CINs (Clinically Integrated Networks) are groups of healthcare providers that work to improve care, reduce costs, and maintain quality standards. They create structures to manage value-based contracts, allow providers to demonstrate value, and integrate physicians and health systems. Key elements of CINs include collaborative physician governance, a focus on population health through data sharing and care management, health IT infrastructure, and aligning provider incentives through value-based contracts and shared savings. Providers commit to engaging with the network, focusing on quality metrics, and using resources to standardize care. In return, CINs provide opportunities for shared savings contracts and support providers through committees and performance feedback.

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Orientation to Clinically
Integrated Networks

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What is a Clinically Integrated Network?
CINs are legal entities with specific, FTC-recognized features
that differentiate such affiliations from monopolies and
price-fixing arrangements
“... an active and ongoing program to evaluate and modify
practice patterns by the network's physician participants and
create a high degree of interdependence and cooperation
among the physicians to control costs and ensure quality”
CINs must actually improve care, reduce unnecessary cost
and maintain quality standards for participation
Source: 1996 Joint Statements of Antitrust Enforcement Policy in Health Care by
the Federal Trade Commission and U.S. Department of Justice

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Why Build ClNs?
Challenges
•Lack of integration leads to poor clinical outcomes and
unnecessarily high healthcare costs
CIN Solutions
•Create structure to manage value-oriented contracts
•Allow providers to define and objectively show value
•Integrate physicians with systems without employment
3
CINs are a major health system strategy in 2014 in response to
market demand for value. According to Health Affairs, there
were over 600 public and private ACOs as of January 2014.

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Four Key CIN Elements
1. Collaborative, Physician-Oriented Governance Structure
2. Population Health Focus
3. Health Information Technology Infrastructure
4. Alignment of Provider Financial Incentives

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Four Key CIN Elements
1.Collaborative, Physician-Oriented Governance
Structure
• Board has physicians in majority and physician in chair role
• Roles and Responsibilities:
• Membership: sets criteria for participation, monitors compliance
• Finance and Contracting: evaluates contractual opportunities
• Clinical Integration Committee
• Roles and Responsibilities:
• Quality: selects/approves quality metrics and oversees overall network
improvement efforts
• Clinical Subcommittees (Primary Care, Cardiology, Post-Acute,
Spine, Oncology)
• Roles and Responsibilities:
• Develop clinical pathways
• Identify quality measures to drive improvement
• Leverage analytics resources to identify areas for quality improvement

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Four Key CIN Elements
2. Population Health Focus
• Quality measurement
• Provides group, clinic, and provider-level performance reports
• Develops clinical programs to support metric achievement
through care gap identification and management
• Patient management across the care continuum
• Development of Care Management infrastructure
• Develop an algorithmic approach to identification of patients
who may benefit from outreach
• Develop partnerships with community organizations and payer
programs

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Four Key CIN Elements
3. Health Information Technology Infrastructure
• Aggregation of claims and clinical data to support quality
measurement
• Harmonizes data from multiple EMR platforms
• Use of analytics to develop insights into utilization and population
health
• Utilization and financial reports
• Communication tools to alert providers to patient status and
movement between care settings
• Support for HIE connectivity, EMR optimization, and
documentation/data collection aligned with quality goals

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Four Key CIN Elements
4. Alignment of Provider Financial Incentives
• Develop value-based contracts that create opportunities for
shared savings after attainment of quality and cost targets
• Distribute shared savings to physicians based on quality
performance

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Provider Commitments to CIN
Engage with Provider Community
•Cooperate and communicate with others in the optimal care of
patients
•Participate in quality committees and governance
•Share best practices, success stories, barriers, concerns
•Use other network providers for referrals to maximize coordination
of care

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Provider Commitments to CIN
Focus on Quality
•Participate in data sharing to enable measurement of
peer-chosen quality metrics
• Clarify any perceived data inaccuracies to improve
reliability and validity of performance reports
• Providers focus on clinical metrics for their
specialty
• Analyze workflows and practices to achieve
performance targets and addressing opportunities
identified in care gap reports
•Use resources such as clinical subcommittees and care
pathways to standardize care, improve outcomes, and
control costs

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CIN Commitments to Providers
• Access to value-oriented contracts and opportunity
for shared savings based on performance
• Governance support through physician-led
committees
• Regular feedback on performance measures
(scorecards)
• Fully-funded care management programs
• New patients through payer contracts which direct
patients exclusively to Alliance providers

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Attestation Statement
Please follow the below link to attest that you
have reviewed the SHA CIN Orientation.

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Questions or Comments?
Meredith Duncan
Vice President
mdDuncan@seton.org
Hayli Baldridge
Manager, Seton Health Alliance Physician Engagement
hbaldridge@seton.org
Gemma Borja
Manager, Clinical Integration
gborja@seton.org