Can There Be True Accountable Care Without Clinical Integration?
For those health systems that have made the considerable investment in value-based care, one truth remains: despite the systems that might have been established and the veritable army of care managers hired and deployed, patients continue to receive care largely through their relationships with physicians. Whether independent or employees of the health system, the physician remains at the center of the delivery relationship, both by law and by custom. Patients continue to trust the physician relationship and make choices based on seeking the best physician for their needs.
Pursuing ACO efforts without engaging the physician community may deepen the historic distrust that often characterizes the existing hospital-physician relationship. Most health systems have many scars related to their interactions with the physician community through prior efforts like Physician-Hospital Organizations (PHO’s) – scars that never truly healed. Getting beyond those issues typically requires an emotional catharsis of sorts, with an opportunity to surface the past and move beyond it.
For all of these reasons, it is highly recommended that the journey to Accountable Care include an organizational platform of Clinical Integration (CI). Clinical Integration is an organizing set of principles for engaging the physician community in a truly physician-led effort to provide care differently than in the past – reducing unwarranted variation, holding peers truly accountable for quality and efficiency variances, and engaging physicians to become the stewards of high quality care. Clinical Integration, when pursued deliberately and with high integrity and a sense of purpose, is the vehicle that provides the physician community the opportunity to lead the shift to value-based care.