Clinical integration is an effort among physicians, often in collaboration with a hospital or health system, to develop active and ongoing clinical initiatives designed to control costs and improve the quality of health care services.

Participation in an effective clinical integration program provides both employed and independent physicians on INTEGRIS Health medical staffs the ability to contract collectively with health plans without violating antitrust laws.

An effective clinical integration program contains initiatives that (1) provide measurable results, which (2) are used to evaluate physician performance and (3) result in concrete remediation of that performance.

In many instances, clinical integration involves both employed and independent doctors on the medical staff of the same hospital or hospital system who join together in an organization that allows them to: (1) identify and adopt clinical protocols for the treatment of particular disease states, (2) develop systems to monitor compliance with the adopted protocols on both an inpatient and outpatient basis, (3) collaborate with the hospital or hospital system to encourage compliance with inpatient performance improvement processes and protocols, and (4) enter into physician-directed “pay-for-performance” and other contractual arrangements with health plans in a way that financially recognizes the physicians’ efforts to improve health care quality and efficiency.

Yes. INTEGRIS Health Partners is governed by a board led by doctors.

INTEGRIS Health physicians should do the following:

• First, because membership in INTEGRIS Health Partners is completely voluntary, physicians need to choose whether they want to participate by signing a Network Participation Agreement.
• Second, physicians are required to collaborate with their physician colleagues and INTEGRIS in the development and adoption of a collection of clinical initiatives designed to enhance the quality, service and cost-effectiveness of patient care.
• Third, physicians must hold themselves and each other accountable for compliance with the initiatives of INTEGRIS Health Partners, including its disciplinary and remediation efforts should physicians not meet benchmarks.

No. INTEGRIS Health Partners was established as a non-exclusive organization, making no limitations whatsoever on a physician’s ability to admit patients to non-INTEGRIS sites of care or a physician’s ability to maintain contracts with health plans on an individual basis.

An ambulatory EMR is NOT A PREREQUISITE for the development of clinical integration. While a common EMR across all participating physician practices can certainly accelerate and strengthen a clinical integration program, most (if not all) successful models of clinical integration nationwide do NOT depend on an ambulatory EMR for data on physician performance. Ultimately, a network of physicians may wish to implement an EMR that is designed in a manner that assists in the capture and extraction of the data necessary to continue to operate their clinical integration program.

Physicians have numerous and overlapping motivations for joining together in clinically integrated networks including: (1) to enhance the quality of the care provided to patients, (2) to legitimately negotiate with payers as a network, (3) to respond to health plans that are under tremendous pressure to use “report cards” that exclude “inefficient” physicians, (4) to provide access to technological and quality improvement infrastructure that will allow physicians to argue against these “report cards,” and (5) to allow networks of physicians and hospitals to market themselves on the basis of quality.

The FTC views clinically integrated physician networks as an opportunity to create efficiency and quality in care that outweighs any restraint on trade. However, the FTC will continue to prosecute those networks that fail to demonstrate the elements of true clinical integration.

You are only asked to consider delegating contracting for agreements entered into by the network. Those agreements will not impact your current managed care contracts in any way.

The network has a contracting committee, led by physician members of the network, who determine the parameters of any contractual relationship. You would be required to treat patients under these arrangements in the same manner that you currently experience under any other managed care relationship.

Partnering with a hospital can provide distinct advantages to a network of independent physicians in the development of clinical integration. In instances where the hospital shares the same quality vision as the physicians, the hospital can be a powerful ally in program development by: (1) collaborating with the physician in the development of clinical integration initiatives based on existing inpatient quality measures, (2) lending financial assistance and personnel in the implementation of inpatient and outpatient initiatives that provide true community benefit and are not tied to the volume or value of referrals, and (3) demonstrating to payers and the community as a whole that the clinical integration program is both legitimate and valuable.

Call INTEGRIS Health Partners administration at 405-713-4476 or email [email protected].