April 20, 2016

4 Essentials to Enabling Clinical Integration

Travis Good, MD

Co-founder & Chief Technology Officer

With all the buzzwords in the healthcare industry, it has become impossible to keep track of their many interpretations and evolutions, but more importantly, tracking how to properly enable solutions. Clinically integrated networks have their many benefits. As regarded by the Federal Trade Commission (FTC) they are permitted collaborations between otherwise competing providers (physicians and/or hospitals). These partnerships are organized in a manner that not only improves efficiencies in care delivery, including care quality and cost reduction, but also avoids any potential rival ramifications, such as competitor pricing fixes. Additionally, clinical integration enables providers to engage in contracted collaborations while evading the heavy scrutiny of the antitrust laws.

Over the years, the notion of clinical integration has evolved. The FTC in 1996 instituted a few guiding principles: 1) The framework must be based on the equal ownership of the substantial risk by the participant providers; 2) Clinical integration must produce an outcome that benefits consumers; 3) The goal is to provide supplemental services at a reduced price point, or that this would at least be an end result. Today, there are a few different features that underlie clinical integration:

  • Utilization of information technologies to establish relevant patient data exchange
  • Implementation and development of clinical protocols to minimize unpredictable variations in care
  • Evaluation of clinical results to confirm compliance with conventions that are furthering positive outcomes

Previously, physicians handled the clinical affairs while healthcare administrators managed the finances and operations. Presently, those roles have blurred. Reimbursement now involves risk-sharing, which necessitates healthcare professionals work together directly to stipulate coordinated care. With such close working environments, some baselines must be met to fully enable the acceleration of clinical integration.

1. Party Transparency

Each party must know how others are providing patient care. Transparency can truly be the catalyst to complete trust in a budding transformative partnership. Data must be exchanged, and all must work in tandem to ensure that data is an accurate clinical representation.

2. Aligned Commitment

Developing a shared mission, vision, and values that each party can commit to will establish a process of inclusion for all involved.

3. Forthright Engagement

Party engagement is critical, but must be based on mutual respect. Management needs to work with physicians at the start instead of strategizing independently and then attempting to assure physician buy-in.

4. Superior Support

Only systems that support the above will be built to successfully deliver. Systems are necessary to cement any process changes into each party’s daily activities. A properly enacted system helps maintain a collaborative culture of safety, quality, and reliability.

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