Hospitals and most healthcare systems often rely on physician liaison to fortify the ties and bond. In most cases, it’s not hard to find a physician charged with being a part salesperson, part customer service agent and part consultant in addition to establishing and maintaining a good relationship with fellow physicians working in their respective community. This link has been considered to be a crucial component of a healthcare organization success for many years now. As the industry continues to grow, the acknowledgment of this relationship is becoming more critical than ever due to increased demand for coordinated care, new organization structures, and value-based health models. Therefore, having a secure physician engagement is imperative for healthcare care organization to achieve and offer high quality, cost-effective healthcare services. This has resulted in the development of integrated physician model.
1.Understanding the concept of an integrated physician model
The financing and delivery of healthcare have recently drifted from a volume-based to a value-based business model with the aim of providing services with the best possible quality, results and access to the low cost, reasonable within the range of patient care services (Song, 2014). Integrated –physician model can be considered to be an innovative hospital model which allows organization and coordination of medical doctors by allocating them with asks and roles for primary medical services (Harrison, 2010). The model also acts as a centralized management unit and a medical coordination unit which oversees the delivery of specialized medical care along with clinical pathways as well as performing and coordinating administrative roles for both medical service and specialist units. The integrated-physician-model, therefore, create value for all stakeholders including hospitals, doctors, and patients.
Under this model, healthcare provider success is achieved by offering best possible healthcare. Having an improved alliance between hospitals and medical doctors is very imperative to improving how healthcare is administered as it enhances the satisfaction of both the patient and physician leading to value equations associated with improvement of crucial health elements. In most instances, it is the sole responsibility of a physician to drive patients’ clinical care. Therefore, their incentives must be driven by value and lined up with those of hospitals and health systems. Having a well-structured is integrated physician model lowers the health cost, improve access, satisfaction as will increase capital and operation efficiency.
2. Importance of having a clinical integration within the process of strategic planning
According to American Medical Association (AMA), clinical integration is defined as ways of facilitating the coordination of patients care across the conditions, providers, setting and time with the aim of achieving a timely, efficient and patient-oriented health care (“What is Clinical Integration? “, 2018). Healthcare integration is imperative because many healthcare providers and organization lack meaningful and helpful information and connection with other healthcare organizations. Strategic planning, on the other hand, is a handy and valid tool for guiding an organization. It is a process that is adopted by a healthcare organization to develop a plan for achievement of its overall and long-term goals. It is a systematic and an organized process where a group expresses its desires for the future by offering a set of decision making criteria and the decision taken and implemented by an organization guide its activities and structures.
Today, hospitals and healthcare organizations are operating in an extremely competitive environment with increasing pressure to improve and quality and lower operation costs. In response to the ever-changing situations, most of the facilities are finding it imperative to having in clinical integration in their strategic planning process (Harrison, 2010). This has played a significant role lowering the problem associated with increasing difficulty in satisfying progressively aware and demanding healthcare user. Additionally, it has reduced the pressure related to the need to occasionally change internal organizations structures to keep pace with rapid change associated with technology and healthcare approach. Another importance of having clinical integration in the strategic planning process is that it leads to a consolidated healthcare delivery networks which have seen a collaboration of different health services in most unlikely ways with the primary aim of resolving a general health mishap.
3. Dynamics and controversies associated with ACO and alternate methodologies to the health system
Accountable care organization refers to a set of both physicians and hospitals involved in healthcare provision who have accepted joint responsibility for healthcare spending and quality for a defined population of patient. Accountable care organizations are considered to be a solution to the cost crisis in most healthcare practices (Harrison, 2010). It involves millions of patients and consequently holds group practices, clinicians and hospital financially accountable for improving their patient outcomes and reduction of expenditure. However, the current debate regarding Accountable Care Organisation (ACO) has raised questions about its value and sustainability. Some people argue that ACO is just another program to confuse patients and that it is not going to be cost-effective and it will become obsolete in the long-run. Most of the critics cite that lack of patient engagement, inability to steer patient to high-quality doctors and lack of timely and useable data among the significant factors affecting the efficiency of ACO (DeCamp, Farber, Torke, George, Berger, Keirns, & Kaldjian, 2014).
According to Song (2014), the current health care system faces significant drawbacks from increased cost. This is mostly motivated by lack of incentives from both the patient and healthcare providers to compete to reduce cost and instead both parties have their focus on high-quality healthcare. This also explains why new medical technology in most healthcare facilities only increases cost instead of cutting it because the only competition is to base on maximizing the quality of healthcare regardless of cost, developers, and innovators. Therefore, one of the alternatives towards this problem can be found towards uniting the decision over what healthcare to consume and purchase regarding the economic responsibility to cater for the costs so that costs can be measured against benefits in healthcare consumptions. This can be achieved by introducing a third party payer with the power to decide what healthcare the patient or consumer is allowed to consume. The third party is mandated to weighing the costs of the patients’ health against the benefit. Alternatively, patients can be given the full responsibility of choosing the best suitable healthcare why considering the cost and the benefit (Song, 2014).
4. Medical foundations Model, its Pros, and Cons
Medical foundations model refers to a methodology and mechanism which allows hospitals and certain other health care entities to create legal objects that are not profit based to employ physicians or healthcare providers (Harrison, 2010). The model allows flexibility in hospitals seeking to employ physicians and health caregivers directly. The model was developed under Connecticut’s medical foundations’ law which authorized hospital and health care systems which are a non-profit or medical school to organize and become a member of a medical foundation to provide health care services and practice medicine through licensed agents or physicians (Manthous & Sofair, 2014).
One of the benefits of this model is that some hospitals have been able to establish physician-affiliated practices groups in the form of captives or friendly professional services corporation. Although the captives are not technically maintained by the health facilities, they serve the vision and mission, and they are managed either directly or indirectly by the hospitals. Therefore, by peopling the captive’s governing board with the senior management of the hospital and having the sole shareholder as the hospital employed physicians, the healthcare facility can maintain tight control over affiliated captive without interfering with the corporate practices. On the other hand, unlike other forms of corporations, a medical foundation is not allowed to engage in in any other business apart from rendering the health care services for which it was initially incorporated for. Additionally, a medical foundation should all time ensure that the compensation for its employed physicians is at fair market value and that it does not take into account the number of referrals made by the physician to avoid violating stark laws (“Medical Foundations”, 2018).