Clinically integrated networks (CINs) are becoming increasingly more prevalent—and necessary—as ACOs and other value-based care organizations take a strong foothold in our industry. Clinical integration is the collaboration between doctors and hospitals that increases the quality and efficiency of patient care. CINs can help improve the efficiency and effectiveness of care, which results in better quality and financial performance, in addition to reinforcing physician autonomy.
To meet their clinical quality and efficiency goals, CINs must have an active and ongoing program among a network of physicians to collaborate and cooperate in a way that improves care. Collaboration requires health information technologies that communicate, aggregate, integrate and analyze data. These efforts to connect health care entities with disparate systems, processes and care delivery approaches have created a need for advanced information technology infrastructures. While data connectivity is a key challenge for CINs, other advanced technologies are needed to facilitate care coordination, data analysis, interdependence and physician collaboration. Best practices from many early models pinpoint a few key areas where the right infrastructure can support these functions.
Supporting operations and fostering interdependence
In order to work and achieve clinical integration, physician practices need to refer within their network, and be both independently and collectively responsible for clinical quality and utilization. Physician practices also must invest time and resources towards the collective goals of the clinically integrated organization. Appropriate technology systems to support communication must be put in place to facilitate the care coordination and team-based care essential for interdependence and collaboration.
Empowering physicians with advanced analytics and decision support
Creating a CIN involves agreeing upon, establishing and complying with a wide range of clinical protocols. An adequate number of diseases and diagnoses must be included. Generally, these diseases and diagnoses reflect the physicians and specialists represented in the network. If they satisfy applicable legal requirements, the physician practices included in the network may jointly contract to improve quality and affordability for a broad array of conditions and diagnoses.
The use of advanced analytics and clinical decision support technology are critical to meet these objectives. This includes appropriate systems that connect and interact with all physicians in the network, and training on both the use of the information technology and goals of the network. Clinicians understand the financial benefits of collaboration, but they might only accept responsibility if they trust the infrastructure established to enable clinical integration.
Key to physician acceptance is clinical validity. Systems must be in place to provide evidence-based care alerts that are meaningful. These alerts can help provide targeted patient insight and identify potential gaps in care based on evidence-based guidelines to optimize treatment plans and meet quality metrics. Identifying which patients are causing the CIN to be unable to meet quality and efficiency metrics is just a start. Advanced clinical decision support goes further by helping physicians identify which patients can be impacted. They can also help physicians eliminate duplication of efforts and reduce waste. As a result, physicians may spend less time reviewing volumes of patient data and can focus on providing clinically sound, personalized patient care.
Enabling population health management and care coordination
Care coordination among the entire care team, including primary and specialty professionals, is another important requirement for a successful clinical integration program. Population health and care management tools should include a patient registry that makes it easy to track and view patient and physician panel snapshots, with key variables trended over time, to support efficient population management. Assessment capabilities can also enable office based care coordination and care management.
Monitoring and improving performance through advanced reporting
Performance monitoring, including feedback and actions to improve care, is at the heart of a CIN. Organizations must understand “where they are” in order to make strategic progress and take specific steps to achieve performance metrics.
Technology must be in place to accurately measure outcomes and track and report on the total population, individual patient, organization, and individual physician performance. Organizations should build a library of clinical quality performance metrics they can adapt as clinical quality measurement evolves and advances. This will help them identify areas of best performance and areas that need improvement. These efforts should also include tools that meet specific government requirements for physician performance tracking and reporting.
Accurately tracking and trending the metrics selected by physicians for payment purposes is only the start of this process. Performance improvement is just as important as monitoring. Enforcing performance standards with physician feedback and improvement initiatives is essential to meeting government requirements. Physicians are also more likely to participate knowing a clinically validated system is helping improve performance.
Together, all of these efforts can lay a foundation for clinical integration and clear a path toward greater care accountability. Fortunately, just as the health care industry is evolving toward greater integration, health information technology is also rapidly advancing to support the needs for greater coordination, collaboration and interdependence inherent in integrated models.