Are Single-Specialty CINs as Valuable as Multispecialty CINs?

As the healthcare industry shifts toward narrow networks, closer alignment, and tighter integration, current trends indicate the advent of more single-specialty-only clinically integrated networks (CINs). However, can a single-specialty network achieve as much value as a CIN that is more encompassing? To answer that question, let’s set the record straight that while single-specialty CINs are inherently more limited, they are not entirely exclusive. For example, orthopedic-only CINs are rising in prevalence given the potential savings within orthopedics, primarily from implants and other could-be high-cost devices. The beauty of an orthopedic-only CIN is that it can encompass subspecialty care, such as spine, hand, foot and ankle, as well as joint replacement procedures.

The first point of significance for single-specialty CINs is that they can be quite comprehensive!The second important point is that single-specialty CINs can contract with other CINs and/or additional providers to offer a complete complement of services. The CIN can contract with other constituents, including hospitals, skilled nursing facilities, and providers within other specialties that are a necessary part of care delivery can be contracted by the CIN, yet they are not formal members of the CIN. In this manner, an orthopedic CIN can have relationships with hospitals, ASCs, primary care physicians, physical therapists, and others who are mutually engaged and often incentivized to provide the optimum continuum of care to network patients. Thus, while the label may appear exclusive and may be regarding its formal membership, the reality is that single specialty CINs should strive to be inclusive by engaging a wide range of providers who will ultimately treat the patients the network manages.

Another important consideration as to how CINs drive value is in their focus on the provision of the continuum of care. As noted, single-specialty CINs benefit the most when they contract with other providers for an expansive scope of services. This allows CINs to be selective with whom they engage, making tough decisions to contract with those providers who provide the optimum care for their patients, i.e., low-cost and high-quality. In a multispecialty CIN, participants are expected to use their colleagues within the network for all services. What happens, however, if their colleagues in the multispecialty CIN aren’t providing the best care? It often takes a while to vet a situation, notify providers, remediate the complaint, conduct peer-to-peer coaching, and pursue other avenues before removing participating providers, if necessary.

However, in a single-specialty CIN, the termination of contracts with outside entities can occur relatively quickly without restricting the participants in the process. Thus, single-specialty CINs can be nimbler and quicker to take action to ensure they can react readily to the value proposition of low-cost and high-quality service.A final important consideration for how single-specialty CINs can drive value is their ease of access.

For example, CINs have an operating agreement that memorializes the structure of the CIN, and they also require participation agreements for participating providers. The operating agreement is a singular document, with its integrity maintained across all users. Likewise, the participation agreements are usually standardized across all participants, thereby eliminating the demand and need for negotiations. Unlike employment where negotiating providers’ employment agreements are a part of the process, CINs can often forego this step and allow easier access because, the documents are prepared once and maintained for all future participants. Eliminating the need to negotiate allows faster access to the CIN. I hope the point is clear that single-specialty CINs can deliver and drive value and should be considered as part of an overall high-quality, low-cost methodology for care delivery that is critical for success in today’s world.

In fact, because single-specialty CINs focus more closely on what they do best while allowing others to focus on their core strengths, they are a worthwhile endeavor considering the potential value of a broad network of aligned single-specialty CINs. While network development and implementation require significant planning given the number of moving parts it would have, perhaps this crazy idea could be the answer to leveraging individual strengths for the best outcomes for the collective!

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