Clinical Integration

1/25/2017

Successful hospital-physician integration is a core element of any successful response to mounting demands for higher-quality, lower-cost patient care. Many practices and organizations are floundering as the healthcare market changes around them. Requirements for data reporting, care coordination, patient follow up, and so on, in order to meet new market and contracting demands is becoming too costly and cumbersome to support.

Being part of a larger network of high performing providers improves leverage, minimizes participation costs, and allows for data to be managed centrally; which can help with CMS reporting, commercial payer pay-for-performance compliance, and patient tracking and management. A Clinically Integrated Network (CIN) consists of a number of physicians, hospitals and post-acute care providers that align around shared risk and protocols to improve quality and reduce the cost of care.

Ten benefits of clinical integration:

1. Increased Collaboration – Use of care teams addresses gaps in the care continuum while reducing ineffective or unneeded process steps. This approach allows better quality, patient safety, and patient and family satisfaction. Teamwork among healthcare providers ensure patients access to care via infrastructure focused on supporting caregivers and patients to efficiently assess, document, communicate, and meet patient needs. 

2. Improved Efficiency – CI eliminates healthcare waste and redundancy, making it possible to provide patient-focused seamless systems of care. 

3. Integrated Systems – Provide more monitoring and enforcement tools than through a typical medical staff organization, including the payment of financial incentives for physicians who actively participate in the program and penalties for those who do not. 

4. Payer Partnerships – With improvement in the quality of patient care and clinical processes and reduction of costs, CINs are able to achieve market differentiation that is attractive to health plans and can serve as the catalyst for payer partnerships

5. Improved Care Management – Care management serves as the foundation to accomplish coordination of care across traditional health settings. Its goal is to achieve the best clinical and cost outcomes for both patient and provider and is most successful when care managers are able to work within and outside organized health systems

6. Clinical Data Systems – An integrated technology (“IT”) platform that supports continuity of care and enables access to critical patient data , easing communications across the care continuum and providing information that measures service, performance, quality, and outcomes on an individual provider and network-wide basis. 

7. Patient-centered Communication – The Joint Commission has cited communication breakdown as the single greatest contributing factor to sentinel events and delays in care in U.S. hospitals. The CI emphasis on timely and clear communication is key to influencing patient behavior, resulting in cost/quality benefits 

8. Improved Pharmaceutical Management – Most medication errors are caused by faulty processes that lead people to make mistakes or fail to prevent the mistakes. CI improves pharmaceutical management allowing hospitals to identify gaps in the medication management process and allow them to take actions to help make patients safer

9. Improved Health of the Community – CI emphasizes wellness initiatives through preventive care, and with other programs to empower the patient with tools, knowledge, and practical solutions to participate actively in their care, ultimately leading to a healthier population.

10. Participating providers can still maintain their independence while belonging to a CIN and CINs are prepared to adapt to changing payment methods.

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