#07 What is a Clinically Integrated Network? SSM Health physician executive David Theodoro, MD, MBA

Cardiothoracic surgeon and SSM Health CIN Chairman David Theodoro, MD explains the purpose and structure of a Clinically Integrated Network.

Also called commercial ACOs or CINs, are entities which enter into managed care and other reimbursement contracts on behalf of independent physician practices and other providers. Physician and other providers are incented to achieve these results with performance incentives and other compensation in addition to, or in replacement of, traditional billing. CIN contracts with health plans, large employers and other commercial payers deliver higher quality at a lower cost by aligning incentives across these disparate providers, a form of ‘fee-for-value’ or ‘pay-for-performance’.

Federal Stark Laws setup to reduce fraud prior to the P4P trend and other federal and state regulations can penalize or even lead to criminal prosecution for independent physicians negotiating as a group. CINs were created to enable this form of group contracting intended to benefit all healthcare stakeholders especially consumers and commercial payers.

Guest

David Theodoro, MD, MBA
Cardiothoracic Surgeon & Chair, Clinically Integrated Network
SSM Health

Full interview in video, podcast and written article:

http://www.bohseries.com/episodes/7/l...