To Join or Not to Join a Clinically Integrated Network (CIN)? That Is the Question.

Many medical businesses today face a critical decision: should they join a Clinically Integrated Network (CIN)?

To answer this, we first need to break down where contracts come from. Medical practices can hold individual contracts with managed care networks and insurance companies. In the current market, there are roughly 900 insurance companies, yet 44% of the market is dominated by just a top five. When you consider that each insurance company offers multiple plans, a practice may be dealing with over a thousand potential plan variations.

So, what are your options for navigating this maze? Generally, they fall into three buckets: negotiating directly with a select few, joining a “messenger model,” or joining a CIN.

Option 1: Direct Negotiation

You can select a few top insurance companies in your area and negotiate directly.

  • The Reality: This is a daunting task. Negotiations can take six months to a year and often recur every 1 to 3 years.

  • The Cost: You will essentially be in a state of constant negotiation. This requires hiring a skilled employee or a third-party contracting company, which can cost tens of thousands of dollars per year (sometimes per contract). For a small group, this is rarely affordable.

Option 2: The Messenger Model

This is frequently done through a hospital or general network. The network acts as a messenger, sending you rates from insurance companies.

  • The Reality: These rates are usually non-negotiable. It is a “take it or leave it” scenario.

  • The Trade-off: You pay network dues, and they handle the administration. You never speak to the insurance; if there is a problem, the network handles it.

  • The Downside: You have zero say over the rate. The network cannot negotiate on your behalf. Ultimately, this is a win for the insurance companies, as they dictate the rates entirely.

Option 3: The Clinically Integrated Network (CIN)

In case you aren’t familiar, a CIN is “a group of independent healthcare providers, often physicians and hospitals, who organize around shared clinical protocols, data, and performance goals so they can improve quality, coordinate care, and (when they truly integrate) contract with payers jointly without running afoul of antitrust law.”

Why go with a CIN? Ideally, it allows businesses to stay private and independent while leveraging the power of a larger network that can and will negotiate rates on their behalf.

Sounds dreamy, right? Not so fast.

The “Catches” of the CIN Model

Before you sign, you need to look closer. While CINs offer leverage, they often come with significant strings attached that can impact your autonomy and revenue.

1. The “Blind Sign” First, they often want you to join without knowing the rates, as these are considered proprietary. You are essentially asked to buy a two-million-dollar house without seeing the inside first.

2. Exclusivity and Handcuffs

  • Loss of Existing Contracts: You typically cannot keep your own hard-won contracts.

  • Network Exclusivity: You are often forbidden from holding a contract with any other network.

  • Forced Participation: You may be required to sign with the CIN’s “most important” payer contracts, regardless of whether the rates are favorable to your specific practice.

3. Performance Penalties CINs rely on data and metrics. However, you may face quality metrics that are difficult or even unattainable for your patient population. If you don’t meet these metrics, you risk getting fined or having payments withheld. (And it’s worth asking: who does that withheld money go to?)

4. The Referral Trap Some CINs require you to refer patients exclusively to the hospital in charge of the network, even if that isn’t in the best interest of the patient.

5. One-Sided Legal Terms Contracts are frequently non-negotiable and written completely in favor of the network, leaving you little recourse if the relationship turns sour.

How Reveon Health Helps You Decide

With so many variables, you shouldn’t have to guess. Reveon Health allows you to strip away the mystery and compare the data directly.

  • Apples-to-Apples Comparison: Compare the rates you get individually against messenger model rates and various CIN offers.

  • Meaningful CPT Analysis: It doesn’t help to have a great negotiated rate on a CPT code you rarely use, only to accept a poor rate on your high-volume codes. Reveon helps you analyze rates based on the codes that drive your business.

  • Model Comparison: Compare different CIN rates against each other to determine which model actually benefits your specialty.

Don’t sign blindly. Use data to decide what is best for your practice, your revenue, and your independence.

Click here for more to consider on Clinically Integrated Networks.

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