Clinical integration is a big buzzword, and it plays a large role in a healthcare market that continues to shift towards rewarding providers and health systems that can effectively manage the health of populations instead of just treating those populations when they are ill. But what does it mean? And how does clinical integration differ from Clinically Integrated Networks?
While Clinically Integrated Networks (CINs) must have certain characteristics to legally operate as such, clinical integration refers to a broader set of activities. A clinically integrated healthcare practice or system can be part of a CIN, but it doesn’t have to be.
The American Hospital Association defines clinical integration as the facilitation of “coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, and patient-focused.” Because of its emphasis on coordination of care, clinical integration is sometimes referred to as “care coordination.”
The tenets of Clinical integration are key to achieving the Institute for Healthcare Improvement’s “Triple Aim”:
- To improve the patient care experience.
- To improve the health of populations.
- To reduce the cost of healthcare.
Recently, many groups have focused on the Quadruple Aim rather than the Triple Aim mentioned above. The fourth element in the Quadruple Aim covers “attaining joy in work”, according to the Institute for Healthcare Improvement.
The IHI article continues, stating “ For many organizations, the fourth aim is attaining joy in work. For others, it’s pursuing health equity. Some organizations highlight other priorities. The Military Health System, for example, has added readiness as their fourth aim.”
A hypothetical patient, Sara
What can effective clinical integration look like? Let’s look at a hypothetical patient, Sara.
Sara is an eleven-year-old girl with type 1 diabetes. She lives with her family in rural Colorado, over 200 miles away from the nearest pediatric hospital.
Sara is currently managing her diabetes with insulin therapy, diet, and exercise. She regularly sees a pediatrician who is part of a PCMH-designated practice in the town where she lives.
Sara’s pediatrician is part of a Joint Venture Physician-Hospital CIN, which allows her to leverage a broader community of experts, including one of the nation’s leading pediatric endocrinologists.
Through telehealth, Sara has check-ins with a pediatric endocrinologist and a pediatric dietitian. “Visiting” these members of her care team virtually allows Sara to miss as little school as possible and saves her family hours of drive-time.
Sara’s pediatrician involves Sara and her parents in care planning and serves as the point person for Sara’s care team.
All of Sara’s care providers use an electronic health record, where they are able to carefully track trends and use decision-support technology to ensure Sara remains on-target with lab work and other testing necessary to monitor her condition.
In short, Sara’s care team partners with her and her family to proactively manage her type 1 diabetes. They communicate well, have clear roles on the care team, and are all working towards well-communicated, documented care goals based on best practices in pediatric diabetes care.
What does clinical integration/care coordination look like, more broadly?
According to the Agency for Healthcare Research and Quality, clinical integration includes activities like helping with care transitions, developing proactive care plans, empowering patients to take an active role in their health, and responding to changing patient needs. It includes helping with care transitions – like a transition from the hospital to the home, for example – and connecting patients with appropriate community resources. Sometimes those resources may not be strictly medical, either. A hospital social worker might connect a patient experiencing homelessness with an application for a housing voucher, for example.
Clinical integration looks different for every practice and patient. No matter where it’s implemented, however, it should improve population health management and the patient experience.
Sources:
- https://www.aha.org/websites/2012-09-12-clinical-integration
- http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx
- https://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html
- http://www.ihi.org/communities/blogs/the-triple-aim-or-the-quadruple-aim-four-points-to-help-set-your-strategy
