Clinical Integration Requires Culture Change

Healthcare’s Triple Aim – providing better care for individuals, better health for populations and lower costs overall – is closely related to the benefits of clinical integration. In a successfully integrated organization, patients have increased satisfaction, providers benefit from higher reimbursements, and payers recognize lower costs of care. But is integration effective and can it be achieved?

Clinical integration has been part of our discussions since the 1980s. Thirty years ago, the primary aim of integration was to provide the means for hospitals to control costs and improve negotiations with payers. We witnessed a move toward larger organizations in the 1990s as hospitals initiated a record number of institutional mergers and practice buyouts. Merely merging or expanding, however, has not necessarily proved effective. 

The physician-employment model, for example, has not been universally successful. We have seen evidence that hospitals have lost thousands of dollars per physician annually, substantially reducing already slender margins. Likewise, some physicians sold their practices, planning to work several more years and then retire. Some of them are now returning to work because of the financial realities of retirement.

Stress between practices and healthcare systems has become apparent as hospitals try to maximize the benefits of practice acquisitions and physicians try to maximize their financial situations as either hospital-owned or independent providers. As a result, some competing practices are merging to form mega-practices or large multi-specialty practices. Hospitals are exploring ways to work with practices without buying them, such as creating specialty partnerships in areas like cardiac care, cancer treatment, pediatrics and orthopedics. 

Financial constraints also may dictate that hospitals focus on practice areas where they have great expertise and expand partnerships in areas where they do not. With the cost of equipment, training and salaries, as well as the change in reimbursement models, hospitals can no longer afford to be all things to all patients. They must identify their strengths and work to maximize the financial benefits in those areas.

As these new strategies prove, clinical integration does not require a hospital to get bigger or more diverse. Instead, true integration focuses on the quality of care throughout a patient’s interaction with the hospital, including admission, care in the facility, and follow-up after the procedure. It requires hospitals to remove barriers between medical staff and administration, as well as the restructuring of silos separating specialties, making the patient’s interaction with the hospital streamlined and comprehensive. In short, it requires a change in culture.

Culture change is inherently difficult because human nature resists change, but integration will not be possible without it. Hospital administrators may see the financial necessity of creating a new model, but physician leaders may well be the key to making a new healthcare culture work. Both sides of the system must learn to work together toward a common goal – the Triple Aim. It will take vision, education, commitment and leadership to achieve. Can the healthcare system make the leap? I believe it can.