URAC Report Highlights the Complexities and Rewards of Becoming a Clinically Integrated Network

Tuesday, August 1st, 2017

WASHINGTON, DC – August 1, 2017 – URAC, a nonprofit, healthcare accreditor, today released a new Industry Insight Report for hospitals, health systems and provider networks entitled “Clinically Integrated Networks: A Framework for Clinical and Financial Success.

The report demonstrates how five distinct healthcare organizations have navigated the complexities of becoming clinically integrated networks (CINs) to achieve success in the new value-based healthcare economy.

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 those related to technology, governance, organizational alignment and care coordination. And there are very real compliance threats. The U.S. Federal Trade Commission (FTC), Department of Justice and state regulators closely scrutinize the structures of these networks to safeguard against antitrust violations.

The Industry Insight Report reveals 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 utilizing 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.”

For example, the report features Phoenix Children’s Care Network (PCCN), which is URAC accredited for clinical integration, and recently 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.”

URAC’s Industry Insight Report, “Clinically Integrated Networks: A Framework for Clinical and Financial Success,” can be downloaded for free at http://info.urac.org/clinical-integration-insight.

About URAC

Founded in 1990, URAC is the independent leader in advancing healthcare quality through leadership, accreditation, measurement and innovation. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in healthcare and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC’s evidence-based measures and standards are developed through inclusive engagement with a broad range of stakeholders committed to improving the quality of healthcare. For more information, visit urac.org.

 

Media Contact:
Che Parker, MA
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cparker@urac.org 
202-326-3968

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