Clinical integration is an increasingly popular strategy for hospitals to align with physicians and improve the cost and quality of care. Dennis Butts, a manager in Dixon Hughes Goodman's healthcare strategy practice, shares seven strategies for hospitals to successfully develop a clinical integration network.
1. Cultivate physician leaders. A successful clinical integration strategy requires the integrated network to be physician led and physician driven, according to Mr. Butts. "Physicians have to have enough power and authority to effect change — to [determine] how quality is defined, what protocols will be developed and how to hold each other accountable for meeting objectives."
To lead the network effectively, it is critical for physicians to be involved in creating the clinically integrated model from the beginning; they need to have a voice in designing the structure of the network. "You can't expect a physician-driven initiative after you've already planned [the network] in the hospital and expect them to buy in to what you've already developed," Mr. Butts says.
Giving physicians leadership roles may require a cultural change in the hospital, as historically hospital administration and physicians have worked separately. "It's a real paradigm shift for most organizations where they're allowing physicians to have a significant say in how things are done at the hospital," Mr. Butts says. Physicians may also have to change their workflows to be successful in their new roles. "Physicians are going to be asked to do things differently and be held accountable for things they maybe haven't been in the past," he says.
2. Provide hospital management. Creating a physician-led clinical integration network does not mean clinical integration is solely run by physicians, however. The most successful programs have embraced a physician-led, professionally-managed culture that maximizes the experience and expertise of physicians and hospital administration, according to Mr. Butts. The hospital can provide data analytics and other resources and expertise to ensure the network is supported from a management perspective.
3. Communicate often. Another critical aspect of clinical integration is frequent communication between all parties. Clinical integration is a major change initiative and leaders should seek medical staff input early and often, according to Mr. Butts. He says one common mistake in developing clinical integration networks is when leaders assign small committees to work on different initiatives, but don't have a robust strategy for these committees to communicate with each other and to the broader medical staff.
4. Choose metrics. Clinical integration networks should choose metrics that span the continuum of care, according to Mr. Butts. "Make sure your metrics cover the inpatient side as well as the outpatient side, so you're not focused on just what happens in the hospital, but also what's happening in the physician practice," he says. He also suggests focusing on metrics related to care transitions between sites and adopting the same metrics across payors.
5. Invest in infrastructure. A successful clinical integration network requires investment in infrastructure that can connect the hospital and physicians through patient registries and other electronic systems. A robust infrastructure provides the tools physicians and hospitals need to monitor quality and cost. "Without that infrastructure in place or access to real-time data, physicians will not be able to change [clinical] patterns to achieve the objectives of the network," Mr. Butts says.
Clinical integration networks can reduce the cost of developing appropriate infrastructure by building off an existing structure. For example, Mr. Butts says the network can build upon the infrastructure already in place from a messenger model physician-hospital organization or independent practice association if they exist. "Instead of recreating the wheel, see if there's an entity already created that is still usable to reach the objectives you're trying to meet," Mr. Butts says.
6. Create a short-term win. When hospitals and physicians develop a clinical integration network, they can build payors' support of the network by quickly demonstrating improvement. Targeting low-hanging fruit to demonstrate improved quality and cost can help validate the clinical integration model. Oftentimes hospitals go after low-hanging fruit by starting with hospital efficiency initiatives in the acute setting or within the hospital-sponsored health plan. When the network negotiates with payors, it can use data from these initial improvements to attain favorable contracts, according to Mr. Butts.
7. Determine a distribution method. Leaders must develop a methodology to distribute incentive dollars once they are in the network. The distribution methodology should 1) distribute funds based on measurable performance, 2) be transparent, 3) reward physicians for their individual contribution and performance and 4) maintain a level of simplicity, according to Mr. Butts. He says leaders of the network often build individual and network incentive pools into the distribution methodology to achieve these objectives.
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1. Cultivate physician leaders. A successful clinical integration strategy requires the integrated network to be physician led and physician driven, according to Mr. Butts. "Physicians have to have enough power and authority to effect change — to [determine] how quality is defined, what protocols will be developed and how to hold each other accountable for meeting objectives." To lead the network effectively, it is critical for physicians to be involved in creating the clinically integrated model from the beginning; they need to have a voice in designing the structure of the network. "You can't expect a physician-driven initiative after you've already planned [the network] in the hospital and expect them to buy in to what you've already developed," Mr. Butts says.
Giving physicians leadership roles may require a cultural change in the hospital, as historically hospital administration and physicians have worked separately. "It's a real paradigm shift for most organizations where they're allowing physicians to have a significant say in how things are done at the hospital," Mr. Butts says. Physicians may also have to change their workflows to be successful in their new roles. "Physicians are going to be asked to do things differently and be held accountable for things they maybe haven't been in the past," he says.
2. Provide hospital management. Creating a physician-led clinical integration network does not mean clinical integration is solely run by physicians, however. The most successful programs have embraced a physician-led, professionally-managed culture that maximizes the experience and expertise of physicians and hospital administration, according to Mr. Butts. The hospital can provide data analytics and other resources and expertise to ensure the network is supported from a management perspective.
3. Communicate often. Another critical aspect of clinical integration is frequent communication between all parties. Clinical integration is a major change initiative and leaders should seek medical staff input early and often, according to Mr. Butts. He says one common mistake in developing clinical integration networks is when leaders assign small committees to work on different initiatives, but don't have a robust strategy for these committees to communicate with each other and to the broader medical staff.
4. Choose metrics. Clinical integration networks should choose metrics that span the continuum of care, according to Mr. Butts. "Make sure your metrics cover the inpatient side as well as the outpatient side, so you're not focused on just what happens in the hospital, but also what's happening in the physician practice," he says. He also suggests focusing on metrics related to care transitions between sites and adopting the same metrics across payors.
5. Invest in infrastructure. A successful clinical integration network requires investment in infrastructure that can connect the hospital and physicians through patient registries and other electronic systems. A robust infrastructure provides the tools physicians and hospitals need to monitor quality and cost. "Without that infrastructure in place or access to real-time data, physicians will not be able to change [clinical] patterns to achieve the objectives of the network," Mr. Butts says.
Clinical integration networks can reduce the cost of developing appropriate infrastructure by building off an existing structure. For example, Mr. Butts says the network can build upon the infrastructure already in place from a messenger model physician-hospital organization or independent practice association if they exist. "Instead of recreating the wheel, see if there's an entity already created that is still usable to reach the objectives you're trying to meet," Mr. Butts says.
6. Create a short-term win. When hospitals and physicians develop a clinical integration network, they can build payors' support of the network by quickly demonstrating improvement. Targeting low-hanging fruit to demonstrate improved quality and cost can help validate the clinical integration model. Oftentimes hospitals go after low-hanging fruit by starting with hospital efficiency initiatives in the acute setting or within the hospital-sponsored health plan. When the network negotiates with payors, it can use data from these initial improvements to attain favorable contracts, according to Mr. Butts.
7. Determine a distribution method. Leaders must develop a methodology to distribute incentive dollars once they are in the network. The distribution methodology should 1) distribute funds based on measurable performance, 2) be transparent, 3) reward physicians for their individual contribution and performance and 4) maintain a level of simplicity, according to Mr. Butts. He says leaders of the network often build individual and network incentive pools into the distribution methodology to achieve these objectives.
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