GOALS OF CLINICAL INTEGRATION –    Class 8

Purpose or Goal of Integration: One way to think of integration is to have the right service provided at the right place by the right provider at the right time – To have a seamless delivery for the continuum of care

In medicine today, the key terms are “wellness”, “prevention”, “outpatient”, “diagnostic services”. When ten years ago “hospital; stays”, “high tech”, “specialist services” and “acute care were the buzzwords. More and more architects are asked to create “womb-to-tomb” environmental solutions, for “health park” which is wholly integrated within a community and the “medical mall” or the “medical hotel”. Value equals cost plus quality.

“Accountable Care” means to Providers:

  • Accountable care is where market, payers and providers are aligned
  • Emphasis of care is preventative since providers are accountable for health status of the people they serve
  • Outcomes are measured and reported
  • Incentives to do the “wrong thing” are eliminated because providers will not want to incur the cost of unnecessary or repetitive procedures

The clinical component of integration has been described as the extent to which patient care is coordinated across the continuum of sites and services. A study of integrated delivery systems has described clinical integration as ” the centerpiece to adding value and promoting performance” within a system. For example, integrated delivery systems have the potential to deliver more cost-effective care by eliminating redundancies, shortening cycle times and having more reliable outcome data. Most patients seem to want one stop shopping, easy and convenient, and do not want to retake tests or answer same questions again.

“Empowered Consumers” means to Providers:

  • Patient-centered care: Keep to minimum number of times patients must be re-treated because they failed to comply with prescribed regimens or must be treated in high-cost acute settings because they did not address a disease in its early stage.
  • Prevention:  To understand how important preventive care efforts can be – includes wellness and fitness programs for employers, industrial injury medicine and rehabilitation services, workers’ compensation management and community health outreach.
  • People:  Empowering the people involved in healthcare delivery system to be able to act in a positive, proactive manner to manage costs and quality under fixed, capitated reimbursement.

One way to think of integration is to have the right service provided at the right place by the right provider at the right time.

Currently, there are four generic major types of integrated delivery systems developing across the United States. The main difference among them is who organizes or leads the network or system:

(1) Probably, the most traditional system is led by the hospital;

(2) Led by physician and physician groups such as Mayo Clinic in Minnesota;

(3) Hybrid of the first two: led by both hospitals and physicians – gaining popularity, these hybrids are trying to become more physician-centered organizations with physicians assuming leadership roles. Sharp Health Care in San Diego and Henry Ford Health System in Detroit are examples;

(4) Led by insurance companies, such as Aetna, Cigna, or Prudential.

Important questions to ask are: Who is going to coordinate the network? Who is going to bear ultimate accountability? Who is going to have the most responsibility for putting it together? Who has the hospital, organizational, and managerial expertise to do the job?

It appears systems that have the greatest degree of physician system integration and clinical integration are doing better financially.

Clinical integration depends heavily on the extent to which functional activities (such as information management and capital allocation) and physician integration (such as leadership roles and practice development) have occurred. This alignment of functional activities and physician integration leads to higher levels of clinical integration.

Clinical integration has been described as the “centerpiece to adding value and promoting performance” within a system. “System-ness” breaks down barriers between departments, operating units, and areas of expertise. Long-standing relationships will be changed by the consolidation of clinical service lines; reductions in acute care beds; redeployment of clinical support services; deployment of case management across the continuum; development of clinical pathways and outcomes measurement systems, and the redesign of patient care and related activities. Management tools can be helpful to create a structure inspired by continuous quality improvement to identify and implement system wide goals. Address priorities concerning quality, managed care, marketing, finance and system leadership.

Goals of integrated delivery include: high quality, lower cost utilization, cost-effectiveness, steady enrollment, and closely monitored patient, staff, and payer satisfaction. Health care executives are increasingly relying on demographics and epidemiology as their planning guides, as the capacities of high-end clinical services shift and often shrink.

Value equals cost plus quality

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