Driving Clinical Integration

Strategic planning efforts in hospitals are increasingly concerned with clinical integration. But the topic is so broad, it is difficult for many to get started. We have found it useful to consider the following eight questions when outlining your approach.

1. What physicians should first be engaged? You will likely want to invite most physicians, but there are some that must be engaged. Primary care physicians. Your largest physician group. Employed physicians. Who can most help you with this strategy?
2. What primary care models should be considered? Evaluate fit of Patient Centered Medical Homes and other approaches to better manage patients in the office setting. This model, and the role assumed by PCPs, will have an impact on your clinical integration.
3. What is your IT strategy? Integrating providers will be impossible to optimize without a viable IT strategy. Simply put, the most effective organizations will spread their system to the doctors identified in number one above.
4. What care management gaps must be addressed, and how should they be prioritized? Many hospitals lack disease management capabilities, or have not coordinated their resources. Defining the gaps and opportunities, and defining the magnitude of those opportunities, is a key first step. Engaging specialists to help define the best practice is a crucial second step.
5. What post-acute care provider partnerships will add value? Defining the array of services required, and the “A” players who do the best job serving patients, is a good place to start. Engaging these providers in planning the handoffs of your mutual patients will be valuable.
6. Are you ready to assume risk? If yes, a Medicare ACO may produce value. If no, you are likely to derive more value from a focus on the private market.
7. Do you have strong, standing relationships with private employers? These are your most profitable payers, and translating their needs into your clinical integration agenda is generally wise.
8. What payers must be engaged? Partnerships with private payers will be important to producing value from a clinical integration model. Define who you wish to work with, and engage them in the discussions early.

Discussion and consideration of these questions will begin to lay the foundation for an effective strategy. But with engagement of physicians, employers, payers, and other providers, it is clearly just the start of a long journey.