Payor Relations: Clinical Integration Program Development

Clinical Integration is a process in which improvements in the quality and efficiency of medical care are achieved through physician/hospital collaboration.  Key to the 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.

Southwind works closely with a health system's legal counsel to provide the strategic and operational components of a clinical integration initiative that complements the legal counsel's contractual and organizational arrangements, as well as government and regulatory relations.  Combined with legal expertise, Southwind offers health systems and health networks a comprehensive approach to developing and implementing a successful clinical integration strategy.

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 proactively optimize compliance with FTC guidelines.

Southwind 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;
• 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.