The term clinically integrated dates back to the 1990s. Providers were first recognized by the Department of Justice and the Federal Trade Commission (FTC) for engaging in joint payer negotiations by working together to improve quality and efficiency. Thus the term clinically integrated was created because of the need to identify providers and organizations, which were often using joint ventures, with contractual agreements. This would also leave those ventures open to scrutiny for possible anti-competitive practices under antitrust law. The FTC has stated that clinical integration is acceptable as long as a group comes together with the goal of improving care and not simply to bargain for better rates. Clinical integration tends to have many definitions, and is not a fixed set of principles or practices. For example, the American Medical Association (AMA) describes clinical integration (CI) as “the means to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, and patient-focused.” (American Hospital Association, 2017) Another example defines CI as, “Physicians working together systematically, with or without other organizations or professionals, to improve their collective ability to deliver high quality, safe, and valued care to their patients and communities”. (Gosfield, J.D. & Reinertsen, M.D., 2010) In addition to its many definitions, the government was also attempting to encourage the creation of CIs.
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This occurred when the Affordable Care Act (ACA) of 2011 included provisions to help promote clinical integration. In general, the act suggests that hospitals and health care organizations are expected to collaborate and improve clinical integration or the coordination of care across settings by expanding coverage, boost the effectiveness and efficiency of care, promote innovation, and control costs. Collaboration is comprised of physicians, hospitals, and other providers that share the responsibility and information about patients as they transition from one setting to another over the entire course of their care. Clinically integrated providers work together to develop and implement evidence-based clinical protocols, focusing on delivery of preventive care and coordinated management of high-cost and high-risk patients. The combination of these results allows these providers to identify opportunities for improvement and ensure adherence to protocols by utilizing shared information and technology to conduct ongoing clinical care reviews. A CI system involves a network of interdependently physicians who collectively commit to improve the outcomes of all of their patient’s one at a time with quality and cost improvement. In this model, physicians share the patient care responsibilities across multiple specialties for disease management and quality measurement, based on local community needs. This model also promotes physicians being rewarded properly for a job well done and sharing in savings generated by their efforts. Physicians …show more content…
Most office-based physicians practice alone, in small groups or in single-specialty groups. This can cause a divide because they may not have access to the networking tools that can enhance communication across settings and enable clinical integration. For the most part, hospitals cannot support true clinical integration because they have limited resources for positively influencing the behavior of the staff and partners involved in patient care. Patients are more likely to receive duplicative diagnostic tests, have adverse prescription drug interactions and get inconsistent care plans without coordination across multiple settings. This can negatively affect the overall patient
This occurred when the Affordable Care Act (ACA) of 2011 included provisions to help promote clinical integration. In general, the act suggests that hospitals and health care organizations are expected to collaborate and improve clinical integration or the coordination of care across settings by expanding coverage, boost the effectiveness and efficiency of care, promote innovation, and control costs. Collaboration is comprised of physicians, hospitals, and other providers that share the responsibility and information about patients as they transition from one setting to another over the entire course of their care. Clinically integrated providers work together to develop and implement evidence-based clinical protocols, focusing on delivery of preventive care and coordinated management of high-cost and high-risk patients. The combination of these results allows these providers to identify opportunities for improvement and ensure adherence to protocols by utilizing shared information and technology to conduct ongoing clinical care reviews. A CI system involves a network of interdependently physicians who collectively commit to improve the outcomes of all of their patient’s one at a time with quality and cost improvement. In this model, physicians share the patient care responsibilities across multiple specialties for disease management and quality measurement, based on local community needs. This model also promotes physicians being rewarded properly for a job well done and sharing in savings generated by their efforts. Physicians …show more content…
Most office-based physicians practice alone, in small groups or in single-specialty groups. This can cause a divide because they may not have access to the networking tools that can enhance communication across settings and enable clinical integration. For the most part, hospitals cannot support true clinical integration because they have limited resources for positively influencing the behavior of the staff and partners involved in patient care. Patients are more likely to receive duplicative diagnostic tests, have adverse prescription drug interactions and get inconsistent care plans without coordination across multiple settings. This can negatively affect the overall patient