What Is Clinical Integration
What is Clinical Integration?
Why Clinical Integration?
Who Benefits?
Q: What is Clinical Integration?
A: Clinical integration allows physicians to evaluate and modify practice patterns while creating a high degree of collaboration, cooperation and mutual interdependence to ensure good quality and cost effectiveness. Physicians are the key drivers of clinical integration and are the leaders in the development of all facets of the program. PHS, as a clinically integrated network, will consist of primary care and specialist physicians whose services are integrated through a program that includes:
- Clinical guideline best practices development and implementation
- Performance improvement and reporting
- Intensive management of high-cost, high-risk patients
Q: Why Clinical Integration?
A: PHS has three main objectives for developing and implementing a clinical integration program.
First, PHS will facilitate the efforts of its physicians to improve patient care and the delivery of services by specifically:
- Collectively working towards improved quality
- Improving the exchange of patient treatment information
- Collectively developing and adopting clinical guidelines based on best practices
- Collaboratively improving and reporting performance
PHS physicians, working cooperatively and collaboratively, will more efficiently provide the best care in the best setting at the best time.
Second, PHS physicians will collectively manage patient care better and more intensively than is possible working independently. Clinical integration will engage all stakeholders - physicians and their patients, PHS's medical director and case managers, payers and employers - in a comprehensive program of care management. The program will facilitate:
- Adoption of clinical guidelines
- Use of health information technology to identify high-risk and high-cost patients
- Interactive patient support by PHS's case managers and medical director to assist the physician in the care of his/her patient
- Involvement of payers and employers in designing benefit and reimbursement models that support clinical integration
This intensive care management will result in identifiable quality improvements for each patient and provide significant financial benefits for patients and payers.
Third, PHS will offer payers an integrated set of services focused on quality improvement and medical management not previously available in the market. This integrated product will be desirable to employers looking to control the rising cost of providing healthcare coverage to employees. It will also offer a competitive advantage to health plans and other payers seeking to distinguish their products on the basis of quality or quality-adjusted cost.
Q: Who Benefits?
A: Clinical integration ultimately is a strategy to help provide a solution to the rising cost of healthcare in Oconee County and serve the interests of the entire community through population health improvement. Clinical integration will engage PHS physicians in a collaborative and cooperative effort to create a new integrated product that will improve the quality and cost-effectiveness of healthcare services. This product will provide important benefits to physicians, patients, employers and payers alike. Clinical integration also will provide PHS with a competitive edge that will keep the delivery of community healthcare and decisions impacting that care in the hands of local physicians.