CIN Success Stories Reveal Bottom-Line Accreditation Benefits

| URAC Staff
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Three industry leaders shared powerful narratives describing how accreditation had boosted performance, better served patients, improved payer contracting and positively impacted the financial bottom line, in a webinar sponsored by URAC.

“One of the biggest advantages from our accreditation is that it validates that we are willing and able to prove that our model, built within the URAC framework, is effective and impactful on improving the health of the population in our community,” enthused Michael Hunt, D.O., CEO and President of St. Vincent’s Health Partners (SVHP).

Hunt also reported that the accreditation has helped align each office and physician to the nearest urgent care facility and wellness centers. The improvements save time and money even as they provide patients with the best possible and accessible treatment, he explained.

While alignment is an important objective at SVHP, it is also important for the Physician Hospital Organization (PHO) to be able to demonstrate it is not engaging in anything remotely in violation of anti-trust statutes from the Federal Trade Commission (FTC) or other regulatory bodies. Accreditation helps St. Vincent demonstrate tangible “compliance and integrity” programs that also improve operational efficiency, Hunt said. St Vincent’s network includes 400 providers across 85 practices sites, a hospital, five skilled nursing facilities, and four home health agencies.

Casey Osborne, vice president, Phoenix Children’s Care Network (PCCN), the first pediatric network to receive URAC accreditation, echoed Hunt’s comments about anti-trust compliance. URAC helped his organization tighten and add transparency to FTC and Department of Justice compliance standards, he said. In its vast network, PCCN has more than 1,000 providers, including 360 primary care physicians and 580 specialists.

Other examples of near- and long-term benefits abound at SVPH. One example: Accreditation tightened operations and led to a 70 percent drop in inappropriate, unnecessary emergency room utilization for one of its member employer groups. Thanks in part to URAC accreditation, Hunt says the system was able to save $3 million for four employer groups in a single year.

Perhaps most importantly, Hunt said, URAC accreditation helped SVPH “validate and verify our commitment to patient care. It shows we’re walking the walk.”

Osborne highlighted some savings of his own, starting with legal and consulting fees. Pre-accreditation, “we were spending millions of dollars on attorney and consultant fees,” he said. Even after spending all those millions and putting in a lot of time with their outside experts, “they would never 100 percent say we were truly operating within FTC and DOJ standards. We were getting very little return on the money we spent.” That dynamic flipped once URAC entered the picture, Osborne explained.

A year after achieving accreditation, Osborne reported more than $20 million in “realized savings for our attributed population.” Those savings are a direct result of a post-accreditation higher functioning network and other partnerships.

“As we dove a little deeper into the URAC standards, we saw it would allow us to be more operationally effective” and better demonstrate it was conducting itself well within regulatory guidelines.  URAC accreditation allowed PCCN to bring the vast majority of its legal counsel in-house – at a fraction of the cost. Another personnel bonus: Accreditation “helped us define” vague staffing models,” Osborne said.

URAC accreditation also helped PCCN to garner new reimbursements from payors. In some cases, payors had been unwilling to pay anything when PCCN lacked accreditation, he said. “It made us a gold star outfit,” he added.  “URAC brings a lot of credibility to the table” today when PCCN works with current and potential partners and customers, Osborne said.

The outside community has recognized the value of PCCN’s URAC accreditation, too. “We’re getting lots of media attention and high visibility” from media outlets, Osborne said.

Accreditation has also delivered tangible benefits in the competitive north Texas market, said Christopher Crow, M.D., CEO, StratiFi Health and president, Catalyst Health Network. Catalyst has 515 primary care providers, touches 900,000 patient lives, boasts 159 office locations, and employs 70 care team members.

A year into accreditation, Crow said his organization has realized $20 million in savings and exceeded payer quality goals. Accreditation has also helped with payer contracting, operational excellence, national recognition, and increased patient engagement. “URAC is a big piece of our credibility,” Crow said.

Click here to register free for the on-demand webinar, “How Three CINs Achieved Measurable Benefits from the Accreditation Process.”

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