2 Health Systems Develop Clinical Integration Programs

In today’s economic and healthcare environment, it is more critical than ever that hospitals engage physicians to enhance healthcare quality while also improving efficiency and cutting costs across all care settings. To achieve this goal, physician organizations at Covenant Health System, a member of St. Joseph Health System based in Orange, Calif., and Memorial Hermann Healthcare System of Houston have developed Clinical Integration (CI) programs. These programs can serve as a bridge for hospitals to join the Medicare Shared Savings Program after first developing accountable care capabilities through contracts with private payers and local employers.

In CI programs, a network of independent physicians collectively commits to collaborate with a hospital or health system to delivering improvements in quality and cost of care. Once the CI program is established, physicians in the CI network may negotiate collectively for commercial payer contracts and present them for antitrust review by the Federal Trade Commission (FTC). These contracts can include pay-for-performance components that allow both physicians and hospitals to receive incentive payments for improved quality and efficiency achieved via enhanced collaboration, which must be demonstrated through compliance with recognized clinical best practices and improved outcomes.

Both Covenant and Memorial Hermann developed their CI programs with CRIMSON physician performance technology services from The Advisory Board Company, a Washington, D.C.-based research, consulting, and technology services firm serving a membership of more than 2,900 of the world's leading health care organizations.