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Super Clinically Integrated Networks: 8 Components to Consider

Posted by Matthew Smith on May 4, 2016 11:31:47 AM

By Susan Corneliuson, MHS, FACHE, and Tina Wardrop, MHA, MSSW, Senior Manager, GE Healthcare Camden Group 

super clinically integrated networksClinically Integrated Networks ("CINs") are evolving quickly across the country in response to changing reimbursement trends and the move to value-based payments. Estimates indicate more than 500 CINs are in operation in the country today.

In most markets, single healthcare systems have formed independent CINs in an effort to more formally align independent and employed physicians in the region. In certain markets, we are starting to see the development of Super CINs or Population Health Alliances. 

The formation of Super CINs and Alliances is motivated by the perceived need to reach larger populations and to form more comprehensive delivery networks, in many cases fueled by increased competition within the marketplace. The main goals of most Super CIN/Alliance structures is to expand network offerings and services through direct-to-employer products and to effectively pool resources to build robust population health infrastructures. 

Independent systems believe they can achieve greater benefits through joint collaboration than on their own and trust that they will ultimately be better positioned for value-based care. 

Alliances are formed by integrating a number of healthcare institutions under one CIN structure, in which hospitals remain independent while pooling clinical, technological, and strategic resources. This includes employed physicians and community physicians within local networks.

Super CINs are the product of multiple CINs under a single superstructure. Super CINs and alliances allow smaller systems, hospitals, and physician organizations to leverage infrastructure costs, management and governance oversight, care management protocols, population health management capabilities, as well as population financial risk while still retaining their independence.

Structuring and effectively managing Super CINs formed between competing healthcare entities is a complex undertaking that should not be pursued without clear and deliberate discussion among the respective parties. There are a number of strategic, operational, and tactical components that need to be evaluated to determine how systems can work together and what challenges may be encountered.

Eight components to evaluate before forming a CIN

1. Leadership and governance. Do the management and physician leaders of each organization understand and embrace the principles and cultural change requirements of forming a Super CIN/Alliance? Have goals and objectives been clearly identified and articulated? Can necessary cultural transformation be executed across the network to deliver on the value proposition? Are individual organizations willing to cede certain functions and/or decisions to the Super CIN?

2. Strategy, sustainability, and transformation. What strategies need to be developed to create a sustainable model? Is there market demand for the product offerings and will it disrupt existing relationships? What activities and services will be provided by the network, and what services will be retained by each individual entity? How can knowledge and expertise be harnessed across the network?

3. Network composition and access. How comprehensive and accessible is the acute, post-acute, allied provider, and facility network in meeting patient care needs? How accessible are these segments today, and what would change under the new superstructure?

4. Population health management capability. What services are required to support the network? What are the population health management and analytic capabilities of each organization? Does one entity have a greater depth of experience, knowledge, and infrastructure? How will the alliance support the integration and launch of value-based products, including network development and management, care management, claims adjudication, risk management and compliance?

5. Clinical care models and coordination. What clinical care models are in place to manage high cost, chronic disease patient groups? What are the gaps and optimal approaches to integrate care to gain efficiencies across the network? Can existing programs be leveraged and re-tooled to support a larger population base?

6. Quality, value and transparency. What quality metrics are being measured and tracked at each organization? How are outcomes reported to providers to promote cost effective and high quality care? What reporting capabilities need to be developed? What will it take to aggregate meaningful data among these groups?

7. Financial management and reimbursement. What are the current financial incentives within the respective CINs? How will funds flow models be integrated across the network to incent and reward providers for improved health outcomes?  How will risk be shared across the network versus borne by individual organizations?

8. Patient experience and activation. What communications, educational, and community support programs are needed to engage patients and improve compliance?  How will these be shared across the network?

Other challenges to consider

The assessment of these critical components is essential and requires leadership to work collaboratively with institutions that are typically considered competitors under traditional reimbursement models.

Cultural differences between Super CIN/Alliance partners can also create governance challenges particularly as infrastructure expenses and shared savings distribution discussions and modeling are initiated.

It is a time of significant transition as providers and payers begin to work under the new healthcare paradigm and a lot remains unknown. In some markets, there is still significant resistance and uncertainty about value-based payment models and overall reform.

Regardless of the skepticism, the formation of Super CINs is gaining momentum across the country. Ascension Health and CHE Trinity Health announced the launch of their alliance in spring of 2014, creating one of the largest clinically integrated networks in the country uniting 27 hospitals, 12 physician organizations, and 5,000 physicians within Michigan.

Other examples of systems that have formed super CINs  include: The Population Health Alliance of Oregon, a collaboration of seven health systems in Oregon and a major medical insurer; Greenville Health System; and Integrated Health Network, a seven health system collaboration including Froedtert Health, the Medical College of Wisconsin, Wheaton Franciscan Healthcare, Columbia St. Mary's, Ministry Health Care, and Agnesian HealthCare. 

The impact on payer contracting and a shift to value-based payment models is among the greatest challenges for both the provider and insurance sectors. As healthcare providers begin to assume more risks for their populations, the roles and financial relationships become more interdependent and blurred. In markets where Super CINs are being formed, managed care contracting has become consolidated as plans begin to work with several institutions that were previously independent.

Timing the activities around care model and financial integration is pertinent to the design of Super CINs. Legal and regulatory issues around antitrust require that the organizations be clinically or financially integrated in order to jointly contract with payers.

Fully developing the payer strategy along with the timing and phases of integration of the Super CIN will support success. However, Super CINs that do not successfully integrate and remain unable to enter into joint agreements may be left with limited functionality.

Thoughtful planning and a well-constructed and executed vision will serve all entities well as they pursue further alignment in the ever changing healthcare landscape.

This article was originally published by Managed Healthcare Executive


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Ms. Corneliuson is a senior manager with GE Healthcare Camden Group and has over 15 years of healthcare management experience. She specializes in physician integration strategies, practice assessments, operational improvement, care and workflow redesign, and compensation arrangements. She is the co-author of The Governance Institute’s signature publication for 2012, Payment Reform, Care Redesign, and the New Healthcare Delivery Organization. She has a strong background in physician practice management with experience in medical foundations, provider-based clinics, and specialty hospital settings. She may be reached at susan.corneliuson@ge.com.

WardropT.jpgMs. Wardrop is a senior manager with GE Healthcare Camden Group. She has over 30 years of experience working in the healthcare provider sector. She has worked with a wide range of hospitals, healthcare systems, and independent and employed physician groups. Her key areas of expertise include strategic planning, medical staff development, physician recruitment and employment, electronic health record selections, hospital/physician integration, and population health. With a diverse background in hospital and physician arenas, Ms. Wardrop has in-depth knowledge of the political and economic factors and implementation processes that determine the success of strategic and operational turnaround initiatives. She may be reached at tina.wardrop@ge.com.

 


 

 

Topics: Clinical Integration, Clinically Integrated Networks, Tina Wardrop, Susan Corneliuson, Super CIN, Super Clinically Integrated Networks

10 Myths of Population Health and Clinical Transformation

Posted by Matthew Smith on Mar 1, 2016 11:40:34 AM

By Daniel Juberg, Manager, and Megan Calhoun, MS, MSW, Manager, GE Healthcare Camden Group

Myths, Clinical Integration, Population HealthIt is a confusing time in United States healthcare. Healthcare organizations are faced with the new reality of value-based care and are identifying the necessary steps for success in an evolving healthcareenvironment. For many, this transformation is difficult, and fear of this change may hinder progress. However, at present, a lack of true understanding of the care processes, tools, and consequences of this transformative shift persists in the healthcare community, and with the public at large. The delivery and consumption of care is rapidly changing for both provider and patient, and not everyone is on the same page. Below are ten myths associated with clinical transformation and its ability to position an organization for success in a value-based world, along with the realities with which providers and organizations must face.

Myth #1:  The best care (or better care) is provided in hospitals.

RealityFor many years, the United States healthcare system has been very hospital-centric. Patients who were sick were directed to go to the Emergency Room or the hospital to get better, and physicians were paid handsomely for services provided in the hospital setting. This cycle has engrained within Americans (and within many physicians) that the hospital is the setting for receiving the highest quality of care. Patients will often even ask to be admitted to the hospital because they believe superior care will be provided there. Today, the healthcare system has begun to shift to improve and increase the suite of outpatient healthcare services to include ambulatory surgery centers, urgent care centers, retail clinics, even home-based care. The hospital is no longer the only place to go to receive care and, in fact, the best interventions will keep patients safely in their homes and out of the hospital altogether.

Myth #2:  All organizations should be negotiating value-based payment contracts.

Reality:  While value-based payments are a driver for clinical transformation, organizations should move at the pace of their market (and their own capabilities). Each market across the county differs in its pace in the shift from a volume to value-based environment. Organizations who are maintaining success in a primarily fee-for-service environment may not be ready for an immediate switch to value-based payments. Instead, these organizations should begin undertaking efforts to prepare for an eventual change to value-based contracting through improved medical management efforts and regular analysis on clinical outcomes and cost of care. This transition for some has had to be rapid, given the speed with which the market had adopted value-based payments. However, for many others who are not yet positioned for success in a value-based market, this transition should be gradual as the organization begins to develop the necessary capabilities; in a volume-based environment, these changes can still have positive outcomes through a focus on treating patients in appropriate care settings, thereby increasing capacity and access. Therefore, the focus for all organizations should be developing and implementing the clinical care model that is in sync with its payer contracting strategy.

Myth #3: Interoperability among information technology (“IT”) systems results in clinical integration.

Reality: As healthcare organizations begin to explore the clinical transformation needed to achieve clinical integration, the number one barrier frequently identified is the lack of interoperability among the health IT systems. Often, organizations may decide a complete IT overhaul is necessary (very costly) or that clinical integration is simply not possible and withdraw from the effort. However, highly integrated IT systems do not magically result in clinical integration. IT systems lack the clinical judgment that is necessary to provide high-quality, patient-centric care. IT systems cannot identify population health objectives and goals and design interdisciplinary medical management programs that aim to meet population health goals. It is the aligned vision for improving health outcomes among all care team members that results in clinical integration; IT systems can simply enable this type of care through real-time alerts, evidence-based clinical pathways, and historical and predictive trending of clinical data and notes. Interoperability should be viewed as a means, not as a deal breaker in its absence.

Myth #4:  Electronic Medical Records (“EMRs”) make physicians lives easier and provide better patient care.

Reality: Advances in technology have provided innumerous innovations to the majority of industries and society in general. While healthcare has been an undeniable benefactor, it is widely assumed that because electronic tools have made the public’s lives significantly easier, healthcare providers have experienced the same benefits and welcome all advancements. Healthcare IT, including EMRs, can provide the care team (e.g., the physician, medical assistant, nurse, social worker, or other care coordinator), with a wealth of knowledge about each patient. Tools exist that track and trend lab results, maintain and update a singular care plan, and provide point-of-care alerts to close gaps in care. Many organizations rely heavily on the information provided through these tools to provide patient-centered, high-quality care. However, it is not the information contained within these tools that has enhanced patient care; instead, it is the care processes and workflows that have been developed to ensure this information is meaningful and utilized that has enhanced care. Without clear care protocols or actionable reports, physicians can be frustrated by the vast amount of information presented to them and the myriad of tasks they must complete within multiple IT systems. Too much data contained in a myriad of health IT systems can actually result in less coordinated care between physicians and across care settings. It is the integration of this information, in a succinct form, into clearly defined care processes that enables the delivery of high-quality patient care and allows the technology to ease the burden on the provider, rather than add to it.

Myth #5: Population health management requires significant IT capital and increased staffing.

Reality: Additional capital to support informatics and staffing are a luxury and can improve efficiency and effectiveness of care management initiatives, but they are in no way a necessity for population health management. Population health management begins with a cultural transformation within the organization that is centered on a dedication to providing high-quality, patient-centric care. A clinical transformation subsequently occurs that leads to the development and establishment of refined clinical pathways and processes and often the redeployment of staff. IT tools can assist with these processes, but they should not drive the clinical transformation that needs to occur within the care teams. Similarly, the role of support staff (e.g., care managers, social workers, health coaches) does not actually increase; instead roles are assessed and redefined, as necessary, to ensure staff resources are deployed in a manner that is targeted to meets the needs of the population and the associated intervention. Too often organizations making this transition attempt to run before they can walk.

Myth #6: Clinical integration results in mass layoffs of staff.

Reality:  The Triple Aim® consists of three components: improved health outcomes, improved patient experience, and reduced overall cost of care. While it is imperative that all three of these tenets are taken into consideration for successful clinical transformation, providers frequently focus on the latter and associate it with cost and workforce reductions. Often, organizations are not over-staffed for population health management; instead, staff members are simply not working to the top of their license and are not always providing care to the right cohort of patients, at the right point in time, with the right care interventions to meet the patient’s needs. A reduction in staff will only increase the volume strain all staff is already experiencing. Instead, an assessment and redesign of clinical protocols should inform the medical management staffing. A re-deployment of staff may be necessary to ensure staffing levels are congruent with the acuity of the patient population, and additional training may become necessary to ensure all staff members are able to perform effectively and efficiently in new roles. In many cases, rightsizing can be replaced by adhering to clinical protocols and reallocating existing workforces.

Myth #7: Buying services that span the continuum is the only way to achieve clinical integration.

Reality:  The desire to purchase services that span the continuum stems from a need to be able to share clinical information, conduct warm handoffs between care settings, and keep healthcare costs and revenue under a single umbrella. However, just because an organization may own these services does not mean that these services are the highest quality, nor even utilized by other providers in the continuum. What is most important when developing a clinical integration model is the provision of high-quality, patient-centric care across the continuum. Services do not need to be owned to meet this obligation. Organizations should be looking, instead, to develop formal relationships with the most high-quality and value-based healthcare service providers. Referrers should have access to cost and quality metrics for all partner organizations and should utilize these results to drive care to the most appropriate providers. Preferred networks should be developed to enable care model development in conjunction with these partner organizations, all with the intent to provide patients with coordinated, seamless care transitions across care settings and, when appropriate, back to their home. There are several ways to achieve tightly aligned networks – organizations should be judicious when deciding if ownership over all components is the right strategy for them.

Myth #8: Maintaining universal physician satisfaction is a critical success factor for population health management.

Reality:  Physicians are critical to cultural and clinical transformation – this is an undeniable truth. However, not all physicians are well-educated about or in favor of clinical transformation to position them for success in population health. Some may be nearing the end of their careers, and this change may present a large burden. Placating to physician needs and preferences will not always bring about successful and unified change within an organization. Instead, try performance transparency. Initially, this may cause some discomfort among physicians; however, no physician wants to be the poorest performer, and this tactic may bring about the most rapid change in behavior. The enforcement of remedial action plans for physicians who do not follow established evidence-based protocols may also not be welcomed by all physicians, but will ultimately ensure that high-quality care is provided. While physician engagement is a critical element for success in population health management, it must be a mutual effort. Organizations that make the successful voyage to population health management need to weed out those vocally not on board, as well as those refusing to row in the same direction in their practices.

Myth #9: Patient satisfaction is the same as optimizing the patient experience.

Reality:  Despite what physicians may think, patients aren’t really rating physicians on whether they “always communicated well with them” or “always controlled their pain well.” The truth is that patient satisfaction has many components. Ultimately, patients are rating physicians on factors such as whether they got better and had timely access, which can ignore critical aspects such as the cost and appropriateness of care being provided. One prominent study contended that patients who reported being most satisfied with their physicians had higher healthcare and prescription costs and were more likely to be hospitalized than less satisfied patients. Could physicians who have patient satisfaction scores tied to their compensation be less likely to advocate against unnecessary requested treatments or less likely to raise concerns about lifestyle and behavioral modification issues?  Or could there be a correlation between high patient satisfaction scores and providers who actively tackle the hard-to-discuss issues the best? More research – and specifically innovative research – is necessary. Further complicating this issue is the new trend towards Yelp-style online public reviews influencing local perceptions of healthcare providers. As with any crowd-sourced review product, an issue arises when the public tends to only be inclined to offer their opinions when the service is exceptional, or the experience was considered an unpleasant one. Managing digital perceptions is yet another responsibility that consumer advancements and innovations have required of providers.

Myth #10:  Patient satisfaction will increase if physicians spend more time with each patient.

Reality: Patient satisfaction is about much more than the length of an appointment. Ultimately, patients are concerned about receiving personal, high-quality care at the time they need it. A patient will be satisfied with their care if they feel they can access it when they need it; for example, when a patient is able to schedule an appointment on the day and at the time they wish to see their physician or other provider and if their wait time is minimal.  Or, when a patient contacts their physician via a patient portal and receives a timely response. Furthermore, the patient wants to feel as though their physician is utilizing the appointment time to truly discuss their care, rather than reviewing old notes and labs and consistently typing on a computer; patients respond very positively to eye contact and listening skills as indicators that a physician is interested in a patient. A medical assistant or other office support staff can greatly assist physicians prepare for their appointments so that patients feel as though they are receiving the physician’s full attention, thereby bolstering the patient’s satisfaction with their visit.

juberg_headshot.pngMr. Juberg is a manager with GE Healthcare Camden Group and focuses on clinical integration, transactions, and strategic and business planning for healthcare organizations. He has extensive experience with the development of ACOs (financial planning and funds flow modeling), managing Medicare Shared Savings Program applications, and implementing clinically integrated networks. He is also experienced in master facility planning, CMMI Innovation Center grants, medical group valuations, and community needs projections. He may be reached at daniel.juberg@ge.com.
 

Megan.pngMs. Calhoun is a manager with GE Healthcare Camden Group and specializes in the areas of care management strategy and design, strategic and business planning analysis, accountable care organization applications, development and implementation, and the development of clinically integrated organizations. Ms. Calhoun has supported numerous clients with the completion of Medicare Shared Savings Program (“MSSP”) applications and implementation strategy and planning. Her experience includes care model design and implementation that spans the continuum. She may be reached at Megan.Calhoun@ge.com.

Topics: Clinical Integration, Population Health, Regional Clinical Integration Networks, Daniel Juberg, Megan Calhoun, Clinical Transformation

Clinical Integration: There Will Be Winners and Losers

Posted by Matthew Smith on Feb 8, 2016 1:13:28 PM

By William Faber, M.D., Senior Vice President, GE Healthcare Camden Group

Clinical IntegrationDue to increasing deductibles and our improving ability to care for conditions in outpatient settings, hospital admissions have declined consistently over the past few years, and industry experts do not expect this trend to reverse. In response, healthcare systems are investing millions of dollars in acquiring physician practices and affiliating with independent physicians through clinically integrated networks in an attempt to enlarge their patient base. Though clinically integrated networks do enlarge the patient base, one of their aims is also to reduce the percentage of admissions from that base.

There is hardly a healthcare system in a competitive market in the U.S. that is not pursuing some form of clinical integration strategy, and competition is being felt in more and more communities. Healthcare leaders know our society is headed towards payment-for-value and away from fee-for-service payment, and they do not want to be found without a competitive value-oriented structure.

Leaders should not assume, however, that just because they invest in clinical integration that their patient bases will be adequately enlarged to keep their hospitals filled. Their competitors are also spending millions on clinical integration strategies in hopes of enlarging their bases! The base does not automatically enlarge because an investment is made. Ultimately, there will be winners and losers.

More Than a Marketing Strategy

Winners will tend to get their fully functional clinically integrated network to market quicker than their competitors and ultimately, winners must create networks that perform better than those of competitors. Specifically, they will do a better job than competitors at controlling the cost of care and demonstrating higher quality and service. The creation of a clinically integrated network must not be just a marketing or physician alignment strategy – it must truly enable effective population health management.

As quality, cost and service information on healthcare providers becomes more readily available, individual consumers and employers will choose networks that provide greater value. Competition will put pressure on under-performers. Some systems that have invested in clinical integration will go out of business or be acquired by more successful systems, which in turn will downsize or divest those facilities.

Physician Competition Heats Up

Likewise, competition among physicians will heat up as consumers have more data upon which to make educated choices. Again, there will be winners and losers. Physicians who chose to not join narrow networks will lose access to patients. If there is an over supply of certain specialists in a certain geography, those who have poorer access, service or quality outcomes will get fewer referrals than others.

We like to think that no healthcare facility or provider should be forced to change or go out of business. We like to think that all of us can grow our patient bases to sustain our hospitals. We often act as if just the right number of facilities was built in a geographic area and that just the right number of physicians decided to go into each specialty. But we know at the macroeconomic level that none of this is true. Informed consumers will give us incentive to change, and some will win through effectively managing change, and some will lose by ignoring reality.


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Dr. Faber is a senior vice president with GE Healthcare Camden Group. As a physician executive, Dr. Faber specializes in the development of Clinically Integrated Networks and ACOs, physician engagement and governance, population health management, and health information technology. Dr. Faber has recently been instrumental in the establishment of six new Clinically Integrated Networks and the development of their quality and care management programs and health information integration strategy, later supporting two of those organizations as Interim Medical Director. He may be reached at william.faber@ge.com or 312-775-1703.

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Networks

Clinical Integration Via Strategic Physician Engagement: 7 Approaches

Posted by Matthew Smith on Jan 26, 2016 3:19:40 PM

By William K. Faber, M.D., Senior Vice President, GE Healthcare Camden Group

physician_engagement.jpgNew payment models make it more important than ever for hospitals to collaborate with physicians. From readmission penalties to bundled payments to Accountable Care Organizations ("ACOs"), providers have a growing economic incentive to pool resources, share information, coordinate care and services, and cooperate on quality improvement.But while the incentives are strong, the obstacles to clinical integration are daunting. Hospital-physician collaboration is operationally complex. Although physician employment can smooth out some of the bumps, practice acquisition is expensive. While a handful of large health systems have devoted extensive resources to launching clinical integration initiatives, most smaller organizations are still sorting out their options.

How can hospitals integrate with physicians without creating political and financial problems? The solution is to focus on building mutually beneficial relationships and use existing resources wisely.

The following practical approaches will help healthcare leaders achieve clinical integration by engaging physicians, strategizing collaborative programs, and making targeted investments.

1. Understand Physician Motivation

Convincing physicians to collaborate more closely with a hospital can be challenging. Physicians are trained as autonomous decision makers. Perfectionism and the need for control can make it difficult to weave physicians into an integrated organization. But there is a positive side to the medical personality: No doctor wants to be an outlier.

Engage physicians by presenting data on their patient outcomes. Most physicians will discover at least a few areas in which their performance falls short of their peers.

Talk to doctors about their patients’ flu vaccination rates, medication reconciliation rates, performance on diabetes control measures, etc. This is easiest for hospitals that have access to physician claims data through a physician-hospital organization ("PHO") or that offer physicians a subsidized electronic medical record ("EMR") with built-in Clinical Quality Measure ("CQM") templates that facilitate reporting.

Most physicians do not track and evaluate their own performance, let alone measure their performance against peers. Relevant patient statistics will earn physicians’ attention and generate interest in working more closely with hospital staff to improve outcomes.

It is also important to educate physicians on the evolving healthcare market. Explain how payers are creating incentives for clinical integration though bundled or global payments and per patient/per month care coordination fees. As physicians become more aware of these payment trends, many will embrace the opportunity to increase their salary by partnering with the hospital.

2. Create True Physician Governance

To gain the most under new payment models, physicians and hospitals have to play nice in the sandbox. The key is establishing a governance body that allows physicians to guide the development of care strategies and clinical protocols. Physician-led governance will create physician awareness and support for clinical integration initiatives and make a positive impact on the overall success of the program. Make sure the clinical integration governance committee includes physicians from solo practices and small partnerships as well as large groups. Include representatives from a range of specialties.

Most important, the governance body should include physicians who are critical or even negative about the clinical integration initiative. Often these “difficult” physicians simply want to be heard and provide their input. Making these physicians feel included will go a long way toward smoothing the transition to integration.

3. Focus on Quality, Not Finances

Physicians are concerned about productivity and payment, but concentrating exclusively on financial metrics will disenchant many providers. Focus instead on clinical quality and performance improvement. After all, this is the main reason physicians entered medicine — to provide quality care to the patients they serve.

The clinical integration committee should establish quality benchmarks and treatment protocols that define performance standards. Benchmarks can be based on evidence-based standards and care plans developed by national quality organizations and disease associations. Micromanaging clinical decisions will be unpopular, so care protocols should be broad guidelines that allow room for individual judgment.

To choose initial improvement goals, review admission and inpatient reports to identify areas of low quality and high cost. For which conditions does the hospital see the greatest number of admissions? Which conditions have the longest length of stay? Physicians using an EMR may be able to report on certain quality measures. For example, what is the percentage of hypertensive patients with adequate blood pressure control? How many heart disease patients have an up-to-date lipid profile?

Begin the clinical integration outreach with physicians in specialties linked to poorer outcomes and higher costs. Another logical starting point is primary care. Family practice physicians and internists often have the greatest impact on chronic disease management.

4. Concentrate on Care Coordination

One of the biggest opportunities in clinical integration is better coordination of care. Focus on high- and medium-risk patients who are responsible for the highest costs or who will likely increase costs in the near future. Target care transitions between the hospital and admitting specialists or primary care physicians. Involve physical therapy, home health providers and long-term care facilities in clinical coordination planning.

Physicians need to ensure that discharged patients complete follow-up visits. The hospital can assist by sponsoring a care coordination team for the entire organization to help manage follow-up appointments, referrals and home health services. To help guide care coordination, stratify hospital discharges by risk of readmission, complication or care plan non-compliance.

5. Use Technology to Get Providers Talking

Clinical integration is nearly impossible without an EMR system, but many medical practices are not far along in EMR adoption. Most practices cite expense as the main obstacle.

To overcome the cost hurdle, consider subsidizing EMR systems for practices that agree to join the integrated organization. Relaxation of the Stark laws allows hospitals to subsidize as much as 85 percent of the purchase and support costs of an EMR system. Subsidy agreements can require physicians to report quality measures and meet quality performance thresholds.

However, do not expect physicians to acquire the same EMR system as the hospital. Many small practices can do very well with free and low-cost alternative systems. The hospital should build interfaces for exchanging information with the EMR systems used by the majority of integrated physicians.

Many physicians who have implemented EMRs have participated in the Medicare and Medicaid EHR Incentive Program. As part of demonstrating Meaningful Use under the program, these physicians have already begun tracking clinical quality measures. Clinically integrated organizations should use the EMR to create aggregated quality reports and share them with physicians. Weekly or monthly reports can track disease management data such as HbA1c levels, cholesterol, blood pressure and preventive screenings. Giving physicians the chance to view quality performance metrics will engage both their competitive personalities and their collaborative spirit.

6. Build Financial Incentives

Clinical integration will require physicians to invest time and money into patient education, technology and additional staff. The problem is that methods of compensating providers for care coordination are still being developed and tested by payers. Given the costs being shouldered by physicians, financial incentives are critical.

Regardless of how incentives are distributed, hospital leaders should reward physicians either for controlling costs, achieving quality benchmarks or both. Focus on achieving care management quality metrics early on, since reduced costs tend to follow well-managed patients. Establish and re-assess these performance targets annually.

One important note: Make sure primary care physicians get a piece of the pie. Although surgical specialists might be responsible for most of the hospital’s costs and revenue, primary care doctors have the most frequent patient contact and are also responsible for most of the work of chronic disease management.

7. Invest Early for Healthy Returns

Even hospitals without the resources of a large medical system can achieve clinical integration by focusing on strategic investment and engaging community physicians through quality improvement. Hospital leaders need to allow physicians to establish the quality benchmarks and evidence-based protocols for the organization’s costliest conditions. Leaders can then concentrate on linking doctors through technology, assisting with care coordination, and negotiating with payers on bundled payments or pay-for-performance incentives.


Dr. Faber is a senior vice president with GE Healthcare Camden Group. As a physician executive, Dr. Faber specializes in the development of Clinically Integrated Networks and ACOs, physician engagement and governance, population health management, and health information technology. Dr. Faber has recently been instrumental in the establishment of six new Clinically Integrated Networks and the development of their quality and care management programs and health information integration strategy, later supporting two of those organizations as Interim Medical Director. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Networks, Physician Engagement

Best of 2015: Six Benefits System Execs Can Achieve Via Clinical Integration

Posted by Matthew Smith on Dec 29, 2015 10:37:54 AM

By William K. Faber, M.D., Vice President, GE Healthcare Camden Group

clinically integrated careLeading into the new year, GE Healthcare Camden Group will be re-publishing the most shared and popular blog posts of 2015.

What’s in it for me? That’s a question systems should ask--and answer--before taking on the challenges of forming a clinical integration program or becoming an accountable care organization. Failure to create a shared vision, and an informed commitment to that vision despite all obstacles and concerns, can easily derail change management initiatives down the road. It is important to identify likely concerns and objections, and formally articulate a response to them, early on in the planning process.

Some of the most common concerns we’ve heard from system executives are one or more of the following:

  1. Why change at all?  Fee-for-service is still working for us in this market. In fact, our entire business model is predicated upon it. Specifically, the Medicare penalties for excess rates of readmissions – an early area of focus for many Accountable Care Organizations ("ACOs") - are a just a small “cost of doing business” compared to the potential lost revenue from commercial insurers if we really improved in this area.
  2. Why change now?  We’ve been told before that “the end is near” and that we have to change. Those predictions did not come true then, so why should I believe they’ll come true now?  In particular, what happens to ACOs and shared savings-type contracts once all the savings have been wrung out?
  3. Can we afford it?  How much will it cost, and for how long will we have to subsidize the program?  We have a lot of competing demands for dollars.
  4. What’s the ROI?  Traditional financial models struggle to find a reasonable return on investment. In fact, some show material losses.
  5. Do we have to partner with “community” physicians to do this?  Many systems have invested heavily in physician employment. Some are struggling to integrate them or to see demonstrably better quality as a result of these investments. Why spend more now with non-system employed physicians?

Here are some of the more common responses to physician concerns:

  1. Better Care for Patients: The investments the network will make in information technologies, care coordination, performance feedback and other initiatives can drastically improve outcomes for patients. It has been demonstrated by other successful clinical integration programs. The vision statement for most every healthcare system talks to the preeminence of caring for the patient. Clinical integration and accountable care structures allow systems to reach whole new levels of quality, value and care.
  2. Responsive to Market Demands: The sheer number of ACOs – both Medicare and commercial – that have emerged in just the past year or so is the best evidence that value-based payment arrangements are in demand. More and more insurers are moving to narrow network products too, as employers have become more open to these kinds of models to help rein in their healthcare benefits expense.
  3. Avoid Risks of Non-Participation: A common characteristic of ACO and shared savings-type contract arrangements is that network physicians – or at least primary care physicians – can only be listed in one ACO in the market. Furthermore, commercial insurers are moving more and more into narrow network products that only contract with organized networks of physicians – primary care and specialists. Few systems are able to employ enough physicians to satisfy the network requirements of even the narrowest of these networks. As more and more organizations are forming ACOs, and as narrow networks are increasingly introduced to markets, systems face increasing risk of being “left out in the cold” as markets mature around them.
  4. Upside Payment Potential: Reductions to “unit price” fee schedules by both Medicare and commercial insurers are widely anticipated. Participation in value-based payment models offer systems some opportunity to access additional payment streams from various “value based” contracting forms that are recently or will shortly be emerging.
  5. The Program Can Increase My Business: One of the concerns commonly expressed by system executives is that greater access to primary care services, care coordination and the creation of other efficiencies – typical areas of focus for ACOs – will cut into traditional hospital “profit centers” such as longer than necessary lengths of stay, excessive Level 1 and 2 ER visits, avoidable readmissions, etc. Appropriately designed, there are many ways in which programs can help direct care “in network” to ensure quality- and efficiency-enhancing protocols are followed. Furthermore, many healthcare systems are now contracting with their own clinical integration programs for the health benefits of their employees. Savings realized by more efficient care management of system employees and family members can represent a significant offset to other lost or diminished sources of revenue.
  6. Our Prospects Are Better Together: There are those systems that think they could participate as effectively in value based payment models by themselves or with just their employed base of physicians. There are certain areas of value creation that can only be achieved through close working relationship with a broad base of physicians in specialties and geographic locations beyond those in which they have employed physicians.
Clinical Integration Networks, CIN, Daniel J. Marino

Dr. Faber is a vice president with The Camden Group. As a physician executive, he specializes in the development of accountable care organizations and clinically integrated networks, physician engagement, and health information technology. Prior to joining The Camden Group, Dr. Faber served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s clinical integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an electronic health records system. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Care, Clinically Integrated Networks

Patient Access Innovations: Integrating Patients Within the System of Care

Posted by Matthew Smith on Dec 1, 2015 3:21:44 PM

As the nation's healthcare system continues to be reshaped by the forces of reform, increased patient engagement will emerge as a defining outcome of this profound transformation. 

Networks, Patient AccessProvider coordination is of paramount importance for healthcare organizations preparing for the industry’s shift in focus from volume to value. The most ambitious coordination model that has been developed to date is the clinically integrated network ("CIN")—a contractual collaboration among hospitals, physicians, and other providers to manage patients across the entire continuum of care. A CIN uses population health management tools, including care management techniques, to build value through improving patient outcomes and controlling costs. This innovative model offers providers access to value-based payment contracts and an opportunity to improve quality and reduce costs.

Despite the compelling benefits of clinical integration, this approach also poses risks. Value-based payment contracts hold CIN participants accountable for both clinical and financial outcomes, although the ability to influence these outcomes depends largely on patient choice and patient compliance. Whenever a patient leaves the CIN, even if the patient returns to the network for certain services, network providers lose the opportunity to fully manage the patient’s care and utilization, ultimately undercutting their ability to coordinate the patient’s care and accrue the benefits of improved clinical outcomes and reduced costs.

This risk makes it critically important for CINs to keep patients within their organized systems of care. CINs need to make sure patients can access the network easily and are motivated to stay connected, requiring a strategic focus on patient access and engagement.

Based on the experiences of leading CINs, strategies aimed at improving patient access tend to be most effective when they are focused on three primary objectives: expanding entry points to the network, making access more convenient and inexpensive, and keeping patients engaged in the care they receive from network providers. The following five strategies, in particular, have been proven effective for ensuring in-network access and strengthening patient engagement.

To read the rest of this article in its entirety, please click the button below to immediately access the article on the hfm magazine site:

  Patient Access, Clinically Integrated Networks

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Networks, Patient Access, Patient Engagement, Daniel J. Marino, Value-Based Payments

Clinically Integrated Networks: Control Your Own Momentum

Posted by Matthew Smith on Nov 4, 2015 3:18:18 PM

By Daniel J. Marino, MBA, MHASenior Vice President, The Camden Group

Many hospital leaders fear the consequences of moving too fast. Last year, we talked to healthcare leaders nationwide about preparing for value-based payment. For many, the biggest fear is reducing their hospital revenues. What will happen if you transition care to lower-reimbursement ambulatory settings faster than you can grow value-based revenue? How do you increase volume to cover the shift in revenue from acute to ambulatory or post acute? Others are concerned about investment costs. Value-based care is new territory. That means many big upfront investments could end up being unnecessary.

Yet moving too slowly carries significant risks. Hospitals that fail to act now could soon lose market share to value-driven competitors. Lagging organizations will be forced to accept lower reimbursement on their remaining volume. They will not be in a position to accept value-based contracts from payers and will also be unable to offset utilization reductions with new revenue streams.

The ultimate penalty of inaction is that you will allow others to dictate your future. How do you find the right pace in transitioning your hospital to value-based care? The key to establishing the right momentum is to clinically integrate with other providers. A well calibrated clinical integration strategy will allow you to maximize value for your organization while minimizing risk.

The Basic Framework

Clinically Integrated Network, CINA clinically integrated network (“CIN”) is a group of provider organizations that come together to form an organized system of care. The network can include one or more hospitals, their employed physicians, independent community physicians, post acute providers, and other provider organizations. Member organizations remain independent but are aligned contractually. The entire network is physician-led and incorporates a multi-stakeholder governance body that oversees quality initiatives, financial goals, and other strategic issues.

Leading clinically integrated networks share a handful of key attributes and capabilities:

  • Physician-led organization with a focus on quality of care within a patient-centric model.
  • Care management capabilities to help improve quality and outcomes while reducing costs.
  • Clinical programs that optimize services for specific diseases and patient groups.
  • Advanced technology that is leveraged to improve electronic interoperability, standardize optimal care, and improve services at the point of care.
  • Population health capabilities that allow the CIN to aggregate data and manage the high-level factors that influence health outcomes.

The ultimate goal of a CIN is to secure value-based payment contracts. Providers receive financial rewards for superior quality and outcomes along with successfully managing cost trends. Value-based contracts align provider incentives with the needs of payers, employers, and patients.

Plan to Evolve

While clinical integration is complex and challenging, it is also a versatile strategy. CINs can develop infrastructure and capabilities step-by-step. Member organizations are able to assume risk at a steady pace while achieving powerful forward momentum.
Here is a simplified pathway for transitioning your organization from traditional volume-based payment to robust value-based care:

Phase 1: Lay the CIN foundation. Start by assembling the building blocks of a clinically integrated network. The risk is low, and potential gains are moderate. Key activities include establishing the appropriate governance structure and building the provider network. Establish the desired care model and the focus of quality programs with the ability to track outcomes. Network leaders should begin negotiating limited risk-based contracts that include provider quality and cost management incentives. Emphasize referral management strategies to keep patients within the CIN and the organized system of care. CINs that properly execute on the foundational elements and establish an organized system of care can create opportunities to increase revenue five to ten percent.

Phase 2: Develop a clinically integrated collaborative. As a CIN begins to experience success in creating an organized system of care, the next step is to assume additional risk, but target bigger rewards, by expanding the network regionally. Move strategically into other markets by partnering with providers that can benefit from your CIN’s provider network, technology, and care management infrastructure. At the same time, refine the network’s ability to manage costs, expand clinical guidelines, and support risk-based contracts. Hone capabilities for managing the entire enterprise through monitoring, analytics, and reporting. Explore opportunities to partner with payers in narrow-network health plans.

Phase 3: Transition to full-risk contracts. The most advanced CINs are creating provider-sponsored health plans that offer compelling revenue opportunities. This phase carries the most risk, but it can be mitigated substantially through strong care delivery, cost management, and utilization management capabilities. Networks at this stage can function as full-service ACOs, including organizations acting as provider sponsored health plans assuming full-risk contracts, similar to Geisinger Health System, Intermountain Healthcare, or Northshore Long Island Jewish Health System. Another strategic option is to offer insurance products directly to the market, either alone or in partnership with a payer. Direct employer contracting allows the CIN to “commoditize” its services, potentially increasing revenue 10 to 15 percent over traditional contracts. In order for this to be achieved, provider-sponsored health plans would need to be in place accompanied by a large provider network and organized systems of care. If “payer dependencies” are removed or limited, the healthcare spend decrease translates into revenue opportunities for the CIN.

Target Financial Opportunities to Mitigate Risk

One key to reducing the risk of value-based care is to take full advantage of its unique financial opportunities. Pay attention to four categories:

  • Infrastructure cost savings. Creating a strong shared administrative and care management infrastructure can allow a CIN to reduce per-member per-month (“PMPM”) costs 20 to 30 percent within 5 to 10 years.
  • Increased volume. Entering into narrow-network contracts with payers and employers can drive strong membership growth and patient volumes.
  • Increased domestic utilization. Minimizing patient leakage allows the CIN to maximize influence over care transitions and quality, a key to controlling costs.
  • Advanced care programs. Hospitals have the opportunity to develop advanced clinical programs and centers of excellence. Offering these programs to other network providers will increase revenue while further leveraging network effects.

The Starting Point

As you plan and launch a CIN, keep in mind one absolute necessity. Your organization must offer a strong value proposition to participating providers, payers, and patients.

For physicians, participation in your network must be an opportunity to improve patient care through access to care management, as well as clinical program and technology resources. Your CIN should also provide a management infrastructure that eases the challenges of practicing medicine today. It must facilitate care redesign to enhance care efficiency and patient focus, and optimize clinical resources.

For payers, your network must provide higher quality care, better patient outcomes, and better patient access, all while reducing the cost of care.

For patients, your network must provide access, affordability, and tools to facilitate care coordination and engagement.

A strong value proposition is key to finding the right “change momentum” for your organization. Focusing on providing value helps make sure you do not embrace change too quickly for your market. It also ensures your organization can maintain a steady forward pace by balancing appropriate risk with solid potential for clinical and financial gains.

Clinical Integration Networks, CIN, Daniel J. Marino


Mr. Marino is a senior vice president with The Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. He may be reached at dmarino@thecamdengroup.com or 312-775-1701.
 
 

Topics: Clinical Integration, CIN, Clinically Integrated Networks, Daniel J. Marino, The Camden Group

White Paper Download: "Building an Integrated Delivery Network? Start Here"

Posted by Matthew Smith on Oct 27, 2015 12:03:43 PM

Integrated Delivery NetworkBalancing the desire to operate independently, while taking advantage of the infrastructure and systems available through alignment with integrated networks has made network participation a necessity – rather than an option – for most physicians.

This need on behalf of physicians, coupled with the requirement for health systems and managed care payers to provide a robust scope of clinical services across a targeted geography, has driven the formation of many integrated delivery networks (“IDNs”) across the healthcare delivery system.

This white paper from The Camden Group titled, “Building an Integrated Delivery Network? Start Here…” focuses on factors to consider when evaluating provider groups for a delivery network.

To download the white paper, please click the button below.

Integrated Deliver Network, White Paper, The Camden Group

Topics: Clinical Integration, Integrated Delivery Network, White Paper

New Download: The New Paradigm of Patient Access

Posted by Matthew Smith on Sep 29, 2015 1:04:53 PM

Patient Access, Clinical IntegrationIn order for new clinically integrated networks (CINs) to achieve success, they must increase ways for patients to access care. To accomplish this, CINs and hospital leaders must embrace non-traditional access points that patients use to enter their systems.

Patients may choose to access the system through retail clinics because it is easy and convenient, and they are able to get what they need quickly. Those components, successfully integrated into a CIN, can serve as significant access points into a network.

In instances when CINs identify outside providers where their patients are going to get care, CINs should establish a contractual relationship with the provider. Such new access points come with their own challenges, including difficulty with sharing patient information and with communication. 

But hospitals need to think about the issue of access beyond patient visits to the emergency department, primary care, or even retail clinics. More CINs are focusing on access points to help keep patients in their networks. When analytics indicate the patient outmigration rate (patients going outside the network—sometimes referred to as "leakage") is more than 5 to 10 percent, the providers must find ways to keep more patients in the network.

Increasing access can also turn into a selling point for the CIN to increase volume by touting its ability to provide convenient care. Selling the CIN to patients is particularly important in the era of high-deductible health plans, where patients actively select providers based on price and quality. 

This new download from The Camden Group provides insight surrounding:

  • How people rate access
  • What consumers want (old vs. new models)
  • Expectations surrounding access redesign
  • Consumer trust statistics
  • The new paradigm of patient access
  • Objectives of "best in class" patient access
  • Creating loyal patients for life
  • The continuum of organized care

Please click the button below to access the download page:

Patient Access, The Camden Group, Clinical Integration

Topics: Clinical Integration, Clinically Integrated Networks, Patient Access, Daniel J. Marino

7 Ways to Achieve Clinical Integration Through Strategic Physician Engagement

Posted by Matthew Smith on Aug 19, 2015 12:11:58 PM

By William K. Faber, M.D., MHCM, Vice President, The Camden Group

Physician Engagement, The Camden GroupNew payment models make it more important than ever for hospitals to collaborate with physicians. From readmission penalties to bundled payments to Accountable Care Organizations ("ACOs"), providers have a growing economic incentive to pool resources, share information, coordinate care and services, and cooperate on quality improvement. 

But while the incentives are strong, the obstacles to clinical integration are daunting. Hospital-physician collaboration is operationally complex. Although physician employment can smooth out some of the bumps, practice acquisition is expensive. While a handful of large health systems have devoted extensive resources to launching clinical integration initiatives, most smaller organizations are still sorting out their options.

How can hospitals integrate with physicians without creating political and financial problems? The solution is to focus on building mutually beneficial relationships and use existing resources wisely.

The following practical approach will help healthcare leaders achieve clinical integration by engaging physicians, strategizing collaborative programs and making targeted investments.

1. Understand Physician Motivation

Convincing physicians to collaborate more closely with a hospital can be challenging. Physicians are trained as autonomous decision makers. Perfectionism and the need for control can make it difficult to weave physicians into an integrated organization. But there is a positive side to the medical personality: No doctor wants to be an outlier.

Engage physicians by presenting data on their patient outcomes. Most physicians will discover at least a few areas in which their performance falls short of their peers.

Talk to doctors about their patients’ flu vaccination rates, medication reconciliation rates, performance on diabetes control measures, etc. This is easiest for hospitals that have access to physician claims data through a physician-hospital organization ("PHO") or that offer physicians a subsidized electronic medical record ("EMR") with built-in Clinical Quality Measure ("CQM") templates that facilitate reporting.

Most physicians do not track and evaluate their own performance, let alone measure their performance against peers. Relevant patient statistics will earn physicians’ attention and generate interest in working more closely with hospital staff to improve outcomes.

It is also important to educate physicians on the evolving healthcare market. Explain how payers are creating incentives for clinical integration though bundled or global payments and per patient/per month care coordination fees. As physicians become more aware of these payment trends, many will embrace the opportunity to increase their salary by partnering with the hospital.

2. Create True Physician Governance

To gain the most under new payment models, physicians and hospitals have to play nice in the sandbox. The key is establishing a governance body that allows physicians to guide the development of care strategies and clinical protocols. Physician-led governance will create physician awareness and support for clinical integration initiatives and make a positive impact on the overall success of the program. Make sure the clinical integration governance committee includes physicians from solo practices and small partnerships as well as large groups. Include representatives from a range of specialties.

Most important, the governance body should include physicians who are critical or even negative about the clinical integration initiative. Often these “difficult” physicians simply want to be heard and provide their input. Making these physicians feel included will go a long way toward smoothing the transition to integration.

3. Focus on Quality, Not Finances

Physicians are concerned about productivity and payment, but concentrating exclusively on financial metrics will disenchant many providers. Focus instead on clinical quality and performance improvement. After all, this is the main reason physicians entered medicine — to provide quality care to the patients they serve.

The clinical integration committee should establish quality benchmarks and treatment protocols that define performance standards. Benchmarks can be based on evidence-based standards and care plans developed by national quality organizations and disease associations. Micromanaging clinical decisions will be unpopular, so care protocols should be broad guidelines that allow room for individual judgment.

To choose initial improvement goals, review admission and inpatient reports to identify areas of low quality and high cost. For which conditions does the hospital see the greatest number of admissions? Which conditions have the longest length of stay? Physicians using an EMR may be able to report on certain quality measures. For example, what is the percentage of hypertensive patients with adequate blood pressure control? How many heart disease patients have an up-to-date lipid profile?

Begin the clinical integration outreach with physicians in specialties linked to poorer outcomes and higher costs. Another logical starting point is primary care. Family practice physicians and internists often have the greatest impact on chronic disease management.

4. Concentrate on Care Coordination

One of the biggest opportunities in clinical integration is better coordination of care. Focus on high- and medium-risk patients who are responsible for the highest costs or who will likely increase costs in the near future. Target care transitions between the hospital and admitting specialists or primary care physicians. Involve physical therapy, home health providers and long-term care facilities in clinical coordination planning.

Physicians need to ensure that discharged patients complete follow-up visits. The hospital can assist by sponsoring a care coordination team for the entire organization to help manage follow-up appointments, referrals and home health services. To help guide care coordination, stratify hospital discharges by risk of readmission, complication or care plan non-compliance.

5. Use Technology to Get Providers Talking

Clinical integration is nearly impossible without an EMR system, but many medical practices are not far along in EMR adoption. Most practices cite expense as the main obstacle.

To overcome the cost hurdle, consider subsidizing EMR systems for practices that agree to join the integrated organization. Relaxation of the Stark laws allows hospitals to subsidize as much as 85 percent of the purchase and support costs of an EMR system. Subsidy agreements can require physicians to report quality measures and meet quality performance thresholds.

However, do not expect physicians to acquire the same EMR system as the hospital. Many small practices can do very well with free and low-cost alternative systems. The hospital should build interfaces for exchanging information with the EMR systems used by the majority of integrated physicians.

Many physicians who have implemented EMRs have participated in the Medicare and Medicaid EHR Incentive Program. As part of demonstrating Meaningful Use under the program, these physicians have already begun tracking clinical quality measures. Clinically integrated organizations should use the EMR to create aggregated quality reports and share them with physicians. Weekly or monthly reports can track disease management data such as HbA1c levels, cholesterol, blood pressure and preventive screenings. Giving physicians the chance to view quality performance metrics will engage both their competitive personalities and their collaborative spirit.

6. Build Financial Incentives

Clinical integration will require physicians to invest time and money into patient education, technology and additional staff. The problem is that methods of compensating providers for care coordination are still being developed and tested by payers. Given the costs being shouldered by physicians, financial incentives are critical.

Regardless of how incentives are distributed, hospital leaders should reward physicians either for controlling costs, achieving quality benchmarks or both. Focus on achieving care management quality metrics early on, since reduced costs tend to follow well-managed patients. Establish and re-assess these performance targets annually.

One important note: Make sure primary care physicians get a piece of the pie. Although surgical specialists might be responsible for most of the hospital’s costs and revenue, primary care doctors have the most frequent patient contact and are also responsible for most of the work of chronic disease management.

7. Invest Early for Healthy Returns

Even hospitals without the resources of a large medical system can achieve clinical integration by focusing on strategic investment and engaging community physicians through quality improvement. Hospital leaders need to allow physicians to establish the quality benchmarks and evidence-based protocols for the organization’s costliest conditions. Leaders can then concentrate on linking doctors through technology, assisting with care coordination, and negotiating with payers on bundled payments or pay-for-performance incentives.


Dr. Faber is a vice president with The Camden Group. As a physician executive, he specializes in the development of accountable care organizations and clinically integrated networks, physician engagement, and health information technology. Prior to joining The Camden Group, Dr. Faber served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s clinical integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an electronic health records system. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

 

Topics: Clinical Integration, Population Health, William K. Faber MD, Physician Engagement, Governance, Care Coordination

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