All CIN members must make a formal commitment to follow clinical guidelines and work on performance improvement activities. Performance improvement covers all aspects and the overall approach to care, including treatment quality, accuracy, efficiency, timeliness, outcome and satisfaction. 1 Moore KD, Coddington DC. Memorial Hermann ACO Case Study. American Hospital Association. January 2011. 2 Dj Ballard, Convery PB. Integration of hospital doctors: Baylor Healthcare System. In Mayzell G, Breen VR (ed). Physician Alignment: Building sustainable roadmaps for the future. CRC Press. 2013.
There is no legal standard definition for an NCI, but it is generally regarded as a network of interdependent and cooperative providers that continuously evaluate and modify their clinical practices in accordance with agreed protocols, in order to control costs and improve quality. The opinions of the Federal Trade Commission and the previous one suggest that there must be five key elements to be considered a CIN: before setting up a CIN, health systems must clearly define why they are pursuing this option and why local doctors wish to join. In markets where clinical integration and the shift to value-based reimbursements are underway, health systems may choose to form an NCI as an «offensive» strategy to gain market share and offer integrated services in a region where others may have difficulty creating a competing offer, or for other reasons. The decision to pursue this strategy should only be made if the move to a value-based refund is considered to be inevitable and that there is an advantage for the first mover. In markets where this change is already underway, CIN education can be a «defensive» step to access an appropriate proportion of life and manage care. In both cases, we see two main reasons for the formation of CINs by health systems: the health landscape is changing, in part by the transfer of health system reform from the cost of service fees Recent laws, such as the Medicare Access and the CHIP Reauthorization Act of 2015 (MACRA) , challenge health organizations to explore additional alternatives to address the costs of addressing quality and value, with many turning to clinical integration to address the changing complexities of health system reform. 5.