|In This Issue|
Alan Weisman, FACHE
Immediate Past President
Kevin Coloton, FACHE
Chief Operating Officer
Bernie Poindexter, FACHE
Acting Director, Medical Logistics Division Defense Health Agency
Fort Detrick, MD
Mike Kemper, FACHE
Director, Medical Equipment Logistics & Solutions
Naval Medical Logistics Command
Fort Detrick, MD
Director Organizational Development
Johns Hopkins Health System
Jonathan "Jody" Goldsmith, FACHE
Project Manager Clinical Support
John A. O'Brien, FACHE
Prince George's Hospital Center
Raymond Dudley, MS
Vice President for Sales & Marketing
Amanda Llewellyn, FACHE
Vice President Supply Chain
Dimensions Health System
Tom Webb, FACHE, LHIMSS
Applied Management Systems, Inc.
Director, Community Outreach
Centers for Medicare and Medicaid Services
Dennis Pullin, FACHE
President and CEO
Medstar Harbor Hospital
|Clinical Integration: The Grand Vision for Succeeding Under Health Care Reform|
|Allan S. Field, Executive Consultant, Clinical Integration, Glenridge Healthcare Solutions|
At the signing of the Declaration of Independence, Ben Franklin is said to have stated, “We must all hang together, or assuredly we shall all hang separately.” While Mr. Franklin and his fellow rebels from the English Crown literally had much more to lose by not hanging together figuratively – literally their very necks - their plight is not so much different from what physicians and hospitals face in this era of health care reform. Physicians and hospitals who learn to “hang together” through viable and sustainable integration and engagement strategies stand much less of a chance of “hanging separately.”
The Federal Trade Commission and the Department of Justice in their joint Statements of Antitrust Enforcement Policy in Health Care, August 1996, provided a legal basis for such a strategy – clinical integration. As an early pioneer in the clinical integration movement, I would like to share some lessons learned for ensuring the launch of a successful clinical integration strategy.
The objectives of such a high functioning organizational framework include:
- Alignment of stakeholder initiatives to improve: total cost of care; quality; outcomes; utilization; access; provider cost of care; and, stakeholder and patient satisfaction.
- Promotion of a high degree of cooperation, collaboration and mutual interdependence among the stakeholders.
- Development of alternative reimbursement methodologies that support a culture of continuous performance improvement.
- Identification of and financially rewarding those physician stakeholders who successfully engage in the program objectives and meet or exceed performance measures.
Regardless of the PO (provider organization) model selected, there are common threads that run through successful models:
- Successful POs create a culture of trust by actively listening to each other, provide timely and data-driven feedback, are willing to respectfully challenge assumptions, especially if the data support the challenge, and relentlessly focus on transparency in all interactions.
- Matching physician and hospital capital investments can give fraud and abuse protection while also giving physicians a financial and governance stake for a relatively low investment amount.
- Key decisions - such as clinical protocols or indicators to standardize care, quality and cost benchmarks to monitor and reflect change over time, the I/T platform to support data collection and reporting, product development, membership rules, credentialing, and policies and procedures to assure uniform compliance - are centralized.
- Competency-based physician governance representation versus specialty-based is recommended. While specialty-based representation is more common, especially with physician-hospital organizations, focusing on specialty may not reveal otherwise unknown or hidden skill sets among various stakeholders.
- Physician-led POs with a high level of professional management are most likely to succeed, especially if the PO invests sufficient time and money in physician leadership development.
- Credible and trusted data that is collected frequently and is available as close to real time as possible and at the point of care is more likely to be utilized than data that is error-prone or “stale.”
- The temptation to “blind” physician quality, cost and utilization scores should be resisted. The POs most effective at moving the mean on these metrics share un-blinded peer comparisons.
- A uniform program for improvement that sets one standard across all payers and products, measures processes and outcomes uniformly, and allows physicians to focus on the delivery of high-quality care, is more likely to appeal to payers and stakeholders and lead to the desired results.
- Engagement in patient satisfaction initiatives by all stakeholders is a hallmark of successful POs.
- When the hospital is a corporate member of the PO, it will have a stake in ensuring success of PO payer negotiations on behalf of the physicians and provide assurance to the physicians that the hospital is not prospering at the physicians’ expense.
- A hospital partner also can make the PO more successful by providing access to hospital support services such as general accounting, information technology, communications, marketing and public relations expertise.
There are four basic tenets of clinical integration. Get these right and these tenets will serve as a platform from which to succeed in virtually all emerging models of care and reimbursement.
- Develop and implement clinical practice and evidence-based medicine guidelines, establish monitoring and reporting systems, and focus on physician and patient compliance.
- Develop care coordination functionality that provides such tools as patient registries, gaps in care reporting and alerts, clinical decision support, patient outreach, health coaching and wellness, and management of care transitions.
- Focus on the nurturing, negotiation and management of payer relationships.
- Provide an IT solution that supports data aggregation from disparate sources, creates a virtual longitudinal community record of care, and encompasses risk stratification, predictive modeling, and performance reporting.
It is said that, in the absence of a great vision, we default to self-interest. While the IHI’s Triple Aim – lower cost, better population health and improved patient experience – is a laudable vision, it does not speak to a sustainable business model necessary to assure its attainment. A solid clinical integration program will not only achieve the Triple Aim but also will serve as that great vision for the community served and protect the interests of all stakeholders.
|Save the Date|
|May 20, 2014
Face-To-Face: The Law and How it Affects Our Healthcare Today - Panel Discussions
This program is jointly offered and coordinated by the Maryland Chapter of Healthcare Executives (MAHCE) and the National Capital Healthcare Executives (NCHE)
UMUC Academic Center
1616 McCormick Dr.
Largo, MD 20774
2014 MAHCE Events
Thursday, July 17: Reimbursement Systems at Sheraton Columbia Town Center
Thursday, September 18 All Day: Healthcare in Maryland: the Future is Now! at Sheppard Pratt Conference Ctr, Baltimore, MD
Thursday, November 13: Career Day (location TBD)