On Friday, March 24, 2023 Dr. Andrew Ziskind and Alan Trimakas of BDC Advisors presented this sixty-minute webinar in which they explored the challenges and opportunities of value-based care and the role that CINs can play in improving patient outcomes and reducing costs.
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- In November 2020, HHS amended the Stark Law and Anti-Kickback Statues to remove government burdens that impeded care coordination. This modification now allows networks participating in value-based arrangements to focus on coordinating care within the network including written referral guidelines and incorporation of those into physician incentive models. Network efficiency must be a priority as it continues to be supported by data that shows better outcomes and lower total costs of care when patients receive in-network care.
- We will discuss the evolution of the CIN model, including its early focus on care coordination and its expansion to include a variety of stakeholders. A CIN creates value by aligning efforts of a team of providers to deliver higher care quality, better clinical outcomes and lower costs of care. It is logical that the aggregate value of the network should be brought to market and contracted with a single signature. This ensures market agility with payers and equally important, presents a value proposition that encourages physician participation. As independent primary care physicians are increasingly recruited by payers, retail providers and private equity funded physician groups, it’s critical that risk-bearing provider-sponsored networks offer aligned contracting support.
- We will also explore the challenges facing CINs, including how to measure and demonstrate value, and how to optimize their operations and processes. This means focusing on the 3-5 high impact areas that generate true value. For example:
- Narrow post-acute networks which seek to match patients with the highest performing post-acute providers.
- Intensive pharmacist-led medication management programs, especially for complex patients requiring high cost pharmaceuticals.
- Appropriate and diligent capture of clinical complexity. RAF scoring is vital for both revenue and risk-adjustment for outcomes and costs.
- Effective disease management programs targeted at the top 5% of patients, for example the medically-complex geriatric patient.
- A culture of physician engagement and partnership with meaningful alignment of performance incentives that are financially significant as a percentage of total physician income.
- Through case studies and real-world examples, we will illustrate best practices for CIN optimization, including the use of technology, data analytics, and process improvement methodologies. Healthcare is rampant with data that’s not being effectively used. As predictive analytics and AI begin to mature, we all need to accept that these tools are going to be essential and will allow network resources to be focused where they have the greatest benefits.
- Whether you are a provider, payer, employer, or community organization, this webinar is designed to provide you with insights and strategies for improving the quality and cost-effectiveness of healthcare. As noted above, independent primary care physicians are being courted by payers, retail providers and private equity funded aggregators, all of whom are not bound by the same fair market value constraints. We believe that tightly affiliated clinically integrated primary care networks are an attractive alternative for PCP’s who wish to remain independent.
Andrew Ziskind, MD
Andy was most recently Senior Executive Officer of Southwestern Health Resources (SWHR), a joint initiative of UT Southwestern (UTSW) and Texas Health Resources (THR) to support their strategic and operational transition to population health management. Recognized as the nation’s leading Next Generation ACO for three consecutive years, SWHR includes a 5,500 provider clinically integrated network, a Medicare Advantage health plan, and is responsible for all contracting for UTSW and THR.
Andrew Ziskind, MD is the Managing Director and CEO of BDC Advisors, LLC, where he is responsible for leading all strategic and operational activities of the firm including supervision of the firm’s core practice areas.
Alan Trimakas, MBA
Alan is a Principal at BDC Advisors with a particular focus on ambulatory system development, strategic planning, and organizational performance improvement. During his time at BDC Advisors, Alan has helped to deliver innovative solutions to the challenging strategic issues that academic medical centers, regional health systems, and employed medical groups face. Areas of focus at BDC have included:
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