Clinically Integrated Networks or CINs are gaining in popularity. A detailed agreement is needed between each provider participant and the network. Providers often focus on how many practices have signed up and whether the arrangement is upside only. However, the providers need to understand who will manage the CIN and at what cost to determine whether there will be any funds remaining for distribution. For example, some CIN’s project IT, labor and other costs to run about $3M per year and will have the opportunity to earn only a few million in the first few years based on its value-based contracts. Thus, even upside-only arrangements may result in very little money and carryovers from early years. Providers also need to sketch what expenses they will be expected to cover to provide data, create metrics and reports, and connect EHRs for the CIN. For this reason, it is prudent to ask questions about ramp up and ongoing costs to both the network and the participants. After the financial picture is explained, then the parties can delve into metrics, governance committees, exclusivity, termination rights, data security, and other terms of the CIN agreement. CINs often create value and enhance patient experience but each one is unique in structure and terms so studying the details is essential!
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