An effective Clinical Integration Program contains initiatives that (1) provide measurable results, (2) are used to evaluate physician performance and (3) result in concrete improvements in quality, cost, and patient satisfaction. Clinical integration fosters interdependence among providers and, by working together on the quality initiatives selected for the program, enables them to achieve higher quality and demonstrate greater cost-effectiveness than likely accomplished on their own.
In most instances, clinical integration involves a hospital or health system and physicians on its medical staff 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 an inpatient, outpatient, and ambulatory basis; (3) collaborate with the hospital or health system to encourage compliance with hospital performance improvement processes and protocols; and (4) enter into contractual arrangements with fee-for-service health plans in a manner that financially recognizes the physicians’ demonstrated improvement of health care quality and efficiency.
Yes. Physician leaders, along with the Hospital’s leadership, are working to create a new, independent physician network. This physician network will be governed by a board composed of physicians and will operate for the explicit purpose of developing and implementing a Clinical Integration Program. Physicians are leading and actively participating in developing the key components of the Program.
Quality initiatives are designed to facilitate and improve:
The goal for the St. Rose Quality Care Network is to enhance the value of services that physicians provide to patient, employer, and payer communities by measuring compliance with initiatives based on data from various sources, including systems associated with claims processing and adjudication, practice management and scheduling, disease registries, pharmacy benefits, and hospital and ambulatory EMR.
Physicians have numerous and overlapping motivations for joining together in clinically-integrated networks, including: (1) to enhance the quality of the care provided to patients, (2) to legitimately negotiate with payers as a network, (3) to develop their own alternatives to heath plan "report cards” and other initiatives that may not accurately assess physicians, (4) to provide access to technological and quality improvement infrastructure, and (5) to allow networks of physicians and hospitals to market themselves on the basis of quality.
An ambulatory EMR is not a prerequisite to participate in the St. Rose Quality Care Network. While a common EMR across all participating physician practices can certainly accelerate and strengthen a Clinical Integration Program, most (if not all) successful models of clinical integration nationwide do not depend on an ambulatory EMR for data on physician performance. The St. Rose Quality Care Network will utilize a technology system, Intelligent Healthcare, to measure, analyze, and evaluate physician performance through claims data, existing hospital data, disease registries, and chart audits.
Doctors and hospitals in multiple states are implementing Clinical Integration Programs not merely for reasons of antitrust compliance, but rather because they believe in its value proposition: