CINs Discover Accreditation Benefits Before, During and After the Process

| URAC Staff

The benefits of URAC Clinical Integration accreditation are crystal clear to Ginger Hines, the new senior director of operations at the Seattle Children’s Care Network (SCCN).

Operating without such accreditation at her previous employer, an adult accountable care organization, “we spent a considerable amount of resources and money on dedicated compliance staff and legal counsel,” she says.

With the help of URAC, SCCN has been able to develop a more robust clinically integrated network (CIN). Leveraged effectively, a CIN “creates a high degree of interdependence and cooperation among the clinically integrated providers to control costs and ensure quality,” she told attendees of “The Path to Clinical Integration: Two Children’s CINs Tell How They Achieved a Framework for Success with Accreditation,” a webinar hosted by URAC.

However, while having a high-quality CIN sounds great, Hines allows it isn’t an easy thing to achieve.  SCCN decided any solution must be able to address seven key areas:

  • Physician governance
  • Contract modeling and negotiation
  • Clinical and financial integration portals
  • Legal analysis and options
  • Incentive alignment
  • Conditions of participation
  • Quality and performance measures

URAC provides 35 standards for Clinical Integration Accreditation, each of which is clearly tied to Federal Trade Commission (FTC) requirements, she noted. “URAC has been very firm and clear from the beginning,” Hines said. The requirements can appear daunting, but taking the steps to meet them is more than worth it, she added.

As part of its implementation process, SCCN incorporated URACs standards via seven existing, internal work streams:

  • Governance and legal
  • Analytics
  • Operations
  • Population health
  • Care management
  • Quality
  • Finance

It took SCNN about eight months to be ready for the desktop review step of URAC’s accreditation process. “One of the best things about the process was that it forced compliance for all operational processes,” Hines said. In addition to honing company-wide organizational skills, SCCN also came out of the process better able to tell a cohesive story about its approach to clinical integration, bolstered by the documentation to back it up, she added. Another bonus: “It’s helping us to onboard new employees.” SCCN anticipates a URAC onsite review in March 2018.

At the other end of the spectrum, Casey Osborne, vice president, Phoenix Children’s Care Network (PCCN), has already enjoyed some of the benefits of accreditation. He highlighted four areas:

  • Legal and Compliance: Corporate counsel feels PCCN has achieved a level of integration sufficient for Department of Justice and FTC oversight. Before URAC, “I was spending more time on the phone with my outside counsel and attorneys across the country than I was negotiating deals or operating PCCN,” Osborne said.
  • Set the foundation: After completing URAC accreditation, PCCN emerged with a much more defined organization and network.
  • Credibility with payers: They “stopped questioning our capabilities,” he said. In fact, relationships with payers became more valuable, in part, because PCCN could now handle more advanced contracting and payment models.
  • Delegation and services: Contracting and payment models for delegated services, administrative services and value-based agreements progressed more quickly.

The benefits of accreditation also have other ripple effects, he said. For example, PCCN’s CEO has publicly stated that he feels comfortable that he is moving things in the right direction strategically, in part, because he knows, “we are a well-oiled machine running under strict principles tied back to URAC,” Osborne said.

He shared another way URAC has positively impacted his organization. Post-accreditation, Osborne said, it’s not uncommon for professionals dealing with a new challenge to ask, “What would URAC do?”

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