Clinical Integration: A Joint Physician-Hospital Strategy to Enhance the Value of Care

Hospitals and health systems are constantly seeking new ways to improve the quality and cost of care. Increasingly, hospitals and physicians are turning to clinical integration as a strategy to jointly partner to increase quality and efficiency efforts. Clinical integration is "a core initiative that hospitals and physicians need to pay attention to in order to have a sustainable future that will be characterized by value-based payment models," says Dennis Butts, a manager in the healthcare strategy practice of Dixon Hughes Goodman, a certified public accounting firm. He explains how hospitals and physicians can use clinical integration as a strategy to reach quality and cost goals.

Dennis Butts explains the benefits of clinical integration.Aligning physicians and hospitals

Physician partners are necessary for healthcare quality and cost improvement because their decisions control 70 cents of every dollar spent within the healthcare delivery system, according to Mr. Butts. "Hospitals recognize they have to provide a lot more valuable care at a lower cost moving into the future, and they need the full engagement of physicians to make that happen," he says. Hospitals can engage physicians in improving care through clinical integration — forming a collaborative network of providers following proven protocols and measures to improve patient care, decrease costs and demonstrate value to the market.      

A flexible alignment model
"Clinical integration is an alignment strategy to work with both employed and independent physicians to achieve [cost and quality] objectives," Mr. Butts says. This is a major benefit of clinical integration. Most hospitals will continue to have a mixed medical staff of employed and independent physicians. Clinical integration provides an alignment vehicle for hospitals to engage the entire medical staff without the financial burden of employing all the physicians necessary to achieve programmatic results, according to Mr. Butts.

However, if hospitals want to use clinical integration to partner with both employed and independent physicians, hospital leaders need to proactively communicate this strategy to physicians in the community during the initial phases of program development. "Articulate that it's not a strategy you're pursuing to eventually employ all physicians or control your share of bundled payments in your market.  Hospital leaders should communicate this is a vehicle that will allow [physicians] to maintain [their] independence while allowing them to be included in a quality program that positions its members for success in the uncertain realities of the future," Mr. Butts says.

Managing patients across the continuum of care
While in the past some clinical integration efforts were led by physicians independently of hospitals, now physicians and hospitals are coming together to address the delivery of high quality and efficient care throughout the entire care continuum. Mr. Butts notes the "strategy of broadening program objectives across the ambulatory, acute and post-acute setting is critical to impacting the total quality and cost of care. Networks should strive to provide the highest quality, lowest cost care at the right time, in the best setting, by the most appropriate provider. To achieve this, the hospital does not have to own all parts of the care continuum; but, having partnerships to support seamless care transitions between providers and sites of care is critical to achieving program results."

Preparing for the future
Many hospitals and physicians are utilizing clinical integration as a preparatory strategy for the future realities of accountable care. "A major goal hospitals are hoping to achieve is really preparation right now — preparation to effectively respond to shifting healthcare dynamics where winners will no longer be determined by volume, but by the demonstrated value they are able to deliver to their local markets," Mr. Butts says.

He says some hospitals are using clinical integration as a strategy to pace their adoption of new models of care under healthcare reform. Many hospitals are struggling with how much risk they should take on to prepare for future changes while continuing to operate successfully in the present. Developing a clinical integration strategy in one's market can help hospitals begin to align with physicians and payors and set the foundation for further collaboration in the future.

"They're proactively managing the pace of change in the market," Mr. Butts says. He suggests hospitals consider clinical integration so they don't fall "too far behind in the marketplace." Taking a proactive approach through clinical integration can help position hospitals for both current and future success.

More Articles on Clinical Integration:

5 Lessons Learned From a Clinical Integration Expert
The 7 Components of a Clinical Integration Network

5 Tips for Implementing an Alignment Strategy With Independent Physicians

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