Clinical Information Systems
Clinical integration sets the stage for positive change
Goal is to promote higher-quality, more cost-efficient patient services by better coordinating care across a continuum of conditions, providers, settings and time.
By Keith D. Terry S
eismic change continues to rumble across the health- care 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 integra- tion 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 legisla- tive 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
16 September 2012
pioneering organizations are already seeing evidence of reduced costs, fewer readmis- sions, increased patient safety, better outcomes, a stronger
Keith D. Terry is a VP at AHA Solutions Inc.
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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 clini- cal, 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 organiza- tion (ACO) that Good Samaritan is currently establishing. As Good Samaritan’s experience demonstrates, clini- cal 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 evolu- tionary 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.
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