An effective Clinical Integration program contains initiatives that 1) provide measurable results which 2) are used to evaluate physician performance and 3) result in concrete improvement of that performance.
Clinical Integration fosters interdependence among physicians, and by working together on the quality initiatives they select for the program, enables them to achieve higher quality and greater cost-effectiveness than they likely could accomplish on their own.
Clinical Integration involves physicians, often with the support of a hospital, who create committees and management capabilities to: 1) identify and adopt clinical protocols for the treatment of particular disease states; 2) develop systems to monitor compliance with the adopted protocols on both an inpatient and outpatient basis; 3) collaborate with the hospital or hospital system to encourage compliance with inpatient performance improvement processes and protocols; and 4) enter into contractual arrangements with health plans in a way that financially recognizes the physicians' efforts to improve health care quality and efficiency.
Yes. In successful Clinical Integration programs, collectively-negotiated contracts with health plans can include an enhanced fee schedule that recognizes the value of the higher quality and greater efficiency furnished through the Clinical Integration program. In addition, such arrangements have also involved financial rewards and incentives for the physicians who perform well against the standards established by the program. Usually, the pay-for-performance dollars are distributed to the group, which then distributes it to the physicians based on the formula they have designed for distribution.
No. Clinical Integration allows physicians affiliated with this clinically-integrated group to approach health plans and large employers as a collective in a legal and appropriate manner. The success of a Clinical Integration program in obtaining better payer contracts will depend on the payer's willingness to negotiate for improved quality through financial incentives for physicians and the physicians' ability to achieve improved quality and efficiency outlined in the clinical initiatives and standards.
Yes. Identified physician leaders, along with St. Rose leadership, have created a new, independent physician network, the St. Rose Quality Care Network (SRQCN). This physician network is governed by a Board composed of physicians and operates for the explicit purpose of developing and implementing the Clinical Integration Program.
Partnering with a hospital or health system can provide distinct advantages to a network of independent physicians in the development of Clinical Integration. In instances where the hospital shares the same quality vision as the physicians, as is the case at Dignity Health-St. Rose Dominican hospitals, the hospitals are a powerful ally in program development by: 1) collaborating with the physicians in the development of Clinical Integration initiatives based on existing inpatient quality measures; 2) lending financial assistance and personnel in the implementation of inpatient and outpatient initiatives that provide true community benefit and are not tied to the volume or value of referrals; and 3) demonstrating to payers that the Clinical Integration program is legitimate and valuable.
Physicians will be asked to do the following:
All of the current clinical initiatives were developed by the SRQCN Initiatives Committee and approved by the Quality Committee and Board of Managers. The goal of SRQCN is to enhance the value of services provided to patients and payers. It will do so by measuring and improving performance against physician developed quality initiatives. Data to accomplish this will be collected from practice management systems, hospital information systems and other potential sources as needed.
Physicians have several motivations for participating in clinically integrated networks. Typical reasons include:
Doctors and hospitals nationwide are implementing Clinical Integration programs not merely for reasons of antitrust compliance, but rather because they believe in its value proposition:
Clinical Integration allows physicians to: a) demonstrate their quality to current and future patients; b) choose the clinical measures against which they will be evaluated; c) enhance revenue through better management of chronic patients; d) gather collective support for building necessary infrastructure; and e) seek higher reimbursement that reflects the higher value they can furnish patients and health plans.
Clinical Integration gives hospitals the ability to a) demonstrate their quality to current and future patients; b) enlist physician support for hospital initiatives, including compliance with "core measures," clinical pathways, standardized order sets, and supply chain management initiatives; c) develop a better, more collaborative relationship with their medical staff; d) improve performance on hospital pay-for-performance measures; and e) position themselves at an advantage in the market on the basis of quality.
Clinical Integration provides patients with: a) better value for their health care dollar; b) more effective care management and outreach from a trusted source, their physician; c) more reliable information to support their choice of health plans, physicians and hospitals; d) more accurate and meaningful provider ratings; and e) greater stability in their relationship with their doctor and hospital, and less likelihood that they will need to choose new health care providers every year.
Clinical Integration gives employers: a) the ability to more effectively manage the health care costs of employees and their dependents through the purchase of better, more efficient health care services; b) increase employee productivity and reduce absenteeism through better management of chronic disease; c) lower health care costs over the long term through the reduction of variation in physician practice patterns; and d) more reliable information to support conversion to consumer-driven health insurance products.