Unit 5

Define the concept of an “integrated physician model.” To define the concept of integrated physician model you first have to understand the importance of clinical integration in the strategic planning process. In order to do this I have to demonstrate the understanding of the dynamics and controversies of dealing with ACO’s (accountable care organizations). This will then pave the way for me to explain other approaches to pertinent issues with ACO’s within our current health systems. I will explain both advantages and disadvantages with one model for integration.

Integrated physician model is the outcome of partnerships between hospitals, clinics, and physicians that has been developed over time. It was thought that this venture was actually developed through several other ventures that have all connected through one main goal. Any organization that had the goal to be able to actively communicate with another facility, any nursing home, hospital, physician offices, etc. would have to start small with just one step to acquire the next facility or physician.

Clinical integration can really be broken down into four pieces. It gets broken down into collaborative leadership, aligned incentives, clinical programs, and technology infrastructure. The first piece of the puzzle is the collaborative leadership which pulls the governance body, compliant legal structure, payer strategy, and culture change. Clinical integrated care is physician compensation, program infrastructure, and physician support. Clinical integrated care is the hands on portions in disease programs, clinical, population health, and care regulations. Technology infrastructure includes health information exchange, disease registry, patient portal, and patient longitudinal records.

These four major pieces of the puzzle are not perfect, but they have paved a nice foundation for physicians, clinics, hospitals, and other facilities while being in a position to support future advances in the clinical integration process. Where you have change you have struggles. ACO’s continually have to follow new policies, but will they? Can they stay in an unbiased accountability? How will new policies effect care? How will this effect basic access to care?

In the United States we are in the beginning steps of the health care reform. We cannot say if it will impact us positively or negatively yet, due to the lack of data so far. As the people who need care and easy access to care, we have to be ready for more changes to come and be prepared for the impact it may have on us. If you look at countries around us like Canada, who have a healthcare system that takes care of all its people no matter what, I agree that we should too have this kind of system. Why do we have access and availability for those who have money and great insurance when it is needed but yet we let those who need the assistance slip between the cracks because they may not have the insurance that reimburses at the highest rate or they cannot pay a bill? As the general population we are in a world set up for failure, we have so much debt, we do not actively assist those who need health coverage, we charge outrageous amounts for our people to go get a higher education, not to mention charge the parents of the youth for their schooling, and we are being pushed out of the era that we depend on ourselves into a society that depends on electronics and others for everything.

No insurance, you get a tax penalty at the tax return time. No money, you get charged for not paying enough taxes. No money to pay for health insurance but too much money to get lower cost insurance, why do we make our people decide between health insurance or food? That money could go to diapers or formula for a child, it could go to a month’s worth of fuel to get you to and from work, that money could even go to basic needs like a home, water, and electricity. Now have a person who is in this situation who has a pre-existing condition like cancer or COPD. They have medical needs that cannot be met and they have to decide if they get treatment or if they feed their child. We live in an impossible world in the standards of the reform act.

If we look at hospital-physician integration most will look for the advantages before the disadvantages under the equity based ventures model. These ventures are between hospitals and their physicians and they have shown that it improves clinical treatments while enhancing communications between the two. Now they have failed to succeed in areas like trust and contribution of capital. They have tried to prevent these problems but when doing so all parties involved must come to an agreement on the end goal, the strategic direction, and the financial performance. Typically the board regulations and facility policies prevent such issues from arising.

To recap the major advantages and disadvantages for the hospital physician integration it comes down to the facility. It can take so many forms and it really depends on the facility, the physicians, and the end goal. Hospitals can write term contracts to succeed in managed care organizations, while this does not mean it will lead to ownership or greater market share but it tends to be growing in popularity. This typically allows the providers to have more free time rather than having to focus on the business end of a facility.

Here I have given a very brief description of the integrated physician model, I have given some insight into the importance of clinical integration in strategic planning processes. I have demonstrated my understanding in the controversies of ACO’s while discussing approaches to current issues with the healthcare reform. I chose the model of hospital physician integration to discuss.

 

References

4 steps for successful hospital-physician integration. (2014, March 28). Retrieved April 30, 2018, from https://www.fiercehealthcare.com/healthcare/4-steps-for-successful-hospital- physician-integration

Harrison, J. P. (2016). Essentials of strategic planning in healthcare (2nd ed.). [Kaplan]. Retrieved from https://kaplan.vitalsource.com/#/books/9781567937916/

Key Issues and Strategies for Physician Integration. (n.d.). Retrieved April 30, 2018, from https://www.beckershospitalreview.com/hospital-physician-relationships/key-issues-and- strategies-for-physician-integration.html

Physician-Hospital Organization (PHO)   //. (n.d.). Retrieved April 30, 2018, from https://www.healthlawyers.org/hlresources/Health-Law-Wiki/Physician-Hospital- Organization-(PHO).aspx

S. (n.d.). ASC E-Weekly. Retrieved April 30, 2018, from https://www.beckersasc.com/e- weeklies/archived-eweeklies.html