The healthcare landscape is filled with various organizational models designed to enhance care delivery, improve outcomes, and lower costs. Key players in this space include Accountable Care Organizations (ACOs) and Clinically Integrated Networks (CINs). While both models support the shift to value-based care, each has unique benefits and require specific types of member involvement.
Accountable Care Organizations (ACOs)
An Accountable Care Organization is a group of health providers, such as doctors, hospitals, and other healthcare professionals, who voluntarily come together to provide coordinated care to Medicare patients. The primary goal of an ACO is to ensure patients, particularly those with chronic illnesses, get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors.
Key Features
- Value-based Care: ACOs are built around value-based care, where provider compensation is tied to quality outcomes rather than the quantity of services.
- Shared Savings: ACOs participate in shared savings programs, where they earn financial incentives by meeting certain performance metrics related to quality and cost-effectiveness.
- Patient-Centered: The focus is on improving patient care coordination.
- Risk-Baring: ACOs can operate under different delivery models, such as shared savings only or taking on downside financial risk if costs exceed expected targets.
Clinically Integrated Networks (CINs)
A Clinically Integrated Network (CIN) is a legal entity that serves as an organizing structure for healthcare providers to collaborate and improve clinical outcomes across different contracts or payor models. Unlike an ACO, a CIN is more flexible, supporting various contracts.
Key Features
- Coordinated Care: A CIN aims to improve care coordination and standardize treatment protocols across the network to ensure high-quality care for patients.
- Quality Improvement: Members of a CIN share data and best practices to improve clinical outcomes and efficiency.
- Physician-Led: CINs are often physician-driven organizations that focus on aligning incentives for providers, promoting collaboration, and reducing care fragmentation.
- Contracting Power: A CIN can negotiate better contracts with payors based on its ability to demonstrate improvements in quality and reductions in the total cost of care.
Key Differences
Although ACOs and CINs are collaborative entities with similar goals, the primary differences lie in their structure and legal obligations. While an ACO is a contract-based term with payment tied to outcomes, a CIN is an organizing body that can support multiple contracts.
| ACO | CIN | |
| Purpose | Improving care for Medicare patients and achieving cost savings through value-based care. | Broader network aimed to enhance clinical integration and performance across all payors. |
| Financial Model | Operates under shared savings or risk-based contracts tied to Medicare. | Works with both private and public payors, focusing on improving clinical quality and efficiency to negotiate better contracts. |
| Scope of Services | Care coordination and quality improvement for Medicare populations. | Clinical collaboration, performance measurement, and care standardization across network of providers. |
| Incentives | Shared savings for reducing cost and improving quality. | Incentives based on meeting performance metrics across contracts. |
Accountable Care Organizations and Clinically Integrated Networks each play essential roles while serving distinct purposes in advancing value-based care. ACOs focus primarily on delivering coordinated, value-driven care for Medicare patients, while CINs work to enhance clinical quality across multiple payors. By understanding the unique features of ACOs and CINs, healthcare organizations can make informed decisions on which model best supports their strategic objectives in the shift to value-based care.