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“A clinically integrated network will only be successful if there is commitment from the physician community. It is part of the Chief Medical Officer’s role to educate physicians so they develop a deep understanding of what they can achieve and improve with clinical integration,” says Doug Ardoin, System Medical Director, Ochsner Health System.

Ardoin is a speaker at the marcus evans National Healthcare CMO Summit 2018, taking place in Florida, March 19-20.

What is absolutely critical for building a clinically integrated network?

First and foremost, there must be commitment from the physician community in that market or geography. Otherwise it will not be successful.

How can CMOs get that commitment from physicians?

Education is a big part of the initial engagement with physicians. If physicians develop a deep understanding of clinical integration, I believe they will naturally gravitate towards wanting to create a clinically integrated network. It is very important that they understand that improving quality of care, cost of care and patient access, in a measurable and cost-effective way, is at its foundation. The ability to better drive coordination of care is extremely important. CMOs need to explain to physicians how this can be achieved through a clinically integrated network, particularly for the community of patients that they care for. As the physicians come together they will naturally understand the importance of improving communication amongst all of the provider members.  

Achieving trust among the community doctors is another aspect. It is important to respect and understand that physicians may be competing with each other for business. We have to convince them that clinical integration is a better way. It does not necessarily completely do away with the competition they may have with each other, but it absolutely brings them together in a way that can improve overall quality, coordination and cost of care for their community. They need to realize that this will allow them to keep the program and enter into joint arrangements with commercial payers for potential rewards for achieving better outcomes.

What tools are required to make the model a success?

There is a very strong technology component that they need to be willing to invest in. To combine claims data from the various payers (particularly with payers they may have a clinically integrated contract with) along with clinical data from their practices, there must be an enterprise data warehouse collecting the information and generating longitudinal reports on performance for chronic disease management, cancer screening, immunizations and so on.

They must also invest in people and processes, to better manage patients with chronic disease or patients with extraordinary care needs. This will also require a people solution. The whole idea is for the clinically integrated network to better manage the current disease burden, and hopefully over time reduce the burden with better care, screening and education of the population.

When it comes to making clinical integration a success, what impacts patient care the most?

What has the biggest impact is improving access to primary care. That should be the goal of every clinically integrated network. To understand if patients with hypertension, diabetes and other chronic illnesses have access to primary care services and if they find it convenient. They need to think about after hours care, weekend care and virtual care in order to do a better job. The second step is to understand the social determinants of illness, particularly within your population, where transportation, lack of caregivers at home and lack of access to healthy food is an issue, and try to develop strategies and tactics to improve those aspects of care.

Any final words of wisdom?

Buckle up and get ready. Building a clinically integrated network in a new geography or marketplace is not easy. It will require a lot of education and conversations, and a culture change in the provider community. It can be done, but it will take time. Celebrate the small wins. Do not get frustrated. Keep working at it. When you achieve clinical integration in your community, it will be better for the patients, providers and the healthcare system altogether, because it will stabilize and lower the cost of care.