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Clinical Integration

Clinical integration is an effort among physicians, often in collaboration with a hospital or health system, to develop active and ongoing clinical initiatives to control costs and improve the quality of health care services. By participating in an effective clinical integration program, independent providers have the ability to contract collectively with insurers and employers without violating antitrust laws.

What are the characteristics of effective clinical integration initiatives?

An effective clinical integration program provides measurable results to evaluate physician performance and support measurable improvement in the quality of patient care.

Why are physicians across the country engaging in clinical integration?

  • Enhance the quality of the patient care
  • Legally negotiate with payers as a network
  • Respond to health plans under pressure to use “report cards” to exclude “inefficient” physicians
  • Provide access to robust infrastructure so physicians have ownership of quality data to ensure accuracy of any “report card” generated
  • Allow networks of physicians and hospitals to market themselves on the basis of quality

In “real life,” what does a clinically-integrated network of independent physicians look like?

As it relates to THN, independent and Cone Health physicians join together in an organization that allows us to:

  • Identify and adopt clinical protocols for the treatment of particular disease states.
  • Develop systems to monitor compliance with the adopted protocols on both an inpatient and outpatient basis.
  • Collaborate with the hospital (system) to encourage compliance with inpatient performance improvement processes and protocols.
  • Enter into physician-directed “pay-for-performance” and other contractual arrangements with health plans in a way that financially recognizes physicians’ efforts to improve health care quality and efficiency.

Within THN, are physicians involved in the development of clinical integration and the leadership of this endeavor?

Yes. THN was developed by a number of physician leaders in the community in partnership with Cone Health. THN is governed and operated by a physician-led Board of Managers and Operating Committee, which includes both employed and independent physicians.

What do physicians need to do to participate in the THN Clinical Integration Program?

THN physicians are asked to do the following:

  • Since THN membership is completely voluntary, physicians who choose to participate in THN will need to sign a Network Participation Agreement and pay a $300 annual participation fee.
  • Physicians are required to collaborate with colleagues in the development and adoption of the Clinical Integration Program – a collection of clinical initiatives that will enhance the quality, service and cost-effectiveness of patient care.
  • Physicians must hold themselves and their THN colleagues accountable for compliance with the initiatives of the THN Clinical Integration Program, including its improvement and disciplinary efforts should physicians fail to meet the benchmarks set by the program.

By agreeing to participate in THN, will physicians be required to abandon medical staff appointments at non-Cone Health System hospitals or admit patients only to Cone Health System hospitals and ambulatory care facilities?

No. THN is a non-exclusive organization, making no limitations whatsoever on a physician’s ability to admit patients to non-Cone Health sites of care.

Is THN just an effort by Cone Health to take over my practice?

No. THN is a physician-led initiative. Physicians in private practice who choose to participate will maintain their practice status. It is important to note that more than half the physicians on the THN Operating Committee, which led the development of THN, are independent and are actively involved in setting the direction of our organization.

Do I have to be a Cone Health employee or affiliated physician to be a part of THN?

No.

What role do physicians employed by Cone Health play in THN?

They are expected to participate in THN and become early adopters of the collaborative behaviors needed to drive quality and cost improvements. However, THN requires that governing committees to maintain balanced participation between employed and independent physicians and between primary care and specialist physicians.

What clinical initiatives does the THN Clinical Integration Program include?

The THN Clinical Integration Program includes initiatives designed to facilitate and improve:

  • Chronic disease management
  • Community case management
  • Reporting of quality outcomes and compliance to established clinical metrics
  • Communication and sharing or information among primary care physicians and specialists
  • Development and adoption of standardized inpatient order sets (Computer Physician Order Entry (CPOE))

The THN Clinical Integration Program enhances the value of the services we provide the patient and payer communities, measuring compliance with the initiatives using data from various sources, including: claims processing and adjudication systems, practice management and scheduling systems, disease registries, pharmacy benefit systems, and hospital and ambulatory EMR systems.

Does participation in the THN Clinical Integration Program require physicians to change the way they practice medicine?

To some extent, yes. Participation in the quality and care management initiatives of the THN Clinical Integration Program requires time and attention from physicians and their office staff. In return, participating THN physicians will be eligible to obtain financial rewards for their achievements through the Clinical Integration Program, funded by contracted health plans and employers. Both the initiatives and the amount of incentive payments will be determined and managed by THN physicians.