How health IT and artificial intelligence can help clinically integrated networks manage risk — and contract-based performance

As new value-based payment models continue to be introduced and the healthcare industry adjusts to changing regulatory demands, provider reimbursement will depend more and more on the quality of care delivered. And in many clinically integrated networks (CINs), these new payment models are driving meaningful changes in how providers view and manage healthcare resources.

While CINs may not be designed specifically to help negotiate contracts, they do help demonstrate value (that is, the highest-quality care at the lowest cost), which in turn helps them succeed with various kinds of value-based contracts.

Within the spectrum of value-based reimbursement, a CIN may hold contracts for pay-for-performance, upside-only risk, two-sided risk and bundled payments. To succeed in these kinds of agreements, we believe a CIN requires a cluster of capabilities that supports key factors such as provider performance management; financial risk management; and the ability to correlate quality, cost and efficiency data.

Those capabilities could include an advanced health IT infrastructure; the ability to collect, integrate and analyze data; and artificial intelligence (AI) to apply myriad risk models.

With the right analytic insights, a CIN can not only stratify patients by risk, but also provide insights in near real-time about which areas of care delivery are costing the most and why, and what CINs can do about it.