Q: What is “Clinical Integration”?
A: Clinical Integration is an effort among physicians, often in collaboration with a hospital or health system, to develop active and ongoing clinical initiatives that are designed to control costs and improve the quality of health care services.
Q: What are the characteristics of effective Clinical Integration initiatives?
A: An effective clinical integration program will contain initiatives that:
- Provide measurable results which
- Are used to evaluate physician performance and
- Result in concrete remediation of that performance.
Such a program should foster interdependence among providers and enable them to achieve higher quality and greater cost-effectiveness than they likely could accomplish on their own.
Q: In “real life,” what does a clinically-integrated network of independent physicians look like?
A: In many instances, clinical integration has involved independent doctors on the medical staff of the same hospital or hospital system who join together in an organization that allows them to:
- Identify and adopt clinical protocols for the treatment of particular disease states.
- Develop systems to monitor compliance with the adopted protocols on both an inpatient and outpatient basis.
- Enter into contractual arrangements with fee-for-service health plans in a way that financially recognizes the physicians’ efforts to improve health care quality and efficiency.
Q: Will physicians be involved in the development of Clinical Integration and the leadership of this endeavor?
A: Yes. Identified physician leaders along with health system leadership will work to create a new independent physician network. This physician network will be governed by a board composed predominantly of doctors, and will operate for the explicit purpose of developing and implementing a Clinical Integration Program, on the basis of which the network would negotiate “pay-for-performance” arrangements and related provider contracts with PPOs and other fee-for-service health plans.
Q: What will physicians need to do in order to participate in the Clinical Integration Program?
A: Physicians are asked to do the following:
- Choose whether they will participate in the Clinical Integration Program by signing a Network Participation Agreement for their practice. Membership in the Clinical Integration Program will be completely voluntary.
- Physicians collaborate with their physician colleagues and the health system in the development and adoption of the Clinical Integration Program – a collection of clinical initiatives that will enhance the quality, service, and cost-effectiveness of patient care.
- Physicians hold themselves and each other accountable for compliance with the initiatives of the Clinical Integration Program, including its disciplinary and remediation efforts should physicians not meet the benchmarks set by the Clinical Integration Program.
Q: Will participation in the Clinical Integration Program require physicians to change the way they practice medicine?
A: Yes. Participation in the quality and care management initiatives of the Clinical Integration Program will require significant time and attention from physicians and their office staff. But, in return, participating physicians will be eligible to obtain financial rewards for their achievements through the Clinical Integration Program, funded by contracted health plans. The amount of incentive payments will depend on both the physician’s personal score and the overall score of the organization. This latter component highlights the importance of physicians working together to improve care.
Q: Why are physicians across the country engaging in Clinical Integration?
A: Physicians have numerous and overlapping motivations for joining together in clinically-integrated networks:
- Enhance the quality of the care provided to patients.
- Develop their own alternatives to health plan “report cards” and other initiatives that may not accurately assess physicians.
- Provide access to technological and quality improvement infrastructure.
- Allow networks of physicians to market themselves on the basis of quality.
Q: Why do a growing number of physicians believe clinical integration to be a good business and health care strategy?
A: Doctors nationwide are implementing clinical integration programs not merely for reasons of antitrust compliance, but rather because they believe in its value proposition:
- 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.
- 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 and supporting clinical staff.
- Increased engagement with their clinical team.
- 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.
- More reliable information to support conversion to consumer-driven health insurance products.
Q: How can I receive more information regarding the details of the Clinical Integration Program?