What you need to know about integration

By: Neil Pithadia

I recently had the pleasure of sitting with Joel Allison, CEO of Baylor Scott & White Health System in Dallas, TX.  Baylor Scott & White Health System completed their merger in September 2013.  Baylor Scott & White has more than $8 billion in combined assets and about $6 billion in annual revenue.  This completed the largest merger in North and Central Texas. It includes 43 hospitals across North and Central Texas, more than 500 patient care sites, more than 6,000 affiliated physicians and 34,000 employees.

During our discussion, I asked Mr. Allison how both Baylor and Scott & White assessed each other’s organization in terms of fitment.  Candidly, I asked how will both organizations’ cultures will come together…Clinical Integration and cultural assessments.

The healthcare arena is seeing integration come into the limelight as uncertainty, increased risks, decrease reimbursements and provider risk-sharing all have become relevant.  In order to stay relevant and competitive through the ACA environment we all are set on embracing, integration of providers and payers will likely continue.  Thus, the terminology, clinical integration (CI), population health management systems (PHM) and accountable care organizations (ACOs) have become mainstay, unfortunately there seems to be confusion here.

Definitions:

Clinical Integration (CI)– The integration of provider and healthcare delivery from a structural and functional standpoint across continuum of services- primary care, specialty, outpatient, acute hospital care, post-acute services, skilled nursing, home health and palliative care. The thought-process here is to reduce costs and improve patients’ care experience by a coordinated system.

Accountable Care Organization (ACO)- A healthcare organization that coordinates provider groups caring for an assigned group of patients where provider reimbursement is tied to quality and reduced cost of care for this defined population.

Population health management– Health care delivery that is based on outcomes and focuses on achievable measurable impacts on health of a defined population.

One of the biggest barriers to successfully integrate is physician resistance.  Business leaders must empower these individuals and enlist physicians as business partners to engage in voice and autonomy.  The next step is to also engage the patients and enlist their help in the care process.  Patient engagement is in essence PHM, the apex of full integration.  Physician involvement and knowledge greatly increases patient participation as physicians have the most influence over patient populations.

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