What is the Southeast Health Statera Network Clinically Integrated Network?
A Clinically Integrated Network (CIN) is a partnership between physicians and hospitals to provide medical and wellness services to a defined population of Large Self-Insured Employer and Medicare Advantage members. As a Department of Justice/Federal Trade Commission physician led and governed organization, the Board is made up of a majority of physicians.
The CIN is formed to take financial and quality performance risk for a defined population of patients. Gains (savings) are shared among the members and sometimes the members can take risks with insurers to gain additional incentive monies in return for potential losses if performance is not achieved.
The Houston County Health Care Authority and the community physicians want to optimize their ability to be successful with current and future value-based reimbursement. An organized CIN is the preferred method. Currently, the reimbursement model is still primarily fee for service; the new reimbursement model of the future will be based on cost effectiveness and quality outcomes. A CIN can bring resources to its physician members to help them individually and collectively be successful.
The legal structure for the Statera Network CIN is a Tax Exempt For-Profit Limited Liability Company (LLC) with the Houston County Health Care Authority as the sole member. The governance of the CIN is a Board of Directors with 50 percent physicians and 50 percent Houston County Health Care Authority representation.
The CIN operations will be supported primarily by Houston County Health Care Authority funding, but also includes physician pro bono investment of their time, a physician application fee and dues.
As a Commercial CIN, we are not associated with a governmental entity; however since Medicare quality initiatives are used for Medicare “accountable care programs”, the Statera Network ACO has adopted quality initiatives that are Medicare Performance measures as its core measures.
The CIN markets its population management approach to providing health care to insurers, employers, and Medicare (Medicare Advantage programs). The Hospital Health Plan employee population was an excellent starting point to prove our population management performance with little risk.