Discover How 5 Healthcare Organizations Navigated the Complexities of Becoming Clinically Integrated Networks

| URAC Staff
image of doctors running with  patient on gurney

Discover how five different healthcare organizations navigated the complexities of becoming clinically integrated networks (CINs) to achieve success in the new value-based healthcare economy, in our Industry Insight Report “Clinically Integrated Networks: A Framework for Clinical and Financial Success.

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Structuring clinically integrated networks is complicated. While CINs enable health systems and providers to deliver value-based care, they come with many clinical and operational challenges, including in those related to technology, governance, organizational alignment and care coordination. And there are very real compliance threats. The U.S. Federal Trade Commission, Department of Justice and state regulators closely scrutinize the structures of these networks to safeguard against antitrust violations.

This report explores how these organizations:

  • Engage physicians to help reduce unnecessary ER visits
  • Show strong commitment to collaborating with and supporting physicians
  • Use a centralized approach to improving patient access
  • Enable data analysis across the network to identify treatment and utilization trends, barriers to access, and cost trends
  • Ensure alignment with FTC regulations
  • Leverage URAC accreditation to negotiate with payers

A growing number of CINs are leveraging accreditation to ensure their framework positions their organization to meet the many clinical, organizational and financial challenges they will face. URAC’s Clinical Integration Accreditation program aligns closely with FTC guidance and provides the roadmap healthcare networks need to be clinically integrated and avoid antitrust issues.

“Organizations need to build a framework for sustainable transformation,” says Kylanne Green, president and CEO of URAC. “Going through URAC’s accreditation process is a path for sustainable transformation because it helps organizations ensure the systems, governance, culture, teams, and metrics are in place for success. Without this framework, a network would fail to achieve quality goals and could possibly violate antitrust laws.”

Phoenix Children’s Care Network (PCCN), which is URAC accredited for clinical integration, landed a contract with a commercial health plan to serve as its exclusive network for pediatric care.  “Our URAC accreditation showed that we have all of the processes and governance in place,” says Casey Osborne, vice president of PCCN. “The fact that we’re accredited by URAC has allowed us and the payer to focus more on operationalizing the product and less on reviewing our capabilities and core competencies.”

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