Clinically Integrated Networking: A Case Study

“An Integrated Physician Model is the result of a series of partnership between hospitals and physician develop overtime” (Harrison, 2016). Primarily, it is a joint venture that has become many joint ventures. In addition, all of this joint ventures are connected through congruent goals, and that is to provide different level of care to all the patients. Integrated physician model also organizing themselves to improve the cost and quality by operating under a clinical guideline. This could include acute care hospital, home care, nursing homes, affiliated medical group, primary care clinics, employed physician and any independent medical groups.

It is important to note that physicians help in recognizing the costs of resources associated with patients being treated for chronic illness, acute care, and palliative care services. More important, they provide prospects to decrease complications, and deliberate the contribution of numerous physicians in the care of the patient (Shi, 2012, p. SR4). Therefore, offering services such as that of primary care providers and clinicians that use a methodical knowledge base and have the expertise necessary to direct the delivery of personal health services to patients across the continuum of care will be beneficial to overall patient outcomes (Shi, 2012, p. 3). In order to facilitate success in creating alliances with other health care providers in managing the continuum of care for patients and coordinate care effectively, physician engagement is needed. According to the special report, key benefit found in a data analytics survey for the state and local government officials was centered on informed decision-making reflected 66%. Thus providing the agencies better decisions affecting finances, payroll, and human resource

Managed care programs remove the majority of the consumer-driven or free market provider selection and health care choices by establishing networks with preapproved providers. These programs include health management organizations (HMOs), preferred provider organizations (PPOs), point-of-service (POS) options and provider- sponsored organizations (PSOS), of which are all network based (Gage, 1998). Patients who utilize a managed care program find there is little or no cost for receiving care within the network, however, require referrals to see a specialist, high cost if a physician is outside of the network, requirements of second opinions for costly procedures/ diagnosis, and pre-defined hospital stay limits. On the other hand, physicians supporting managed care programs contract and accept various risks, including insurability, utilization rate, price, reimbursement rates and legal risk (Brown & Reiss, 2000) for the

Despite the first hospital in the region to have a clinical information system with available bedside computing on the inpatient units since the1990s, and has received several industry recognitions, the Leonard Williams Medical Center (LWMC) faced many challenges. Most importantly, the challenge in the information system is the most comprehensive and needs alignment and strategic planning in order to successfully implement electronic health records (EHRs). While an approval in acquisition and implementation of the CPOE from the steering committee was undergoing, the Williams Medical Service (WMS) physicians worried in acquiring such information technology. The main reason the WMS physicians’ anxiety was

With the onset of value-based payment models, primary care physicians and specialists are reorganizing to form networks in order to improve patient care while reducing operating costs and duplication of services to patients. Clinically Integrated Networks are one type of these physician-led networks. In 1996, the Federal Trade Commission (FTC) defined clinically integrated networks with certain requirements that exempted CINs from anti-trust law. The requirements that CINs must have are as follows:

According to Petri (2010), interdisciplinary collaboration is an interpersonal process which is characterized by health care professionals from multiple disciplines with shared objectives, decision-making, responsibility, and power, working together to solve patient care problems. Although the concept of interdisciplinary collaboration has existed in health care since 1978, there is still ambiguity over the meaning of collaboration, and this impedes its complete integration in health care. Petri’s study aims to provide an in-depth understanding of the meaning of interdisciplinary collaboration so the concept can be fully incorporated into health care practice (Petri, 2010).

The integrated-physician-model is described as an innovative model of organization and collaboration of medical doctors which grants tasks and interprets roles differently for primary medical services within the hospital. This model aims to improve participation between competing medical groups within the same hospital and between competing hospitals. By establishing this improvement, the integrated-physician-model creates merit for doctors, hospitals,and also patients.”To achieve a hospital-physician integration strategy that is sustainable for both parties, hospitals and health systems must lay the needed groundwork of knowledge, capabilities, infrastructure, resources, performance targets and physician

Several key characteristics of which will help health insurance industries modernize the health care system is to increase quality of care, access to clinical services, and reduce health care cost by empowering technology. Empowering technology helps health insurance industries promote data collection and information sharing across the health care system as a method to increase provider communication and align patient care. The newly emerged payment and data-driven model called Value-based payment plan reflects this strategic objective. The Value-based payment comes in many forms such as pay for performance programs, patient-centered medical homes, and Accountable Care Organizations (Japson, 2015). In an ACO, health care providers are contracted to become in network providers. These in network providers are required to accept the responsibility of cost and quality of care for a defined population. The goal for in network providers in an ACO is to increase quality, patient satisfaction, reduce cost and maximize patient health (Mulestein,

PHM is very effective and resourceful for all healthcare service providers. In order to get the best out of it, it is imperative that the concept should be well understood. However, there are some myths associated with PHM that have many providers confused. We shall discuss these myths and clear them so that PHM can be used to optimize

We created two types of networks in this study. The first is a directed bipartite network and represents interactions between providers and patient records (Figure 2). The second network is undirected and depicts shared patient record access between providers (Figure 3). Visualization for both networks was performed using Gephi. [59] Further description of these networks follows.

The health care reform in the United States has increased the patient quality of care and cost -effectiveness. However, it has affected to the roles of nurse incredibly. According to American Academy of Family Physicians (2012), the patient -centered medical home (PCMH) has become a fast-growing and remarkable model care. More organizations such as Utilization Committee for Quality Assurance and the Joint Commission currently has credited the PCMH led by nurse practitioner (NP) (Stokowski, 2012).

A major shift regarding care delivery at a macrosystem level is occurring within the organization. The system is working towards a health model, rather than a medical model. In addition, the medical home model, in which a primary care provider (PCP) provides coordination of care for patients’ across the continuum, utilizing evidence based medicine is in the works. The medical home model assures continuity of care via coordination by the PCP. Furthermore, through the utilization of the medical home model the quality of patient care will increase concurrent with a decrease in costs (Helfgott, 2012). The medical home model is an initiative for all entities within the organization that is being cascaded from the system level.

The CMS’s conclusion here based In the preamble to our Phase II rulemaking, they concluded that a non-competition provision may not be placed on a recruited physician. 69 Fed. Reg. 16094, 16096-97 (Mar. 26, 2004] Phase III rulemaking that non-competition provisions should not be categorically prohibited from recruitment arrangements. They also stated: Upon review of the comments, however, they were persuaded that categorically prohibiting physician practices from imposing non-compete provisions may have the unintended effect of making it more difficult for hospitals to recruit physicians.

In these model hospitals and physicians collaborative to operate a specific service line and work together to achieve a common goal of improving quality and reducing costs. In these clinical or service line co management agreement hospitals pays the fixed compensation and incentives for improving quality, outcomes or reducing costs. In addition to these benefits physicians also gets hourly compensation for administrative work, the main advantage of these models is third party payers recognize and prefer this alignment for specific services.[10] [11]

The Center for Connected Medicine (CCM) has not made any updates to its digital marketing in over 20 months. This is due primarily to drastic staff changes. In addition approvals for marketing in the format of a joint partnership, such as the CCM, can dramatically slow down the marketing process.