Issue link: https://beckershealthcare.uberflip.com/i/112775
Physician-Hospital Relationships & ACOs 30 FEature The 7 Components H ealthcare providers are preparing for the reality of the post-reform environment that will require hospitals and physicians to be more accountable for the delivery of higher quality and more efficient care delivered at a lower cost. As hospitals and physicians navigate through the challenges of planning for this future, they also have to remain focused on current operations that are threatened by thinning margins due to an increased cost structure and reimbursement declines in the current fee-for-service environment. control costs and ensure quality. Generally, the FTC considers a program to be clinically integrated if it performs the following: To effectively position for the future realities of healthcare while maintaining focus on current operations, many hospitals and physicians are turning to clinical integration as a viable option to (1) increase quality, (2) reduce cost and waste in the current system to maintain margins, (3) sustain independence for physicians not ready for hospital employment and (4) position providers to take on higher levels of accountability to effectively manage utilization and the health of populations in the future. 3. Utilizes investment of significant capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies. CI is commonly defined as a health network working together, using proven protocols and measures, to improve patient care, decrease cost and demonstrate value to the market. Once the CI network can demonstrate a value proposition, payors and large employers are approached to support the network and other incentives that are based on achieving defined results. In most cases, CI networks and the initial conversations with payors are initiated by health systems. However, to be successful, CI networks must become physician-led, professionally managed organizations. Organizations should keep the Federal Trade Commission's clinical integration definition and requirements in mind during CI program development and implementation. In 1996, the Department of Justice and the FTC defined CI as an active and ongoing program to evaluate and modify practice patterns by the CI network's physician participants and create a high degree of interdependence and cooperation among the physicians to 1. Establishes mechanisms to monitor and control utilization of healthcare services that are designed to control costs and ensure quality of care. 2. Selectively chooses CI network physicians who are likely to further these efficiency objectives. 7 Components To effectively implement CI, the network should understand the relevance and the possible options for each of the seven components discussed below.