May 25, 2021

One of the questions that I’m frequently asked is whether physicians should join a provider network?  First, let’s get the alphabet soup mumbo jumbo out of the way. IPA stands for Independent Practice Association and CIN stands for Clinically Integrated Network. Today, I’m going to talk about the things that you will want to think about when considering if you should sign up for one of these networks.

As a physician participating in one of these networks, you’ll be paid according to the provider network’s master contracts. I also want to be clear that you can also see patients outside of the insurers contracted through the provider network. You don’t have to limit your practice to only patients within the network.

Independent Practice Association (IPA)

• Loosely formed alliances among physicians
• Primarily focused on independent private practicing physicians
• Main purpose for forming an IPA is for payer contracting
• With the recent changes in reimbursement from fee-for-service to value-based, IPAs that aren’t not clinically integrated can’t effectively negotiate payer contracts

Clinically Integrated Network (CIN):

• Consists of a group of providers who come together to improve quality and cost efficiency in healthcare delivery
• Provide higher value to the consumer of healthcare services
• Employ best practice, process improvement methodologies and measure true cost and outcome metrics via direct methods such as patient surveys and activity-based cost accounting methods
• Facilitate referral optimization by matching patient needs with those providers best capable of meeting those needs
• Contract for services on behalf of their members
• Usually include a care management or care coordination infrastructure as well as an IT infrastructure that serves multiple purposes

In the end, you have to do the due diligence to make sure that you will be gaining enough—either in better contracted rates or reduced overhead—to make it worth joining a provider network.

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