Clinical integration is becoming a top priority for all kinds of health care providers and entities as our health care system gradually shifts from a traditional fee-for-service model to the continuum of care framework, which focuses on coordinating care efforts across a range of services to provide better-quality, higher-value care to patients. Widely described by industry experts as one of the best ways to achieve care coordination, clinical integration can be pursued by a variety of health care entities, from health plans and pharmacies to retail clinics and ASCs. A recent article from the Camden Group, a health care thought leader, outlines the following important benefits that a clinical integration strategy can offer:
Increased collaboration—When care teams work together to implement a clinical integration program, it becomes easier to identify places in the care continuum where services are either missed or unnecessarily duplicated. This kind of collaborative approach also gives hospitals and health care providers practice in operating effectively as a team, allowing delivery efforts to be better aligned or realigned, thus enabling improved quality and patient safety and satisfaction.
Improved efficiency—Clinical integration is a critical part of eliminating waste and redundancies in the health care system. Due to inconsistent or incomplete information, siloed care providers are often forced to carry out unnecessary procedures, as the alternative would involve the risk of accidentally missing or overlooking a vital procedure. Integrated care networks are better able to streamline delivery to allow for seamless care, both across and between health care providers.
Integrated systems—Support for and reinforcement of monitoring and enforcement tools are much easier to achieve for clinically integrated entities than for a typical medical staff organization. Tools that become more feasible under a clinically integrated system include financial incentives for physicians who actively participate in the clinical integration program, as well as penalties for those who do not.
Payor partnerships—Thanks to its associated improvements in patient care quality and reductions in cost, clinical integration helps health care providers more easily achieve market differentiation. This differentiation is an important factor in attracting health plans, and can serve as an important launching point for payor-provider partnerships, which promote value-based collaboration and help drive further improvements in care delivery cost, quality, and efficiency.
Improved case management—Successful clinically integrated organizations are much better able to deliver effective case management, which is often seen as the foundation of good care coordination across different health settings. In conventional systems, patients who see multiple doctors typically experience fragmented care and redundant services. But when case managers can work together, as they do in a clinically integrated program, both within and outside of organized health systems, they can achieve the best possible clinical and cost outcomes for patient and provider alike.
Integrated continuum of care—The desire to ensure that all patients get the care they need at the right time and in the right setting is the main goal of a clinical integration program and the team of health care providers working to implement it. Clinical integration prioritizes infrastructure and systems that support patients and caregivers in assessing, documenting, communicating, and meeting patient needs; in addition, collaboration between such diverse partners as adult day care, assisted living, independent living, and nursing facilities means that hospital systems and health care networks are better able to achieve holistic care delivery across the entire continuum.
Clinical data systems—Siloed health care providers often struggle with outdated or legacy IT systems. But a big part of clinical integration—indeed, usually a requirement of an integration program—is an updated IT platform that supports care continuity and allows all key stakeholders access to important patient medical history and clinical data. This greatly improves communications across the continuum, helping to boost service, performance, and quality.
Patient-centered communication—A vital part of a successful clinical integration program, and one that reflects the primary role of the patient in the continuum of care framework, is greater emphasis on patient-centered communication. With communications breakdown cited by the Joint Commission (an independent, nonprofit health care accrediting organization) as the largest contributing factor to care delays and sentinel events, the emphasis on and training for clear and timely communication that clinical integration programs provide helps improve both patient and provider behavior, leading to better outcomes and cost-quality benefits.
Improved pharmaceutical management—Faulty processes and poor communication are significant causes of medication errors, much more so than individual carelessness. As with other key processes, clinical integration helps providers identify critical gaps in the medication dispensing and management process and implement important actions to increase patient safety.
Improved health of the community—When providers are successfully clinically integrated, entire populations can benefit from better health and wellness. This is not only because clinical integration efforts improve care delivery, but also because such integration prioritizes overall wellness initiatives, offering community members outreach and educational programs that empower them to become active participants in their own care, equipping them with tools, knowledge, and practical skills.