As one of Michigan's largest healthcare systems, with 12 hospitals in the state and 47 nationally, Livonia-based Trinity Health has developed a regional strategy to integrate physicians, hospitals and other healthcare companies in an effort to reduce costs, increase quality and improve patient safety.
"Looking at new payment models going forward, everybody recognizes that current cost structures in health care are not sustainable," said Dr. Paul Harkaway, Trinity's vice president of clinical integration.
"We don't want to ration care, so we have to start to drive out the waste and coordinate care more effectively. It takes a village to drive out the waste and start to create opportunities for patients. We are working with physicians to do this.
Last year, Trinity began to focus its clinical integration strategy in key Michigan markets, including Ann Arbor, Livonia, Grand Rapids, Muskegon and Grayling. Nationally, Trinity also is experimenting in Columbus, Ohio, and Boise, Idaho, Harkaway said.
"We are furthest ahead in western Michigan (St. Mary's Health Care) and we are just starting" at St. Joseph Mercy Oakland Hospital in Pontiac, Harkaway said.
In Ann Arbor, Harkaway said, Trinity is working to integrate care at St. Joseph Mercy Health System and several physician groups it acquired in 2010, including IHA and Michigan Heart PC.
"We have a fair amount of independent and private practice physicians in the market who are not part of the employed group who we will have a relationship with, either in a joint venture or some other way," he said.
In each market where Trinity operates a hospital, Harkaway said, a steering committee of hospital executives and physicians is formed to determine what types of contracts are present and how to best organize integration.
"We need to design each clinically integrated network or joint venture based on the dynamics of the market," he said. "Both models are intended to be physician-governed or -run. We are very interested in getting physicians a strong role in governance."
Dr. Don Bignotti, Trinity's chief medical officer, said there are several reasons the health system and other health care provider organizations need to integrate patient care.
"I talk with doctors about what is going on in healthcare and the rationale for clinical integration," Bignotti said. "We just cannot continue to care for patients the way we have been doing."
Bignotti said a "perfect storm" is brewing in healthcare financing that requires hospitals and physicians to work together to improve care.
"We have a growing shortage of doctors and nurses, demographic changes where patients are getting older. People age 75 or older will double over the next 25 years, and the numbers of people with chronic disease will grow as well," he said. "All this requires coordinated care because reimbursement is going down."
Bignotti said one challenge in integrating care is that 80% of physicians on the medical staffs of Trinity's 47 hospitals are independent practitioners. The health system has more than 11,000 independent physicians on its hospital medical staffs, with about 3,400 employed physicians and residents.
"We have to improve teamwork to better take care of patients and lower costs," he said. "We will be asked to take financial risk for many more patients under health reform. We need a clinically integrated structure to do this."
Trinity CEO Joseph Swedish said the health system has spent $1 billion to improve its information technology systems to help coordinate care among providers and hospitals. The information systems will help Trinity manage Medicare and private payer contracts that have quality incentives built into them, he said.
Last year, Trinity Health-Michigan signed a contract with Blue Cross and Blue Shield of Michigan that tied higher reimbursement payments to improved patient outcomes.
"This agreement leverages health insurance dollars not to encourage high volumes of services but, rather, more effective care for the population of members cared for by Trinity Health and its physician partners," Susan Barkell, Blue Cross' senior vice president for healthcare value, said in a statement.
Harkaway said Trinity has gained experience with performance-based contracts under Blue Cross' physician group incentive program.
"We have well-established physician organizations and have been trying to connect them to combine services and become more highly integrated," he said.
For patients, clinical integration usually means reducing the hassle factor of filling out multiple patient information forms each time a new appointment is made, Harkaway said.
"It is not uncommon for you to go to a new physician and the staff not knowing why you are there. You have to fill out the papers over and over again," Harkaway said.
For hospitals and physicians, improved coordination of care is a better model. It reduces costs and paperwork and frees staff for patient care instead of more administrative duties, he said.
"We need to redesign the system to be seamless and highly coordinated," Harkaway said. "It is where healthcare is going."