Why clinical integration is vital

Medical care in America is fragmented. Independent private practice means that every physician does his or her part in the care of patients. Other healthcare providers, such as physical therapists, do their part. All have their own medical records. All charge their fees. Somehow patients navigate their care among various providers.

Joseph E. Scherger, MD, MPHMedical care in America is fragmented. Independent private practice means that every physician does his or her part in the care of patients. Other healthcare providers, such as physical therapists, do their part. All have their own medical records. All charge their fees. Somehow patients navigate their care among various providers.

If a person fell and broke her hip, more than 30 separate businesses may end up billing for services by the time the rehabilitation is over. These include the primary care physician, emergency room, radiologist, surgeon, anesthesiologist, pathologist, etc. All will charge what the market currently bears. Th e story is similar for a stroke or major cardiac event.

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Compare that with an integrated delivery system where all of these providers work for the same organization and have a common billing system and medical record. Imagine the advantages of such integration and even the ability of such a system to bundle the charges for such services. The entities that pay for healthcare, such as Medicare, Medicaid and private insurance companies are increasingly interested in having healthcare provided by integrated delivery systems for the control of costs and consistency of quality.

Next: This is imperative and here to stay

Since Medicare and private insurance are moving toward “value-based reimbursement” in the future, does that mean that every physicians needs to work for a large integrated delivery system? Not necessarily. Private practice physicians can work together and compete in this new market.

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The best known example of clinical integration among private physicians is the experience of Mesa County, Colorado. Grand Junction is the city at the heart of this large county in western Colorado. Th is county is home to private physicians and historically has the lowest per capita Medicare costs in the nation. It was featured in Atul Gawande, MD’s 2009 New Yorker article, “The Cost Conundrum” (Read that artticle at http://bit.ly/costconundrum).

In Mesa County the doctors in all specialties are dedicated to highquality care provided to all patients at reasonable costs. In addition, all the doctors decided jointly that everyone would take care of the whole population regardless of their insurance or lack of it. Everyone shared the Medicaid patients so that no one was overloaded. No one was guilty of price gouging. Th e result was health care outcomes as good as any large integrated delivery system in America.

Clinical integration is an imperative that is here to stay. No longer will healthcare covered by insurance be just one patient at a time. With modern information systems, the population being served is now visible in ways never seen before in medicine.

Next: Independent physicians don't despair...

While care is still provided to individuals, the organization of care will be designed to achieve better outcomes at aff ordable costs for everyone in a service area. This is the Triple Aim: better care, better health and lower costs for a population. Independent physicians should not despair. Join a network of your colleagues and make this work for your area.