Frequently Asked Questions

CIN is a term used to describe a variety of different collaborative efforts among physicians and healthcare systems designed to deliver The Triple Aim — improved patient experience, better quality of care and lower healthcare costs. A CIN brings together healthcare systems, physicians employed by healthcare systems and physicians practicing in privately owned medical groups (also known as independent physicians). CINs have existed for decades but became common following passage of the Affordable Care Act (ACA) in 2010. ACA provided incentives for the formation of CINs and removed legal barriers to collaboration among providers.

Novant Health has always been committed to improving the health of our communities and providing care to individuals that is high quality, safe, patient-centered and affordable. However, the healthcare industry is in a transition period, moving from an episodic payment model toward reimbursement models that center around "value" — paying for quality, not quantity. Novant Health will need to understand how to thrive in a market where we manage patients under new risk arrangements — risking higher losses if the care we deliver costs us more than what we are reimbursed, but also creating the opportunity to capture greater gains if we are successful in delivering the highest possible quality for the lowest possible cost.

It will require us to collaborate with providers of care outside our system and anticipate how quickly we shift to payment models that can deliver value.

Value is about delivering outcomes that matter to patients. We must:

• Improve the quality of care our patients receive by:
  • Reducing unnecessary variation
  • Preventing or slowing the progression of disease
  • Identifying the right level of care, provided at the right time and in the right location for each patient
• Embody our value of teamwork and learn to:
  • Partner with providers, payors and employers to reduce costs
  • Avoid unnecessary treatments that don't help patients get better while focusing on the ones that will
  • Manage care and outcomes across the entire care continuum, within and beyond our clinics and hospitals

According to the Centers for Medicare and Medicaid Services, an Accountable Care Organization (ACO) is a type of CIN accountable specifically for Medicare beneficiaries. There are additional legal requirements regarding the structure and operations of a Medicare ACO that are not applicable to all CINs. NHCIN may opt to transition to an ACO structure in the future but will not initially focus on government payors.

Market forces already signal a shift away from a fee-for-service model toward a value-based approach. By creating NHCIN, Novant Health is joining with physician partners to implement a new value-based paradigm for care to benefit our communities. We will collectively develop clinical pathways and protocols, create improved systems, share and analyze clinical outcomes data, and determine the most efficient way to deliver care for our patients. The time to create capabilities to realize The Triple Aim is now; and creating NHCIN positions participating physicians and Novant Health well for the increasing shift toward value-based care.

NHCIN is a wholly-owned subsidiary of Novant Health. NHCIN has its own board of directors and operational structure with a balance among Novant Health and independent physicians. Details regarding the operational design and governance of NHCIN are outlined in the operating agreement and participating provider agreements, both of which are available to physicians interested in joining NHCIN after signing a nondisclosure agreement.

CINs are typically state-based. Novant Health's first CIN will be in North Carolina, focusing on its two largest markets, Charlotte and Winston-Salem.

Novant Health is taking an inclusive approach to the recruitment of high quality physicians to join NHCIN. Independent physicians will be invited to join Novant Health physicians and participate in NHCIN governance and operational responsibilities.

• Sign a participating provider agreement
• Successfully complete NHCIN credentialing process and remain credentialed by NHCIN
• Engage in ongoing network performance management activities that meaningfully improve patient outcomes and efficiency of care
• Share cost, quality and outcomes data through NHCIN
• Bring real value to the patients we serve through the efficient, appropriate utilization of healthcare resources

No. NHCIN will require providers to invest time in operating the network but will not require a membership fee. Operations examples include involvement in the detailed development of evidence-based clinical best practice guidelines, the creation of chronic care pathways for post-acute services and ongoing practice improvement initiatives within NHCIN. However, current credentialing fees will apply, and providers will need to meet NHCIN infrastructure requirements.

No. While a common EMR/EHR across all providers can accelerate and simplify data exchange within a CIN, it is not expected or needed to establish a successful clinical integration model. NHCIN will develop data exchange mechanisms to enable the bi-directional flow of data and real-time analysis.

No, there is no requirement to work exclusively with a single network. The only potential exception is participation in a Medicare ACO. In a Medicare ACO, providers with "attributed lives" may only participate in one ACO. This typically, though not always, impacts primary care physicians, rather than specialists. As noted above, NHCIN will not initially focus on government payors.

Although CINs do not always participate with value-based payment models, these arrangements are often efficient ways to align financial incentives and reward physicians for providing high value care to their patients. NHCIN will have the ability to contract with payors through many value-based reimbursement models. Options NHCIN may explore include:

• Employee health plan: NHCIN will promote value for Novant Health's team members. Team members are a limited population of patients for which Novant Health is already assuming full financial risk. Delivering value to our team members will build the foundation for success with other payors and employers.
• Narrow network plan: NHCIN will explore opportunities with commercial payors and self-insured employers to provide health services to specified cohorts of individuals, balancing a narrowing of care options with lower premium costs for patients.
• Shared savings program: This model can apply to almost any payor/provider relationship and often combines traditional fee-for-service contracts with pay-for-performance (P4P) opportunities. The P4P opportunities may be linked to cost savings, quality benchmarks or a combination and will be determined by NHCIN physicians in collaboration with each payor.
• Bundled payments: NHCIN will explore contracts to receive a single payment for a defined service or set of services provided by a hospital, physician and/or post-acute provider or facility.

• Become a preferred network provider for members
• Use care management resources provided by NHCIN
• Identify and measure best practices
• Demonstrate improved patient outcomes
• Potential to receive financial rewards for value-based outcomes and achievements

Patients

• Access to information, enhancing their ability to make informed healthcare decisions
• Better value for their healthcare dollars
• Development and implementation of quality care initiatives and the use of best practice pathways, all designed by their physicians in collaboration with other community physicians

Physicians

• Accurate collection and reporting of outcomes and other quality data
• Potential to use quality data for board certification requirements
• Resources to identify, develop and achieve best practice pathways
• Operational support for participation in value-based payment programs

Novant Health

• Achieve the Triple Aim and succeed in the value-based arena
• Access to a larger pool of physician expertise regarding best practices and protocol development
• Access to a broader network of physicians providing the highest quality care for the patients and communities we serve together

Employers/payors

• Improve and accurately track the wellness of beneficiaries
• Document and ensure high quality care for beneficiaries
• Increased ability to manage rising care costs
• Improve overall patient health while decreasing absenteeism and increasing productivity and quality of life for the workforce

• Greater continuity of care and satisfaction for patients through increased clinical data sharing and flow of information among NHCIN providers, allowing us to make informed decisions about the quality of care delivered and cost to deliver it
• Seamless connectivity with independent providers participating in NHCIN, improving ease of access to specialty care, timeliness of consult notes and test results and flow of referrals both into and out of Novant Health
• Broader alignment on referral timeframes
• Expanded collective scope of knowledge to inform the development of clinical pathways and protocols across the spectrum of care

• Greater continuity of care and satisfaction for patients through increased clinical data sharing and flow of information among NHCIN providers, allowing us to make informed decisions about the quality of care delivered and cost to deliver it
• Central role in building the care pathways needed to achieve the Triple Aim for our patients
• Framework and support needed to shift from fee-for-service to value-based care, a transition being mandated by government and commercial payors
• Increased collaboration with Novant Health physicians and leadership at the NHCIN board and committee levels to create the strategies needed to pursue value-based payment models and drive cultural change