Communities are right to question the value created for them so far by integrated systems ("Communities ask, What's in it for us?" Jan. 6, p. 39). Our research has shown that integrated systems can suffer from significant "merger hangover" for quite a while following their formation. Systems have been formed primarily for contracting power-not something that particularly benefits the community. Only as systems move on to the difficult work of optimizing the whole instead of piecing together the parts do they start to emerge from this hangover.
This struggle is made worse by the fact most systems don't have a plan that maps out the specific niche for each player in the organization. In essence, they need to determine who will do what for whom in which location. This guiding operational vision directs them to short-term, focused changes that prevent the predictable sag in performance shortly after the merger. This vision also leads them to more difficult rationalization and consolidation decisions that yield real cost benefits for the community.
An operating strategy can act as a free-market certificate-of-need mechanism within an integrated system. The quest for market share ensures systems maintain patients' access to services. Price pressure leads them to appropriately deploy resources. Without an operating strategy, the scales tip invariably to pursuit of market share. As more systems recognize the need for balance, communities will begin to see the true benefits of integration.
MITCHELL G. GALLOWAY
Co-founder and director,
Lumen, Marietta, Ga.