Imagine your health system but better: The clinical integration makeover we all need

With more access to information about the cost and quality of their care than ever before, healthcare consumers are becoming more conscious of value. This rise in consumerism, as well as the growing prevalence of value-based, alternative payment models, has pushed hospitals and health systems to more strategically integrate into high-value networks by pursuing mergers and acquisitions. In this environment, achieving clinical integration is no longer an option for providers that want to keep a competitive edge — it's a necessity.

                                                   This content is sponsored by Premier

Clinical integration is the facilitation of coordinated patient care across all care settings and is characterized by increased communication between clinicians, health system leaders and frontline staff, with the aim of improving patient outcomes. The need for clinical integration is one of the driving forces behind providers' mad dash toward consolidation.

Consolidation is one of the defining trends of healthcare in the 21st century. If providers have not made proper investments in clinical integration, they often look for potential partners who have. In a recent Premier survey of health system leaders conducted in April and May, 48 percent of respondents said they completed a merger or acquisition in the last 24 months. Seventy-seven percent said they plan to complete one in the next 24 months.

Twenty-four percent of survey respondents said their strongest motivation for consolidation is to integrate care across the continuum, thanks in large part to payment models that reward value. Sixteen percent of respondents cited consumerism as their primary motivation for mergers and acquisitions, making it the second most selected answer.

This article will examine the positive benefits of clinical integration and explore best practices for how healthcare leaders can ensure mergers and acquisitions maximize their organization's ability to coordinate care.

The importance of quality, reaffirmed

Healthcare's siloed nature makes it possible for patients to fall between cracks at various points in their care journey. Successful clinical integration can bridge the communication gap between acute care clinicians and those involved with pre- and post-hospital encounters, which can contribute to better outcomes and costs.

For a 2016 study on care coordination and patient outcomes, researchers with Baltimore-based Johns Hopkins University Bloomberg School of Public Health analyzed data from three large commercial insurers on 1.7 million lives. The team found patients with the highest levels of care density, which is the amount of information shared about a patient between clinicians, experienced significantly lower rates of adverse events.

Care coordinators and care navigators are critical players who help close gaps patients may otherwise experience in their care journey. They help guide patients and their families through their care episode, communicating with different clinicians to ensure the patient receives top quality treatment. These vital members of the care team don't just ensure patients receive the most effective care, but also help improve the overall patient experience and satisfaction — a growing determinant of reimbursement.

"Care coordinators and navigators have more facetime with patients and their family members and can have a significant impact in terms of helping to direct and guide the patient to the appropriate care," said Beth Anctil, principal at Premier, an industry-leading healthcare improvement company. "As you know, you've got pre-hospital, hospital, post-hospital, back to the doctor; there's a lot of different points of contact, so having someone take that accountability is really critical."

Clinical integration not only helps improve communication between clinicians, but also facilitates the creation of longitudinal care plans, which can help improve care efficiency. These plans consider a patient's entire episode of care across settings as opposed to traditional care plans, which are generally more site-specific.

It is healthcare organizations' fundamental mission to provide patients with the best possible care. However, as patient outcomes are increasingly linked to reimbursement, the all-important nature of care quality has been reaffirmed to hospitals' financial and operational teams. Industry leaders now understand that the promotion of clinical integration is one of the most instrumental steps they can take in service of their quality goals.

Clinical integration for a competitive edge

The competitive advantages of consolidation have motivated many hospitals and health system leaders to expand their organization's footprint in recent years. However, traditional economies of scale are not the sole motivating factors behind mergers and acquisitions: Evolving payment models have driven providers to turn a critical eye to their care coordination efforts.

When care coordination is lacking, organizational leaders often seek partners to supplement these capabilities. In a marketplace where consumers and payers place a premium on quality, systems that do not value clinical integration put their bottom lines in jeopardy. Ms. Anctil leads Premier's clinical transformation team and emphasized that providers dedicated to clinical integration must ensure their efforts are not splintered across the organization.

To truly leverage the competitive advantages of care management, especially when it comes to mergers and acquisitions, leaders must not only consider the care management infrastructure of their partners, but actively work to break down barriers that impede these processes.

"Organizations must avoid building siloed care management programs and drive alignment. I think the real opportunity for success is centered around integrating the organizational structures, workflows and technology solutions to optimize the investment," Ms. Anctil said. "This creates the optimal patient experience and enhances return on investment, especially in mergers."

Where the rubber meets the road — Cultural alignment and physician buy-in

It's no secret that clinical integration can yield substantial benefits for hospitals and health systems. However, there is a vast gulf between understanding the complexity of mergers and acquisitions and executing them in a way that improves clinical integration.

To truly support care coordination, leaders must perform thorough examinations of their potential partners and select those with complementary assets. Beyond the actual mechanisms of clinical integration, several cultural considerations can determine whether organizations are able to achieve clinical integration post-merger.

"Successful organizations are evaluating the culture and values of the acquisition to determine if they have an aligned vision," Steve Valentine, Vice President at Premier, said. "You always want to think about your organizational philosophies should always drive the criteria for potential partners to avoid conflict down the line. If the values, cultures and organizational philosophies are different, it could mean conflict down the line."

While it's often difficult to discern the cultural compatibility of an organization eager to present itself as an attractive partner, Premier offers services to help leaders decide whether clinical and administrative staff is up to the difficult task of merging and integrating care along the continuum.

"We run a data-driven process to identify potential partners. We then screen those organizations, narrow the list down to a handful of strong choices, and participate in and facilitate site visits to closely review the terms of the transactions, the cultural fit, and what needs to be done to effectively consummate the merger or affiliation," Mr. Valentine said.

Ms. Anctil's team interviews administrative and clinical leaders to evaluate how their teams operate and asks scenario-based questions to assess how they respond to different situations. One of the biggest challenges organizations face when trying to achieve clinical integration is generating buy-in among physicians.

"It is sometime difficult to get physicians on board with models that would be driven by care coordinators, removing them from the center of the decision-making process," Mr. Valentine said.

However, Premier helps health systems align physicians with a clinical integration mission by working directly with physician leaders. Ms. Anctil collaborates closely with physician leaders to show them the efficacy of care coordination so they can act as influencers and convince skeptical colleagues to get on board.

"The rubber meets the road when you can bring together an internal champion and a physician that understand the goals and are willing to get their coworkers on the bandwagon," Ms. Anctil said. "Just recently, a physician we worked with told me how much she valued her care manager because the more coordinated process helped her more effectively transition patients and avoid the risk of readmission, while boosting her revenue. It proves how clinical integration truly adds value when aligned to financial goals."

Turn potential into production

Both Mr. Valentine and Ms. Anctil emphasized clinical integration does not bear immediate results. Organizations that dedicate resources to these efforts will have to wait before they begin to reap the rewards. Many organizations have the capabilities in place to coordinate care effectively but do not have the patience or expertise to properly utilize them. Premier's team of experienced clinical and administrative experts, backed by its robust physician and claims analytics, can help health systems improve clinical integration, especially when it comes to mergers and acquisitions, to optimize the patient experience and their own bottom line.

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