The Importance Of Clinical Integration In The Strategic Planning Process

With the implementation of two milestone in the healthcare system, the Affordable Care Act (ACA) and Health care education and reconciliation act of 2010. The ACA assist in easy access to high-quality and cost-effective and also assist in the shift of the nation’s health care system in the direction of primary and preventive care. Also the health care education and reconciliation act is an initiative to motivate nurses and provide grants and scholarships to acquire higher education and take active part in the reformed health care system. In order to create the health care system which focus on primary and preventive care, the role of nurses is very vital and important especially the advanced practice registered nurses (APRN) (Implementing Health Care Reform: Issues for Nursing, 2010). American Nurses Association always advocate and nurture nurses including APRNs and Patient Protection and Affordable Care Act (PPACA) also acknowledged and recognized the role of APRNs in the provision of primary and preventive care. This acknowledgement of PPACA open the new horizon for the APRNs in the transformed patient-centered care system (Haney, 2010). In this presentation, the writer will discuss new emerging care delivery model which are mentioned in the PPACA. These delivery model involve interdisciplinary and care management services of RNs (The National Academies Press, 2011).

Under Medicare Advantage plan, the insurer gets a fixed capitation payment from Medicare and then it pays to the physicians, hospitals and other providers. The health system executives can coordinate care more effectively. Integrated delivery networks are created by health systems and other providers which includes Acute care hospitals, Primary care physicians, home health care, long-term care etc.

The author has been employed in the healthcare field for over fifteen years that has allowed the time to observe the transformation of the primary care practice. This paper will examine the industry using Aspirus, Inc. as the reference point; however encompassing an examination of other healthcare institutions. Evidence suggests the Patient Centered Medical Home (PCHM) model, also known as the medical come, of care can offer many benefits, including improved quality in the patient experience and disease management and lower costs to the patient and system because of reduced emergency room visits or hospital admissions. The main objective of this paper is to highlight the challenges and explore what the PCMH model will be like in five years within the primary care setting of a healthcare organization.

Stakeholders at all levels of a healthcare organization benefit from the collaborative practice model since it crosses boundaries that span all disciplines and departments to create a team-based planning and treatment approach. This strategy is conducive to meeting the requirements of healthcare reform that promote patient-centric care while maintaining efficient operations, optimized reimbursements, reduced costs, and most importantly better patient

In the 1900s and early 2000s, the United States started the integration movement to improve the efficiency and effectiveness of the health care delivery system. The integrations system was designed to introduce various strategies that healthcare organizations use to achieve the diversification in their services. However, these policies have helped the health care system to gain market share, become more diversified, reduce competition, and increase cost advantages by using existing operation to offer new products or services (Shi & Singh, 2015).

More and more integrated hospitals and other providers are becoming prevalent in our community; two large systems in the Dallas Fort Worth area are Texas Health Resources and the Baylor Scott White systems. What exactly are these integrated hospital systems? An integrated healthcare system is one that through official agreements or ownership sets up a horizontal and vertical line of healthcare facilities and services to better deliver seamless healthcare to patients. An example to use is Texas Health Resources since its found in most corners of the Metroplex. With any large corporation and system comes confusion and other problems: such as regulatory obstacles, the complexity of operations, and unclear financial ownerships. Integrated healthcare systems appear at face value to be the solution to curbing the

There are various models designed to enhance the quality of health care provided in today’s society. Within the health care system the objective is to provide quality care to the patient is the primary goal, however, over time due to such a strong concentration on this objective expenses have been forgotten. Medical care has now grown to a ridiculous expense. Congress, medical professionals, administrators, and many others are now devising various plans and models to attempt to conquer and eliminate such expenses. The patient centered medical home, managed care plans, and accountable care organizations are just some of the ideas

The U.S healthcare system has been characterized as complex, fragmented and costly, and one that thus results in an inefficient allocation of resources. Due to this, the concept of integrated healthcare delivery systems (IDSs) has gained much interest over the past few decades. Throughout healthcare policy, these systems have been considered the better solution to addressing issues surrounding not only the cost of care to the system, but the quality of care that is provided from the system. Much in alignment with the concepts of managed care, integrated delivery systems act to contain the cost of healthcare, while providing quality care to the consumer.

Clinical integration by definition represents the “coordination of care across a continuum of services, including preventive, outpatient, inpatient acute hospital care, post-acute including skilled nursing, rehabilitation, home health services, and palliative care to improve the value of the care provided.”

To achieve the benefits of integrated care it is necessary to create an integrated service plan for patients enrolled in the integrated care program at Rivers Integrated Care Clinic.

The term physician/Hospital alignment model define as the “state of agreement and cooperation between hospital systems and physicians to achieve better, cheaper and effective healthcare system. In other words hospitals and physicians must work together to provide an agreeable solutions to the healthcare problems. This kind of alignment sounds really good from the patient perspective. Over the past 30 years, relationships between hospitals and physicians have evolved from the physician as customer to the physician as potential competitor. As health care moves into a “patient-centric” era, both the physician and the hospital must align to provide service to the patient-customer.

With the ability of performance level and quality reporting methods, Accountable care organizations should define population as every patient who comes under the provider network and at the same being highly accountable for the cost of care. Financial rewards depends on the cost and quality of procedures opted by the ACO in improving the population health. ACOs can play a vital role in population health as primary care physicians who are the basic building blocks of ACO play an important role in managing the patient’s care. Through the physician engagement with the patients at the primary care physician level can focus more on the preventive measures, educating the patients about the disease management, chronic medical illness at a community level. This patient-based population model along with ACO financial and clinical performance requirements will enable the organizations with networking in the group practice can identify and manage the individuals with costly and risky conditions in the provider network region. Overall, group practices within the ACOs can play an important role in monitoring the health status of the entire community population by taking

In United States health care system with increasing patient expectations towards better outcome coupled with need to improve financial and clinical outcomes which forces health systems and hospitals to relate with physicians. New health care reforms stresses mainly to improve efficiency, effectiveness and quality of providing health care, by which physicians and hospitals are motivated to form new alignment models.

When two organizations come together to build one, it can become very successful. Physicians are more involved then hospitals and this is because they bring in all the patients, are treating the patients, ordering the supplies, choosing the staff and must deal with all the complaints and comments from patients and their families. The way care is delivered depends on how the physicians and hospitals work together. It is essential that the two organizations focus on improving quality, costs, outcomes, access, and patient satisfaction. There are strategies that can be followed to help hospitals integration with physicians become more successful. The 12 strategies to guide integration efforts are:

Will the implementation of coordination of care rounds at Peninsula Regional Medical Center lead to improved patient outcomes and experience?