Goal is to promote higher-quality, more cost-efficient patient services by better coordinating care across a continuum of conditions, providers, settings and time.

Seismic change continues to rumble across the healthcare landscape, fueled by a powerful confluence of economic, demographic and regulatory forces. As pressure mounts to transform the current volume-based payment system to a value-based one, and to move from a fragmented care approach to a cohesive and collaborative model, many healthcare organizations are racing to embrace clinical integration strategies.

A popular buzz phrase these days, clinical integration may be defined somewhat differently by various stakeholders and constituencies. In fact, a broad range of strategies fits under the clinical integration umbrella, from basic initiatives to coordinate treatment of a particular chronic disease to a fully integrated healthcare system with employed physicians.

Across the board, however, the goal of clinical integration is to promote higher-quality, more cost-efficient patient services by better coordinating care across a continuum of conditions, providers, settings and time. Of course, translating this vision into reality is often easier said than done.  But the sooner hospitals and health systems start practicing clinical integration, the better positioned they will be to thrive in the brave new world now taking shape.

Supporting five-star performance

Skyrocketing costs, declining reimbursement, aging baby boomers, regulatory mandates and uncertainty on the legislative front are just some of the factors powering redesign of healthcare delivery in the U.S. Slowly, but noticeably, the system is shifting to a greater emphasis on preventive care, evidence-based practice standards and clinical protocols and a consumer-driven marketplace for services.

In the face of this revolution, clinical integration offers tantalizing potential for improving care and managing costs, without having to overcome legal hurdles, such as Stark regulations and antitrust, anti-kickback and tax laws. Some pioneering organizations are already seeing evidence of reduced costs, fewer readmissions, increased patient safety, better outcomes, a stronger competitive position and an improved relationship with physicians, both employed and independent.

For example, Advocate Good Samaritan Hospital in Downers Grove, Ill., credits its innovative clinical integration program with advancing clinical excellence and patient safety. The program rewards physicians for achieving superior clinical, service and efficiency outcomes. It has contributed to a win-win partnership that has generated breakthrough results in quality, physician satisfaction and market share at the hospital, a 2010 recipient of the Malcolm Baldrige National Quality Award. In addition, the clinical integration program will serve as the centerpiece of the accountable care organization (ACO) that Good Samaritan is currently establishing.

As Good Samaritan’s experience demonstrates, clinical integration establishes a core framework for value- and outcome-based delivery models, such as ACOs and patient-centered medical homes, further supporting hospitals’ efforts to achieve quality, efficiency and cost-management objectives. As a result, clinically integrated providers will lead the way in responding to – and capitalizing on – federal healthcare reform initiatives.

Defining strategies for change

Clinical integration requires a commitment both to a radically different vision of delivering care and to the evolutionary process necessary to reshape the existing model. In fact, successful clinical integration begins with two of the 10 “must-do” action strategies identified in the American Hospital Association’s recent “Hospitals and Care Systems of the Future” report.

1: Hospitals, physicians and other providers must be aligned across the continuum of care, sharing strategic and clinical objectives as well as financial incentives. Without engaged physicians who buy in to the collaborative approach, change simply won’t happen. Establishing mutually beneficial arrangements between healthcare organizations and physicians helps meet patient-centered goals by creating a system where all parties are accountable and rewarded for high performance.

It will also become increasingly critical for hospitals to develop a collaborative culture among previously independent physician practices, invest in physician leadership development training, adopt evidence-based care protocols and create multidisciplinary teams that not only treat patients when they’re ill, but also support patient efforts to remain healthy.

2: The need for greater information sharing across providers demands the development of an innovative and comprehensive health information technology (HIT) environment. Timely and real-time access to information by all stakeholders plays a crucial role in clinical decision making, information management and communications, helping to improve patient safety, quality and efficiency.

In particular, the adoption and meaningful use of electronic health records (EHRs) – propelled by federal financial incentives – can act as a game changer, providing the critical real-time information required to more effectively and efficiently diagnose and treat patients at the point of care, whether at the hospital bedside, physician’s office or patient’s home. Health information exchange (HIE) is also becoming increasingly critical for facilitating the internal and external collaboration key to better, results-focused care.

However, the capability to capture, access and share information marks only the beginning. C-suite leadership must spearhead the use of HIT to create knowledge-driven organizations. That means performing sophisticated data mining and analysis to enable continuous care and performance improvement, learning, planning, evaluation and operational efficiency. It also involves leveraging the technology to better understand population disease patterns and develop new care strategies for reinforcing public health.

Selecting and deploying the right information technologies to fast-forward their clinical integration efforts can pose daunting challenges for healthcare organizations. EHR adoption and deployment demands careful organizational development, expansion and launching. At the same time, hospitals must ensure they have implemented a robust infrastructure that incorporates the security, networking, storage, server and mobility solutions necessary to accommodate the required systems, products and services. Recognizing this, AHA Solutions – a subsidiary of the American Hospital Association – assists hospitals with identifying and researching technologies, products and services best aligned with supporting clinical integration efforts.

Building a foundation for success

Since there’s no one-size-fits-all model for clinical integration, hospitals and healthcare organizations need to take a comprehensive view to planning and executing an effective approach. Although hospitals must tailor individual tactics to meet their specific needs, successful clinical integration programs should include these key components:

  • Mechanisms that monitor and manage utilization of healthcare services, helping to control costs and delivery of higher-quality care;
  • Alliances with physicians who share a vision of greater collaboration and coordination of care and are willing to practice in an environment with new rules;
  • A commitment to invest financial and human resources in the infrastructure necessary to support clinical integration; and
  • A comprehensive information technology system.

To build the framework and implement the strategies that ensure clinical integration can become a reality, forward-thinking healthcare organizations are creating cross-functional teams of administrative and clinical leaders and partnering with vendors, consultants and industry groups. These organizations recognize that when the shockwaves of change stop reverberating and the dust settles, they will need to be prepared for a fundamentally different healthcare environment. By practicing clinical integration, hospitals can achieve compliance with healthcare reform legislation, serve patients more effectively and operate more efficiently in a world where long-term sustainability will depend on consistently achieving better outcomes at lower costs.

About the author

Keith D. Terry is a VP at AHA Solutions Inc. For more on AHA Solutions, click here.

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