Q: What is “clinical integration”?
Clinical integration is an effort among physicians, often in collaboration with a hospital or health system, to develop active and ongoing clinical initiatives that are designed to control costs and improve the quality of health care services. Participation in an effective clinical integration program will provide both employed and independent physicians on INTEGRIS Health medical staffs the ability to contract collectively with health plans without violating antitrust laws.
Q: What are the characteristics of effective clinical integration initiatives?
An effective clinical integration program will contain initiatives that (1) provide measurable results, which (2) are used to evaluate physician performance and (3) result in concrete remediation of that performance.
Q: In “real life,” what does a clinically integrated network of independent physicians look like?
In many instances, clinical integration has involved both employed and independent doctors on the medical staff of the same hospital or hospital system who join together in an organization that allows them to: (1) identify and adopt clinical protocols for the treatment of particular disease states, (2) develop systems to monitor compliance with the adopted protocols on both an inpatient and outpatient basis, (3) collaborate with the hospital or hospital system to encourage compliance with inpatient performance improvement processes and protocols, and (4) enter into physician-directed “pay-for-performance” and other contractual arrangements with health plans in a way that financially recognizes the physicians’ efforts to improve health care quality and efficiency.
Q: At INTEGRIS, will physicians be involved in the development of clinical integration and the leadership of this endeavor?
Yes. INTEGRIS and a number of physician leaders are now actively engaged in the process of developing a new physician network to be known as INTEGRIS Health Partners. This physician network will be governed by a board led by doctors, and will operate for the explicit purpose of developing and implementing a clinical integration program, on the basis of which the network would negotiate “pay-for-performance” arrangements health plans with INTEGRIS Health facilities to share in the savings generated by improving quality and reducing costs.
Q: What will physicians need to do, to participate in the INTEGRIS clinical integration program?
INTEGRIS physicians will be asked to do the following.
- First, because membership in INTEGRIS Health Partners will be completely voluntary, physicians will need to choose whether they will participate in the INTEGRIS clinical integration program by signing a Network Participation Agreement.
- Second, physicians will be required to collaborate with their physician colleagues and INTEGRIS in the development and adoption of an INTEGRIS clinical integration program – a collection of clinical initiatives that will enhance the quality, service and cost-effectiveness of patient care.
- Third, physicians will need to hold themselves and each other accountable for compliance with the initiatives of the INTEGRIS clinical integration program, including its disciplinary and remediation efforts should physicians not meet the benchmarks set by the INTEGRIS clinical integration program.
Q: By agreeing to participate in INTEGRIS Health Partners, will physicians be required to abandon medical staff appointments at non-INTEGRIS hospitals or admit patients only to INTEGRIS hospitals and ambulatory care facilities?
No. INTEGRIS Health Partners will be established as a non-exclusive organization, making no limitations whatsoever on a physician’s ability to admit patients to non-INTEGRIS sites of care or a physician’s ability to maintain contracts with health plans on an individual basis.
Q: What clinical initiatives will the INTEGRIS clinical integration program include?
Although the INTEGRIS clinical integration program is still in the process of development, it is likely that it will include efforts designed to facilitate and improve:
- Inpatient EMR and CPOE adoption
- INTEGRIS facility cost reduction efforts
- Ambulatory EMR adoption
- Chronic disease management
- Care episode management
- PQRI reporting
- Communication among primary care physicians and specialists
- Community case management
- Quality-based credentialing.
The goal is that INTEGRIS Health Partners will enhance the value of the services we provide the patient and payer communities, measuring compliance with the initiatives using data from various sources, including claims processing and adjudication systems, practice management and scheduling systems, disease registries, pharmacy benefit systems, and hospital and ambulatory EMR systems.
Q: Will participation in the INTEGRIS clinical integration program require physicians to change the way they practice medicine?
Yes. Participation in the quality and care management initiatives of the INTEGRIS Health Partners will require significant time and attention from physicians and their office staff. But, in return, participating INTEGRIS physicians will be eligible to obtain FINANCIAL REWARDS for their achievements through the clinical integration program, funded by contracted health plans as well as INTEGRIS Health. The amount of incentive payments will depend on both the physician’s personal score and the overall score of the organization. This latter component highlights the importance of physicians working together to improve care.
Q: What role does an EMR play in clinical integration?
An ambulatory EMR is NOT A PREREQUISITE for the development of clinical integration. While a common EMR across all participating physician practices can certainly accelerate and strengthen a clinical integration program, most (if not all) successful models of clinical integration nationwide do NOT depend on an ambulatory EMR for data on physician performance. Ultimately, a network of physicians may wish to implement an EMR that is designed in a manner that assists in the capture and extraction of the data necessary to continue to operate their clinical integration program. One opportunity offered by the anticipated INTEGRIS clinical integration program is the ability of the health system to underwrite a physician office EMR. But still, the INTEGRIS clinical integration program will likely begin its efforts to measure, analyze
Q: Why are physicians across the country engaging in clinical integration?
Physicians have numerous and overlapping motivations for joining together in clinically integrated networks including: (1) to enhance the quality of the care provided to patients, (2) to legitimately negotiate with payers as a network, (3) to respond to health plans that are under tremendous pressure to use “report cards” that exclude “inefficient” physicians, (4) to provide access to technological and quality improvement infrastructure that will allow physicians to argue against these “report cards,” and (5) to allow networks of physicians and hospitals to market themselves on the basis of quality.
Q: How is it lawful for a network of clinically integrated physicians to collectively negotiate with health plans when the FTC is actively investigating and prosecuting physician networks for negotiating PPO contracts?
The FTC views clinically integrated physician networks as an opportunity to create efficiency and quality in care that outweighs any restraint on trade. However, the FTC will continue to prosecute those networks that fail to demonstrate the elements of true clinical integration.
Q: If I delegate my contracting to the network, how will that affect my current managed care relationships?
You will only be asked to consider delegating your contracting for agreements entered into by the network. Those agreements will not impact your current managed care contracts in any way.
Q: How will contractual arrangements be negotiated, and will I be required to see any patient covered under that arrangement?
The network will have a contracting committee, led by physician members of the network, who will determine the parameters of any contractual relationship. You would be required to treat patients under these arrangements in the same manner that you currently experience under any other managed care relationship.
Q: What benefit do hospitals provide in the development of clinical integration programs?
Partnering with a hospital can provide distinct advantages to a network of independent physicians in the development of clinical integration. In instances where the hospital shares the same quality vision as the physicians, the hospital can be a powerful ally in program development by: (1) collaborating with the physician in the development of clinical integration initiatives based on existing inpatient quality measures, (2) lending financial assistance and personnel in the implementation of inpatient and outpatient initiatives that provide true community benefit and are not tied to the volume or value of referrals, and (3) demonstrating to payers and the community as a whole that the clinical integration program is both legitimate and valuable.
Q: How can I receive more information regarding the details of INTEGRIS Health Partners?
The physician leaders developing the INTEGRIS clinical integration program are developing a website that will provide detailed information regarding your participation in INTEGRIS Health Partners, the clinical quality initiatives of the clinical integration program, and their pay-for-performance and incentive opportunities. If you wish to speak to someone in person, please feel free to contact one of the following.