By Naveen Sarabu, Director, Product Management and Strategy, Liaison Healthcare Informatics
Recently I attended the American Hospital Association’s Annual Leadership Summit in the beautiful and sunny San Diego, California. One of the main topics discussed is Clinically Integrated Network. The idea of clinical integration has been around for a while but gained momentum with the pioneers like Advocate Physician Partners and others that used this construct to negotiate value-based contracts and showed better outcomes both in cost reduction and clinical improvements. Health Systems and hospitals are now creating more of these clinical integrated networks (I heard someone mention more than 700 at the conference) with their Physician-Hospital Organizations (PHOs) and independent physicians. All thanks to recent rulings by Federal Trade Commission (FTC) that state it will not recommend antitrust challenge to the organizations that are proposing to providing member physicians services through clinical integration program (see here).
So, what is a clinical integration network? In 1996, Department of Justice and FTC defined clinical integration as “an active and ongoing program to evaluate and modify practice patterns by the clinically integrated network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.” Being part of the clinical integration network, a provider has flexibility to keep his/her fee-for-service contracts and can opt in or opt out of each shared savings agreement between the organization and a particular payer. The technology requirements are to: aggregate data from disparate sources, stratifying data performing analytics to identify high-risk patients, care coordination and care management and reporting the quality and cost measures to payers. Our experience working with multiple IPAs in creating a clinical integration network has been validated by the speakers at the conference and it requires lot of patience. One of the speakers said that the things he went and purchased include “a pair of knee pads, pompoms and a silver spoon” to reach out to the physicians in signing up with the clinical integration network. Aggregating data from disparate sources is a major challenge since the clinical integration network includes employed physicians and independent physicians that are on different EHRs and as explained by one speaker this challenge as “eating glass”. This is one of the core competencies of Liaison and we can help you meet the integration challenges along with the needed analytics and reporting. I would to love to hear your success stories or experiences regarding this.