What is “clinical integration”?

September 30, 2016, 06:17 PM | by: merge | No Comments

In general, clinical integration is the process of coordinating healthcare services across healthcare providers and sites-of-care. Through over a decade of rulings and advisory opinions, the Federal Trade Commission (FTC) and U.S. Department of Justice (DOJ) have provided consistent guidance in regard to what they feel constitutes “meaningful” clinical integration. Given the continuous evolution of competitive dynamics within the healthcare industry, the FTC and DOJ view clinical integration as more of an ongoing effort than a state to be achieved. This is reflected in their definition of clinical integration as, “…an active and ongoing program to evaluate and modify practice patterns by the network’s physician participants and create a high degree of interdependence and cooperation among physicians to control costs and ensure quality.”

In the eyes of these regulatory bodies, “meaningful” clinical integration is achieved when a network of healthcare providers’ investment of intellectual, physical and financial capital results in the establishment of a more competitive, higher quality healthcare product that can be offered to interested healthcare consumers and payers in the communities that the providers serve. When a network demonstrates that it is likely to increase competition in its relevant healthcare marketplace, initially through its business plans and strategic investments but over time through measureable improvements in key indicators of quality, patient satisfaction, and cost-efficiency, the FTC and DOJ have ruled that the network may be justified in engaging in joint contracting efforts, even if the network includes otherwise competing independent and/or employed physicians. Given this fact, in addition to being an opportunity for providers to optimize patient care, clinical integration can also be a means for physicians to realize fair reimbursement for the investment of time and effort that they dedicate to effecting positive change in the healthcare delivery system.

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