care and treating the patient holistically. Lastly, the collaboration of like-minded providers who engage in conversations about how to develop best practices, address patient needs across the continuum of care, and build on previous experiences and lessons learned.

According to ACO data, providers who are not involved in risk-based payment arrangements must prepare to be paid 5-10% less than their peers who participate in an ACO. However, there are certain perceived risks that have prevented some providers from joining an ACO.

The benefits of participating in an ACO are often best understood by examining the current state of value-based care. Over the next 10 years the eligible Medicare population is expected to double. The Centers for Medicare & Medicaid Service (CMS) has set a goal to have every Medicare beneficiary  enrolled in an accountable care relationship by 2030. Risk-based payment arrangements require providers to take on risk within three years of operation, as per CMS. This can present as a daunting task for rural-based providers and other organizations concerned with the increasing costs of delivering high quality healthcare. 

Taking advantage of the Medicare Shared Savings Program 

The Medicare Shared Savings Program (MSSP) offers providers advantages they would not otherwise have to improve patient care including the ability to: (1) promote accountability for their patient population, especially specific demographics, (2) coordinate services for their Medicare beneficiaries, and (3) encourage investment in high quality, efficient services. The MSSP also provides a strong foundation for a high-performing value-based structure. In the webinar, value-based care experts discussed the ways CINs couple with the MSSP to help providers master the core components to expand value-based initiatives across all patients.

Signify Health launched the Collaborative ACO model to not only stabilize results but also provide the foundation for provider independence - the best of both worlds. In our collaborative ACO model, Providers have the security of operating with the size and scale necessary to protect against the statistical variation in their ability to earn shared savings that smaller ACOs experience, while largely continuing to operate their practices in the manner that best suits their collective organization, mission, patients, and community.  As organizations migrate to taking on risk, Collaborative ACOs better position them for earning reliable shared savings and expanding their risk arrangements. In 2020 and 2021, all of Signify Health’s collaborative ACOs earned shared savings.

CINs & ACOs: Better together

John Henderson, is the President/CEO of the Texas Organization of Rural and Community Hospitals (TORCH) for 158 Texas-based rural hospitals. TORCH was created to support rural hospitals and their local communities. Historically, Texas rural healthcare providers have not had wide access to value-based contracting opportunities, causing them to miss out on significant financial resources and quality improvement opportunities. 

TORCH is committed to creating an avenue through which rural healthcare providers in Texas can successfully participate in value-based contracting programs. The organization established a high- performing statewide rural healthcare CIN with leaders who are focused on improving care outcomes through value-based incentive agreements.

According to Henderson, “We have a tendency in a rural provider community to view everything that comes along as one more thing that we have to do and we've got to shift that conversation and have enough trust to say, no, actually what this is about is finding a better way to take care of people.”

Since forming the CIN, TORCH has also joined a Signify Health collaborative ACO, to expand resources and capacities. Now under both models, TORCH is able to serve a wider patient population. Henderson shares this is important because of the challenges that come with changes in process. It is essential to bring the majority of patients in a primary care setting into the same process and treat them with equanimity. 

“Change is difficult. People prefer what they know and part of this journey is discovering and experiencing new things. Not every deal made will benefit every member and this needs to be understood through consensus.  Uncertainty - sometimes it’s hard to see what you’re going to be. The important thing is to continue making progress, even incrementally.  It’s not a sprint -nothing moves as quickly as you would like. We need consensus among a group of managers and enough trust that the rest of the group can and will move together. This requires unwavering patience and the knowledge that your labor will be rewarded in the end.”

Improving patient care through collaboration

Patient care outcomes can be improved and the patient experience can be enhanced when we collaborate and maximize resources and opportunities. Demonstrating this value is the story of the Rough Rider High Value Network- a sustainable network of rural North Dakota Critical Access Hospitals and clinics (RRHVN). 

Clinton MacKinney, MD, MS has worked in rural healthcare for over 40 years. He is the Interim Medical Director of RRHVN. The network works together to integrate clinically, share resources, manage risk, and deliver high-quality care. While still in its early stages, the RRHVN recognizes the value of forming a CIN. Dr. MacKinney believes that clinical integration is necessary for the advancement of patient care and access to necessary resources.  

“We wanted to create and advance the Rough Rider High Value Network as a sustainable network of rural North Dakota's critical access hospitals that increases clinical quality, pools our resources, manages risk, and improves community health.”

23 out of 24 independent rural hospitals in North Dakota have joined the Rough Rider High Value Network (RRHVN). Despite their varying differences in size and revenue, the hospitals have a collective service area of nearly 250,000 individuals which rivals the state’s bigger healthcare systems.

“When I was in private practice,” explains Dr. MacKinney, “my first day in private practice, I had 25 patients on my schedule. I never got less. And I think if I would've had time to sit and think a little bit more about my situation, I would've realized that practicing in isolation really isn't the best way to do this…Collaborations, shared learning, and team-based care are really the way to go.”

With the right resources, providers can transition into new and unknown territory with confidence. Signify’s mission is to provide the necessary components for ACO and CIN success to every provider and healthcare system. To create a dialogue around challenges, necessary changes, and shared experiences, while offering established systems, and proven solutions. 

Signify Health's recent on-demand webinar, ‘Payers, Providers, & Patients: The Impact of ACOs on Accelerating Clinical Integration’, features Laurel Douty, Executive Vice President, Growth and Business Development, and Shawn Rhodes, Vice President, Strategic Accounts at  Signify Health. Guest speakers, John Henderson, President/CEO from TORCH and Clint MacKinney MD, MS,  Interim Medical Director of RRHVN also participated in the webinar.

Learn more about the ways Signify Health can support you

There has never been a better time to begin an ACO and CIN partnership. Signify Health provides much-needed services and resources, while partnering with you in this journey. Feel free to contact us, and learn more about the solutions we offer. 

Watch Signify Health's on-demand webinar: Payers, Providers, & Patients The Impact of ACOs on Accelerating Clinical Integration.