innovative health alliance
The Capital Region's First Clinically Integrated Network
 
 

For general questions or additional information about Accountable Care Organizations, please visit www.medicare.gov/acos.html
or call 1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048.

Frequently Asked Questions

 
 

Health care is complicated and filled with industry acronyms that are often hard to keep track of and understand. The following are answers to some often asked questions and definitions for many acronyms related to the work of clinical integration.

1. 

What is a Clinically Integrated Network (CIN)?

A CIN is a partnership between physicians, hospitals and health systems that is collectively committed to improve the quality and efficiency of care delivered to the patient population it serves.


2. 

What is an Accountable Care Organization (ACO)?

An ACO is a network of physicians and other health care providers who are willing to work together and accept responsibility to improve quality and reduce the costs of health care services for a defined population. It is believed that greater clinical integration, collaboration and shared accountability among a network of independent physicians, employed physicians, hospitals, and regional partners will create better health outcomes.


3. 

What is the Medicare Shared Savings Program (MSSP)?

The MSSP was created under the federal Affordable Care Act to help health care providers better coordinate care for Medicare fee-for-service beneficiaries and reduce unnecessary costs through approved accountable care organizations, or ACOs. The MSSP is not a Medicare Advantage plan or an HMO. Participation in MSSP is voluntary. Beneficiaries with fee-for-service Medicare still have the right to use any doctor or hospital that accepts Medicare, at any time.


4.

What is IHANY?

IHANY is the acronym for Innovative Health Alliance of New York, LLC, a collaborative started in 2014 to provide the organizational structure needed to create the first Clinically Integrated Network in New York’s Capital Region. The new CIN allows private physician groups, health systems and health providers to work together in coordinating and improving the delivery of health care, as well as participating in new methods of reimbursement.

This innovative business partnership started with founding members St. Peter’s Health Partners (SPHP) and Ellis Medicine (Ellis) and is growing to include numerous physicians, other health systems such as St. Mary’s Healthcare, Amsterdam, and providers such as Hometown Health. Today, IHANY is a physician-led effort focused on access, quality, population health, and health costs. IHANY’s Accountable Care Organization was approved to participate in the Medicare Shared Savings Program beginning in January 2015.


5. 

What are the benefits of clinical integration?

 

Doctors and hospitals nationwide are implementing clinical integration programs to improve the health of the communities they serve, and to ensure future success in the evolving health care industry:

Doctors and hospitals nationwide are implementing clinical integration programs to improve the health of the communities they serve, and to ensure future success in the evolving health care industry:

1.  Clinical integration provides patients with: 

  • a better value for their health care dollar; 
  • more effective care management and outreach from a trusted source, their physician; 
  • more reliable information to support their choice of health plans, physicians, and hospitals; 
  • more accurate and meaningful provider ratings; and 
  • greater stability in their relationship with their doctor and hospital, and less likelihood they will need to choose new health care providers every year.

2.  Clinical integration allows physicians to: 

  • demonstrate their quality to current and future patients; 
  • choose the clinical measures against which they will be evaluated; 
  • enhance revenue through better management of chronic patients; 
  • gather collective support for building necessary infrastructure; and 
  • seek higher reimbursement that reflects the higher value they can furnish patients and health plans.

3.  Clinical integration gives hospitals the ability to: 

  • demonstrate their quality to current and future patients; 
  • enlist physician support for hospital initiatives, including compliance with “core measures,” clinical pathways, standardized order sets, and supply chain management initiatives; 
  • develop a better, more collaborative relationship with their medical staff; 
  • improve performance on hospital pay-for-performance measures; and
  • position themselves at an advantage in the market on the basis of quality.

4.  Clinical integration gives employers: 

  • the ability to more effectively manage the health care costs of employees and their dependents through the purchase of better, more efficient health care services; 
  • increased employee productivity and reduced absenteeism, through the better management of chronic disease; 
  • lower health care costs over the long term, through the reduction of variation in physician practice patterns; and
  • more reliable information to support conversion to consumer-driven health insurance products.

For more information about health trends aimed at improving the health care delivery system, visit that National Institute of Health’s website.

For more information about the Medicare Shared Savings Program and Accountable Care Organizations, please visit the Centers for Medicare & Medicaid Services website.

    For general questions or additional information about Accountable Care Organizations, please visit www.medicare.gov/acos.html or call 1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048.