Hospitals and Physician Groups
Value-Based Contracting Networks

 

As reforms mandated by the PPACA unfold, there are a growing number new provider contracting entities working with payers to deliver value-based care. Increasingly, SSB's practice centers on planning and development of these value-based networks, which broadly fall into four categories:

Clinically Integrated Organization (CIO)

CIO's are state-based, legal entities typically comprised of physicians, hospital(s) and other providers structured to hold value-based payer contracts. These entities must be structured and organized to meet FTC criteria for "meaningful clinical integration".

Accountable Care Organization (ACO)

ACO technically refers to a state-based entity participating in the Medicare Shared Savings Program defined in the PPACA However, term has been used more generically to broadly encompass same concept as a CIO.

Specialty ClO

CIOs focused on specific medical/surgical subspecialties (e.g., neurosciences, orthopedics, CV, oncology, etc.) that can hold contracts as part of a larger CIO/ACO or directly with additional payers.

SuperCIO

Large at-risk contracting entities that bring together individual system CIOs into combined, market dominant networks that provide new opportunities to share the cost of infrastructure, technology and clinical expertise among and between providers.