DHG Healthcare, a company that provides advisory and accounting services to the healthcare community, released a report clearly defining clinical integration and the industry forces driving its popularity.
According to the report, clinical integration is commonly defined as "a network of providers working together, using proven protocols and measures, to coordinate patient care, improve quality, decrease cost and demonstrate value to the market." Attempts to define a clinically integrated network started as early as 1996 when the Department of Justice and the Federal Trade Commission defined it as "an active and ongoing program to evaluate and modify practice patterns by the network's physician participants to create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality."
Although the FTC's approval is no longer required for the formation of a clinically integrated network, its definition of clinical integration is still the basis for the design. However, there still are misconceptions about clinically integrated networks, provoking the following lists:
According to DHG Healthcare, clinical integration is not:
• Simply physician employment
• Led solely by hospitals
• A reduction of choice or limiting services
• Only based on a new electronic medical records system
• Simply a mechanism to gain negotiating leverage over payers
• A stand-alone independent practice association/physician-hospital organization messenger contract model
• A return to capitation of the 1990s
On the other hand, clinical integration is:
• A network led by select employed and private practice physicians typically working with a hospital to improve quality and efficiency of care
• Increased coordination between providers, supported by reliable data, to improve outcomes and reduce waste
• A legal structure that allows members of the network to be financially rewarded for demonstrated performance
• A vehicle that allows the network to collectively negotiate contracts on behalf of its members
• A model that lays the foundation for the future realities of accountable care
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