CIN Analyzer
🛡️ Public data only — no PHI permitted on this instance.
Clinical Integration Network Analyzer
Provider roster · payer contracts · quality measures · network adequacy · compliance — 1,485 corpus deals
Network Providers
600
Attributed Lives
250,000
Annual Contribution
$7.02M
Expected Distribution
$43.93M
Quality Score
0.818
Network Adequacy
37.0%
Rating
DEVELOPING
Corpus Deals
1,485
Provider Member Roster — Specialty, Lives, Quality, Engagement
| Provider Group | Category | Providers | Lives | Contrib ($M) | Quality | Engagement | Tenure (yr) |
|---|---|---|---|---|---|---|---|
| Primary Care Network | PCP | 228 | 140,904 | $2.736 | 0.880 | 73 | 6.0 |
| Cardiology Associates | Specialist | 48 | 23,424 | $0.576 | 0.720 | 63 | 7.0 |
| Orthopedic Group | Specialist | 42 | 16,002 | $0.546 | 0.830 | 66 | 7.0 |
| Gastroenterology | Specialist | 30 | 13,470 | $0.330 | 0.850 | 84 | 8.0 |
| OB/GYN Women's Health | Specialist | 36 | 19,296 | $0.360 | 0.700 | 91 | 6.0 |
| Psychiatry / Behavioral | Specialist | 30 | 11,430 | $0.390 | 0.830 | 86 | 5.0 |
| Endocrinology | Specialist | 24 | 14,376 | $0.216 | 0.690 | 84 | 3.0 |
| Pulmonology | Specialist | 24 | 12,792 | $0.312 | 0.850 | 78 | 7.0 |
| Oncology | Specialist | 30 | 12,960 | $0.360 | 0.800 | 57 | 2.0 |
| Dermatology | Specialist | 18 | 7,794 | $0.234 | 0.690 | 78 | 6.0 |
| Urology | Specialist | 18 | 7,038 | $0.198 | 0.750 | 56 | 3.0 |
| Ophthalmology | Specialist | 24 | 9,672 | $0.264 | 0.730 | 58 | 2.0 |
| Nephrology | Specialist | 18 | 10,422 | $0.198 | 0.790 | 74 | 7.0 |
| Pediatrics | PCP | 30 | 18,480 | $0.300 | 0.880 | 81 | 4.0 |
Payer Contract Portfolio — Shared Savings & Risk
| Payer | Type | Lives | Premium PPMY | Shared Savings % | Quality Weight | Expected Savings ($M) | Distribution ($M) |
|---|---|---|---|---|---|---|---|
| BCBS Network PPO | Shared Savings | 65,000 | $4,950.00 | 50.0% | 35% | $13.19 | $5.31 |
| UHC Commercial | Shared Savings | 55,000 | $4,850.00 | 45.0% | 30% | $15.20 | $5.41 |
| MA Global Risk (UHC) | Full-Risk MA | 45,000 | $11,800.00 | 95.0% | 25% | $22.83 | $16.81 |
| MA Shared Savings (Humana) | MSSP/Shared | 30,000 | $10,950.00 | 65.0% | 40% | $13.14 | $7.00 |
| Aetna Commercial | Shared Savings | 25,000 | $4,550.00 | 40.0% | 30% | $5.57 | $1.76 |
| Medicare ACO REACH | Full-Risk | 20,000 | $12,800.00 | 90.0% | 50% | $9.98 | $7.64 |
| State Medicaid MCO | Quality Bonus | 10,000 | $5,850.00 | 0.0% | 70% | $2.52 | $0.00 |
Quality Measure Performance vs HEDIS/STARS Benchmark
| Measure | Domain | Current | Benchmark | Gap | Weight | Financial Impact ($M) |
|---|---|---|---|---|---|---|
| Diabetes HbA1c Control <8 | Chronic | 72.0% | 78.0% | -6.0pp | 12% | $1.85 |
| Hypertension BP Control <140/90 | Chronic | 68.0% | 75.0% | -7.0pp | 10% | $1.42 |
| Breast Cancer Screening 50-74 | Preventive | 74.0% | 80.0% | -6.0pp | 8% | $0.95 |
| Colorectal Cancer Screening 50-75 | Preventive | 61.0% | 72.0% | -11.0pp | 8% | $1.18 |
| Annual Wellness Visit Completion | Preventive | 82.0% | 88.0% | -6.0pp | 6% | $0.68 |
| Behavioral Health Follow-Up 7d | Behavioral | 48.0% | 60.0% | -12.0pp | 8% | $1.32 |
| Readmission Rate 30-Day | Utilization | 14.8% | 12.5% | -2.3pp | 10% | $2.45 |
| ED Utilization / 1000 | Utilization | 385.0 | 340.0 | -45.0 | 8% | $1.85 |
| Generic Dispensing Rate | Pharmacy | 86.0% | 90.0% | -4.0pp | 5% | $0.48 |
| Medicare Wellness (AWV + PHA) | Preventive | 68.0% | 78.0% | -10.0pp | 5% | $0.72 |
| Care Gap Closure < 90d | Chronic | 54.0% | 70.0% | -16.0pp | 10% | $1.22 |
| Patient Experience (CAHPS) | Experience | 82.5 | 88.0 | -5.5 | 10% | $1.15 |
Geographic Coverage & Network Adequacy
| Market | Attributed Lives | PCPs | Specialists | Adequacy | Growth |
|---|---|---|---|---|---|
| Metro Core | 87,500 | 102 | 204 | gap | priority expansion |
| Metro Suburban | 70,000 | 79 | 169 | gap | priority expansion |
| Secondary Cities | 45,000 | 84 | 171 | adequate | fill-in needed |
| Tertiary / Rural Adjacent | 30,000 | 83 | 175 | adequate | fill-in needed |
| Border Counties | 17,500 | 48 | 101 | adequate | fill-in needed |
Distribution Cohorts — Quality-Weighted Payment
| Cohort | Provider Count | Avg Dist/Provider ($k) | Quality Bonus ($k) | Productivity Bonus ($k) | Total Distribution ($M) |
|---|---|---|---|---|---|
| Top Quartile Quality | 150 | $140.6 | $77.3 | $63.3 | $21.09 |
| Above Avg | 180 | $68.3 | $37.6 | $30.8 | $12.30 |
| Avg | 180 | $43.9 | $24.2 | $19.8 | $7.91 |
| Below Avg | 72 | $30.5 | $16.8 | $13.7 | $2.20 |
| Bottom Quartile | 18 | $24.4 | $13.4 | $11.0 | $0.44 |
Regulatory Compliance — FTC / Stark / Anti-Kickback / State Insurance
| Regulation | Status | Last Review | Remediation | Exposure ($k) |
|---|---|---|---|---|
| FTC Statement 9 (CIN Safety Zone) | compliant | 2024-09-15 | none | $0 |
| Stark Law In-Office Ancillary | compliant | 2024-07-22 | none | $0 |
| Anti-Kickback Statute | compliant | 2024-10-02 | none | $0 |
| State Insurance Licensure (risk-bearing) | monitoring | 2024-06-15 | file update Q1 2027 | $150 |
| Medicare ACO Waiver Compliance | compliant | 2024-08-30 | none | $0 |
| Data Use Agreement (payer-shared PHI) | minor gap | 2024-05-12 | 6 pending signatures | $85 |
| HIPAA Security (data exchange) | compliant | 2024-09-01 | none | $0 |
| OIG Advisory Opinion - Distribution | monitoring | 2023-11-20 | methodology review | $240 |
CIN Value Rating: DEVELOPING.
600 providers across 5 markets support 250,000 attributed lives.
Quality score 0.818 (weight-avg); adequacy 37.0% of markets.
Expected $43.93M distribution across 7 payer contracts.
Quality gap closure represents $15.27M additional annual shared savings.
Compliance exposure $475K on monitoring items — manageable but requires Q1 remediation.
CINs with strong quality + full risk contracts are fundamentally different from traditional PPO networks — they capture value rather than rent-seek it.