Clinical Integration Planning And Implementation

Clinical integration is an active and ongoing program to evaluate and modify healthcare practice patterns by physicians. The program creates a high degree of interdependence and cooperation among physicians that result in positive impacts on cost and quality.

One key to a successful program is the ability of non-financially integrated physicians to jointly negotiate with payors on contractual and reimbursement issues without violating antitrust guidelines. To meet legal and regulatory guidelines, physicians participate in programs that result in process and outcome improvements in the quality, cost and utilization of health care services. The payor contract must be critical to the ability to make the quality and efficiency improvements for the program to meet federal anti-trust guidelines.

To effectively implement a clinical integration strategy, required legal services include:

• Representation in any legal action before the FTC;
• Legal advisory services related to FTC requirements, including FTC staff communication;
• Provider network and Health System Board of Directors advisory services; and
• Coordination and overview of the network’s strategic and operational activities to pro-actively optimize compliance with FTC guidelines.

Development and implementation services may include:

• Strategic assessment of physician concerns and readiness for implementing a clinical integration strategy (interviews and surveys);
• Technical readiness assessment of the current network infrastructure;
• Advisory services on proactively optimizing compliance with FTC guidelines;
• Development of a communication strategy, key messages, and tactical plan for physician education, provider contract execution and program implementation;
• Management of multi-modality communications production (PowerPoint, webinars, podcasts) with outside resources if necessary;
• Leadership of on-site communication process on behalf of the health system; and
• Coordination with legal counsel on strategy, key messages and process in order to meet FTC guidelines; and
• Leadership of clinical quality improvement program development including data analysis, meeting leadership and physician communication.