Clinical Integration

Clinical Integration is a phrase that has been used throughout the healthcare literature to describe a myriad of efforts that have been made to coordinate, or integrate, the clinical care delivered to patients across providers and sites-of-care. While the current lay definition of clinical integration is relatively broad, the Federal Trade Commission (FTC) and the United States Department of Justice (DOJ) have provided a definition of Clinical Integration that is more prescriptive and meaningful. The DOJ and the FTC define Clinical Integration as, “an active and ongo­ing program to evaluate and modify practice patterns by the network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality. This program may include: (1) establishing mechanisms to monitor and control utilization of health care services that are designed to control costs and assure quality of care; (2) selectively choosing network physicians who are likely to further these efficiency objec­tives; and (3) the significant investment of capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies.”

Clinical Integration is an inclusive physician-hospital alignment model that not only promotes the fundamental principles of value-based competition but also provides a bridge to recently proposed transformative delivery and reimbursement models like the Patient Centered Medical Home (PCMH), Accountable Care Organizations (ACOs), and Episode-Of-Care / Bundled Payments. The foundation of a successful Clinical Integration program will help healthcare organizations to efficiently and effectively accommodate many of the provisions laid out in healthcare reform while allowing providers to realize the potential benefits of joint contracting.

Although Clinical Integration may seem to be complex and ambiguous at first, the Blue Consulting team will help your organization to navigate the Clinical Integration process. Our consultants can provide your organization with a full spectrum of customized, client-centric services throughout the process including:

Clinical Integration - Healthcare Consulting

Let our Consultants guide you on your journey to Clinical Integration.

ACO, Alternative Care Organizations, Healthcare Consulting