As new healthcare delivery system relationships are being developed on a regional basis, considerable attention is being devoted to the various integration models evolving for hospitals, medical groups and health plans.
The Center for Research in Ambulatory Health Care Administration, the research arm of the Medical Group Management Association, has sponsored a study on the key factors for successful healthcare integration. The data were collected at two levels, with the focus on 10 integrated systems (See map). Each was studied through in-depth interviews and a detailed analysis of descriptive material. In addition, 50 other organizations, either moving toward integration or having achieved that goal, also provided information.
The head of a large multihospital system recently asked: "What are the unique characteristics of integrating healthcare systems? And what are the common threads running through these organizations that set them apart from traditional hospitals and medical groups?" In our judgment there are several key factors or themes:
Physician leadership.One of the most pronounced themes running through integrated systems is the new role of physicians in leadership positions. Doctors often manage the entire business, or are paired with a professionally trained healthcare administrator to run the enterprise. Either way, physicians play a key role in strategic decisions and policymaking.
Two of the important questions to be addressed are: How do you identify potential physician leaders? And, do they need to be primary-care physicians? We have found that every healthcare community, even the most fragmented, has physicians who are capable of stepping forward to serve as leaders or who are willing to learn the role. And, many of those potential leaders are specialists. Key characteristics of a physician leader are the ability to see clearly what it will take for the entire organization-physicians, hospital and health plan-to be successful, and a willingness to set aside personal agendas and financial objectives to help the entire organization move ahead in terms of positioning for the future.
Strong primary-care component. Every integrating system has emphasized the development of primary care through recruiting additional family practice, general internal medicine and pediatric physicians. In some systems, OB/Gyn is considered primary care, and this specialty also is being emphasized.
Most integrating systems long have recognized the importance of primary care as a feeder network for specialists. However, in a healthcare future likely to be dominated by managed care and capitation, the emphasis is shifting to primary-care physicians as the managers of patient care for the entire system.
Most integrated systems also take primary care to their customers by establishing satellite offices. This is for the convenience of patients, especially those living in rural areas.
Although many integrated healthcare systems began their emphasis on primary-care satellites as a source of referrals for specialists, most now have switched to thinking of their primary-care satellites as necessary for providing care to their health plan customers. A satellite strategy also positions systems to offer broad geographic coverage, an important consideration under healthcare reform.
Ability to shift capital. Integrating systems find ways to shift financial resources to where the dollars are needed most. For example, a physician-hospital organization often needs to invest in developing its primary-care network or starting a health plan. Group practices often do not have the capital to expand their networks, recruit and subsidize more physicians or start a health plan. Not-for-profit hospitals find it difficult to invest in medical practices for fear of violating laws prohibiting private inurement or (in some states) the corporate practice of medicine. But integrated systems can more effectively accomplish the needed redeployment of capital.
Satisfying customer needs. Based on the research and our experience, integrating systems are even more customer oriented than traditional hospitals or physician groups. A central tenet is to focus on consumer needs. This may mean providing accessible primary-care outlets, improving cost-effectiveness or enhancing services (such as reducing the time it takes to set up an appointment or adhering more closely to office schedules).
Information system development. The databases and information systems of integrated systems encompass everything from common medical records to financial and demographic information on customers. While most of the efforts to develop common information systems are in the developmental stage, the research shows that many large integrating organizations are committing substantial financial resources and management energy to these systems.
Physician leaders and managers believe it will be necessary to have real-time information systems covering physician offices, hospitals, health plans and customers in order to manage and control utilization and costs in a system that will be dominated by capitation. Comprehensive patient-care databases will be used to study treatment patterns to identify more efficient or better quality approaches to patient care.
This article is based on the book "Integrated Health Care: Reorganizing the Physician, Hospital and Health Plan Relationship," published by the CRAHCA.