The Medical Practice Guide to ERISA: Employee Retirement Income Security Act

The Medical Practice Guide to ERISA: Employee Retirement Income Security Act

543 - Financial Management of the Medical Practice

Financial Management of the Medical Practice

The Advocate Physician Partners Experience

Case Study in Clinical Integration: The Advocate Physician Partners Experience is a primer for organizations wishing to duplicate the experience of Advocate Physician Partners (APP), whose CI program encompasses 3,800 physicians and has resulted in improvements in patient outcomes and significant cost savings.

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Although not a new concept, clinical integration (CI) is considered essential to the framework of an accountable care organization (ACO) because of its ability to generate physician trust, commitment, and acceptance of performance monitoring to achieve goals.

Case Study in Clinical Integration: The Advocate Physician Partners Experience is a primer for organizations wishing to duplicate the experience of Advocate Physician Partners (APP), whose CI program encompasses 3,800 physicians and has resulted in improvements in patient outcomes and significant cost savings, according to its 2011 Value Report.

In this 20-page report, Mark Shields, MD, MBA, senior medical director for Advocate Physician Partners (APP) and vice president of medical management for Advocate Health Care, details the CI program APP developed for its 3,800 physicians — from the structure of the CI group to funding, incentives, mechanisms and technology that support CI.

Dr. Shields shares the key strategies of this IPA to improve physician performance and why a successful CI program can provide the framework for an ACO.

PLUS: Get an update on the expansion of the APP Clinical Integration initiative — the new measures, tools and staff added.

The FTC first defined clinical integration in 1996, and some physician organizations have considered themselves clinically integrated for decades. However, there's renewed interest in CI and the clout it can contribute to payor-provider negotiations, especially in light of the CMS rollout of ACOs for Medicare beneficiaries via its Shared Savings Program.

Because clinical integration gets physicians working in a more united way to ensure that that patient is getting optimal and efficient care, CI is also a recommended prerequisite for a move toward bundled payments and other alternative reimbursement methodologies.

"We need more providers out there becoming clinically integrated not only for the acute care episode, but for post-acute care services, so that we can survive and thrive under bundled payment for CMS," says Jim Reilly, managing partner of TRG Healthcare Solutions.

Case Study in Clinical Integration: The Advocate Physician Partners Experience, the latest in HIN's continuing series of Case Studies, provides details on the following:

  • How to design clinical integration with independent doctors;
  • How clinical integration leads to an ACO;
  • The key ingredients to improve physician performance; and
  • Legal and regulatory hurdles for clinical integration and ACOs.
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