Q: What is clinical integration?
A: Clinical Integration is an effort among physicians, often in collaboration with a hospital or health system, to develop active and ongoing clinical initiatives that are designed to control costs and improve the quality of health care services. Participation in an effective clinical integration program provides a platform and product line for independent physicians to contract collectively with insurers/payers, employers and other providers without violating antitrust laws.
Q: What are the characteristics of effective clinical integration initiatives?
A: An effective clinical integration program contains initiatives that provide measurable results in quality improvement, efficiency of care, and patient safety, which are used to compare physician performance, which results in quality improvements that are likely to improve the health of a community.
Q: What are clinical integration program advantages for physicians who participate?
A: Clinical integration allows physicians to: demonstrate their quality to current and future patients; partner with health plans to develop clinical measures, relevant to specialty, against which the physicians will be evaluated; enhance revenue through better management of chronic patients; gather collective support for building necessary infrastructure; and engage in group contracting.
Q: Why are physicians across the country engaging in clinical integration?
A: Physicians have numerous and overlapping motivations for joining together in clinically integrated networks, including: to enhance the quality of the care provided to patients; to legitimately negotiate with insurers/payers as a network; to respond to health plans that are under tremendous pressure to use “report cards;” to provide access to technological and quality improvement infrastructure and; to allow networks of physicians and hospitals to market themselves on the basis of quality.
Q: What are clinical integration program advantages for patients?
A: Clinical integration provides patients with: a better value for their health care dollar; more effective case management and outreach from a trusted source, their physician; more reliable information to support their choice of health plans, physicians, and hospitals; more accurate and meaningful provider ratings; and greater stability in their relationship with their doctor and hospital and less likelihood that they will need to choose new health care providers every year.
Q: What are clinical integration program advantages for employers?
A: Clinical integration gives employers: the ability to more effectively manage the health care costs of employees and their dependents through the purchase of better, more efficient health care services; increased employee productivity and reduced absenteeism, through better management of chronic diseases; lower health care costs over the long term, through the reduction of variation in physician practice patterns; and more reliable information to support conversion to consumer-driven health insurance products.
Q: Has the Federal Trade Commission (FTC) established a definition for “clinical integration?
A: The FTC views clinically integrated physician networks as an opportunity to create efficiency and quality in care that outweighs any restraint on trade. Since 1996, the FTC has been very consistent in its definition of clinical integration as well as the analytical framework it applies when evaluating clinical integration among a network of independent physicians.