Integrated
The demands and realities of health care reform—and health care payment reform—have illustrated the need for cost-effective, high-quality, integrated healthcare. Clinical integration can play a major role in that movement, with three areas driving interest and movement towards clinical integration:
- Affordable Care Act (ACA) and healthcare reform. The U.S. health care system is undergoing systemic changes. The ACA of 2011 includes provisions to promote care coordination and integrated health care, in addition to expanding health care coverage, rewarding effective and efficient care, promoting innovation and controlling cost. According to the American Hospital Association, “Achieving greater clinical integration… is essential to the system change needed to achieve these goals.”1
- New payment models. Policymakers are also looking at payment reform as a means to promote integrated healthcare and greater collaboration across the health care continuum. Both the federal government and commercial payers have begun moving to value-based reimbursement, with programs that include the Centers for Medicare & Medicaid Services (CMS) program for risk-adjusted reimbursement, Pay-for-Performance (P4P) incentives and economic credentialing. The ultimate goal for each of these models? Promote integrated healthcare to improve quality outcomes while decreasing costs.
- Advances in health information technology. Health information technology (HIT) has been evolving to support provider networks manage a vast amount of information. An integrated health care network must collect, maintain and provide appropriate access to administrative, clinical and financial data. This is imperative for monitoring quality and costs while providing patient-centered care. Today, health care leaders look to several different kinds of HIT solutions—such as electronic medical records (EMRs), health information exchanges (HIEs) and data aggregation solutions—to support care delivery.
