This post is the sixth of an 11-part series that proposes structures and actions that characterize successful accountable care organizations. Click here to download A Model for Value-Based Provider/Payer Partnerships white paper that covers the subject more in-depth.
Based on Federal Trade Commission (FTC) statements, the following can describe five primary legal characteristics of clinical integration:
- Monitoring and controlling quality, service and costs
- Selectively choosing a physician network that includes primary care and specialist
- Having a well-developed care management program that uses evidence-based guidelines for a broad spectrum of diseases and disorders
- Showing significant investment by physicians in both time and capital
- Integrating data management, enabling extensive data collection, information sharing, quality reporting and utilization review
Clinical integration is far from easy. Clinical processes can be fragmented, redundant, conflicting and—perhaps most daunting—heavily ingrained. Integration of care requires rethinking the delivery processes to coordinate patient care services across people, functions, activities and operational units to maximize the value of services delivered.
Becoming clinically integrated means collectively defining acute and disease-specific standards of care, educating physicians on the standards, providing tools to support physician compliance and measuring physician performance against the defined standards. The key to clinical integration is to continually monitor and evaluate performance that will identify areas of opportunity to improve care delivery across providers and improve physician performance.
Our next ACO models for success post will delve deeper into how clinical integration affects the delivery of care.
- Register today for the Provider Journey Webinar Sept 10 (Free)
- A Model for Value-Based Provider/Payer Partnerships–White Paper
- Trailblazers in Accountable Care–White Paper
—Cynthia Kilroy, Sr. Vice President, Provider Strategic Initiatives, Optum