Clinical Integration: An Integrated Physician Model

“An integrated physician model is the result of a series of partnerships between hospitals and physicians developed over time. Essentially, it is a joint venture that has become many joint ventures, and all these joint ventures are connected through congruent goals (Harrison, 2016).” It is a business model with defining elements of assigned roles and tasks. As well as the core functions of patient advocacy, quality management and productivity management within the (PMU) Performance Management Unit. By achieving this, the integrated-physician-model does not only create value for doctors and hospitals, but also for patients. It was determined that only those physicians and hospital providers who focus primarily on the patient will emerge strengthened

from the increasing competition in the health care sector. This allowed me to better understand the integrated physician model. It is a shared effort of physician and hospital integration to work together to accomplish objectives and work towards progress. It enables organizations to incorporate the all-round patient settings by infusing primary care, clinicians, patient physician feedback, emotional wellness and so much more.
“The American Medical Association (AMA) describes clinical integration as “the means to facilitate the coordination of patient care across conditions, providers, settings, and time to achieve care that is safe, timely, effective, efficient, equitable, and patient-focused.” ("What is Clinical Integration | Knowledge Hub | athenahealth," 2018).” Clinical integration is important to strategic planning because it gives physician the ability to be a part of the decision-making processes within an organization.

Clinical integration can assist the organization by evaluating and improving the quality of healthcare that is being provided, influence and improve the patient experience and regulate the cost of care. When use effective clinical integration with strategic planning provides an avenue to incorporate clinical pathways, quality improvement programs, use of electronic records, carry out administrative tasks and service planning. Clinical integration is simply coordinating patient care between physicians and hospitals through the healthcare system. With the use of clinical integration hospitals and physicians can create an information connection and lessen

competition.
Clinical integration offers hospitals and physicians to coordinate healthcare services through centralized scheduling, electronic medical records, clinical pathways, chronic disease management, and pioneering quality improvement programs. The ability to deliver affordable, high-quality healthcare is dependent upon clinical integration (Harrison, 2016). Clinical integration is necessary to facilitate coordinating patient care across conditions, settings, providers, and time to accomplish care that is equal, patient-focused, safe, timely, effective and efficient (Clinical Integration, n.d.).
“Clinical integration across the continuum of care is necessary to delivering high- quality, affordable care in the current environment (Jacquin 2014).” Communication across the continuum of care is vital in many aspects of healthcare.

Financially clinical integration can benefit both hospitals and physicians. Clinical integration can help improve access to expensive medical technology and ease the burden of unprofitable services. Since hospitals and physicians are naturally interdependent it would benefit both parties to improve their relationship. The ability of a hospital to attain and retain quality physicians is vital to the organizations reputation, market share, and profitability long-term. Physician referrals are how many patients are admitted to hospitals; conversely physicians depend on hospitals for facilities, the newest technology, and high-quality medical staff. Due to the nature of this interdependency it would be in the best interest of hospitals and physicians to work together (Harrison,

2016).
Physicians should be involved in hospitals’ decision-making process, that way both parties will be able to reach an agreement based on the values, ethics, and culture of the new business venture. It is important to have physicians participate in key roles such as being on the hospital board of directors, board committees, and strategic planning and finance committees. This will empower them to be engaged in the future of the hospital. Asking for physician input, including them in focus groups about new initiatives, creating strategic plans and schedules, and giving them the opportunity to own a part of the organization hospitals can ignite a spark for physicians to commit to new business ventures with the organization (Harrison, 2016).
Many healthcare leaders think that one of the biggest challenges facing the United States healthcare system is the alignment between physicians and hospitals. These two parties are burdened with the task to find ways to work together while taking advantage of both of their combined economic interests. Accountable care organizations offer a solution and can help merge the interests of the both parties. Accountable care organizations are groups of doctors, hospitals, and other healthcare providers who voluntarily come together to provide high-quality, coordinated care to Medicare patients. The goal of this type of organization is to avoid needless service duplication and medical error prevention. This goal is reached by coordinated care which helps these groups ensure that their patients, especially the chronically ill, are getting the right care at the right time (Harrison, 2016).
The Affordable Care Act established accountable care organizations, and it is designed to reward coordinated care and value rather than duplicate care and how many patients are seen. The emphasis on preventive services and coordinated care will help to decrease healthcare costs growth and outcome improvement. Although accountable care organizations offer many benefits, they also have some downfalls. In this type of organization patients are not required to use a specific set of providers, they are free to get care from a Medicare provider whether they are in the network or not. Patients are assigned after they have been seen to an organization based on where they received most of their primary care. Regulators were concerned that providers would use the system by rejecting expensive care, they also worried the ability to meet goals for quality measurement, governing structure, and transmitting information (Harrision, 2016).
Other potential solutions to the current healthcare system are medical foundations, hospital-owned group practices, and joint venture initiatives. The medical foundation model is an arrangement in which independent physicians sell their practices to a medical foundation, the physician is then under contract to provide medical services at the foundation’s sites. Under this model hospitals and health systems can create legal nonprofit organizations to directly employ physicians. It also allows gives physicians more independence and improves physician and hospital relations. Hospital-owned group practices are medical practices that have been purchased by a hospital. This model can be beneficial because it can improve integration, increase access to care and foster longer relationships with the patient’s physician. Joint ventures are when two businesses create a legal entity to share its profits (Harrison, 2016).
Joint venture initiatives have a competitive edge because the customer base increases as the combining organizations customers have merged. Physicians and hospitals will face advantages and disadvantages under this model (Harrison, 2016). Joint ventures will be appealing to new generations of providers because these types of business initiatives will reward them based on improved patient care (Moses, et al, 2013). Physicians, nurses, and other clinical healthcare providers could become the primary source of clinical innovation given their clinical judgment and skill to involve patients in the decision-making process. This improvement in patient satisfaction and healthcare service value will result in joint ventures that use people, information, and technology more effectively. The increased innovation will benefit hospitals and physicians by increasing sales volume, technology sharing, research collaboration, and expertise sharing. Hospitals had higher occupancy rates, offered more clinical services, and had higher returns on assets engaging in joint ventures. There are possible pitfalls of joint ventures such as lack of trust, inequitable contribution of capital, and conflict on overall control.
The United Stated healthcare system has not been a cohesive unit, which reduces the quality of healthcare services. More collaboration between hospitals and physicians is necessary to get the healthcare system moving in the right direction. Collaborative relationships between hospitals and physicians can lead to joint ventures, which will increase the quality of care and efficiency of the healthcare system. Integrated healthcare systems will be able to deal with healthcare needs more effectively because they will have more access to resources and better ability to deliver integrated care (Harrison, 2016).

References:
Clinical Integration. (n.d.) http://www.aha.org/advocacy- issues/clininteg/index.shtml

Harrison, Jeffrey. P. (2016). Essentials of Strategic Planning in Healthcare, 2nd Edition.

Moses, H., D.H. Matheson, E.R. Dorsey, B. P. George, D. Sadoff, and S. Yoshimura. 2013. “The Anatomy of Health Care in the United States.” Journal of the American Medical Association 310 (18):1947-63.

Salas-Lopez, D., Weiss, S. J., Nester, B., & Whalen, T. (n.d.). Physician clinical alignment and integration: a community-academic hospital approach. Retrieved June 27, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/24988674