Healthcare

It amazes me how seemingly disparate ideas, when considered together, can create new ways of seeing the world. Bear with me for a minute, and I’ll share an insight I’ve received lately based on two seemingly unrelated ideas.

Here’s the first idea: NY Times bestselling author Bruce Feiler gave a TED talk a couple of years ago about how to apply the concept of agile programming to families. He said that when using an agile programming model, teams meet once a week to answer three questions:

Clinically Integrated Networks (CINs) are gaining traction in many areas of the country, but the concept of clinical integration isn’t new. The terminology pre-dates the ACA by over a decade, as the FTC coined the term in 1996 in its Statements of Antitrust Enforcement Policy in Health Care. Today’s CINs, however, have a different look and feel than one of their more common predecessors, the Physician-Hospital Organization (PHO). The PHO similarly attempted to integrate hospitals and physicians through hospital sponsorship and physician membership, but most PHOs never reached the levels of financial and clinical integration necessary to accept risk-based payer contracts. Today’s CINs, spurred on by ACA reforms and the gradual shift from fee-for-service payment models, are making strides in collaboratively increasing the quality of care while reducing costs.

Healthcare reform has undoubtedly created more integrated delivery and payment models based on a culture of quality-focused and cost-efficient clinical management. In one example, many healthcare systems have begun implementing clinical co-management arrangements (“CCMAs”) to accomplish the physician alignment and integration required to achieve these goals. 

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. 

Leaders in the hospital field are already pursuing integration to improve patient outcomes and reduce the ballooning cost of health care. The Centers of Medicare and Medicaid Services' quality initiatives, and now the Affordable Care Act, demand a new health care model that brings hospitals and physicians together to coordinate the continuum of care for improved patient care. One emerging trend to enhance care coordination is clinically integrated networks, or CIN.