Amid the current state of payment reform, pressure is mounting to move from the current volume-based payment system (fee-for-service) to a value-based model, and transform a fragmented care approach into a cohesive and collaborative one. To respond and prepare for the post-reform environment, more hospitals have been looking to clinical integration as a strategy for aligning with physicians to improve the cost and quality of care.
The overarching goal of clinical integration serves the new paradigm well: Promote a higher quality of care and more cost-efficient patient services, by better coordinating care across the continuum of conditions, providers, settings and time.
Quality of care
Clinical integration efforts can facilitate rapid and seamless information sharing, thereby improving care continuity, eliminating duplicative diagnostic testing, and reducing the risk of medical errors. Clinical integration can also make it easier for health care organizations to track quality and outcome measures, an important facet of improving quality of care and increasing Pay-for-Performance (P4P) revenue. This unified set of clinical information can also promote community-level disease management, thus improving overall health.
Cost control
In addition to improving the quality of care, clinical integration can also help to reduce overall expenditures by managing costs at the patient level, rather than the encounter level. An effective approach to improved care and costs requires the right incentives, management and infrastructure, all available via the clinical integration model.
Participation in quality-focused programs
Once a clinical integration program is established, physicians in a clinically integrated network may negotiate collectively for commercial payer contracts and present them for antitrust review by the Federal Trade Commission (FTC). These contracts can include Pay-for-Performance components that allow both physicians and hospitals to receive incentive payments for improving the quality of care and efficiencies. Achieving these goals requires enhanced collaboration, which must be demonstrated through compliance with recognized clinical best practices and improved outcomes.
Beyond improved cost and quality of care, there are additional benefits that a true health system integration can produce: improved market position, expanded continuum of care, increased scope of services, improved organizational performance and a better patient experience.
