How Clinically Integrated Networks Can Help the Health Care System

As American politicians continue to debate what was obvious to the United Nations in 1948 — that timely and effective health care is a basic human right — regulators and operators in the free market are turning to modern technologies to update our treatment models and health care infrastructure.

One of the major stumbling blocks on the way toward real progressive change was realizing that, under our current profit-driven health care system, individual insurers and providers can reward themselves for referrals or otherwise conspire to put money first and health results second.

Moreover, regulations at the state and federal levels have long assumed that this kind of siloed, unnecessarily competition-driven marketplace was in the best interests of all parties. Competition is, after all, the major pillar of capitalism. Although competition ostensibly delivers better products at lower prices, it also creates — in what should clearly be a stable, accessible, safe and sustainable industry — a nearly untenable combination of fragmented and ineffective care, inconsistent safety procedures and criminally untenable pricing schemes.

On a scatterplot of per-capita health care spending, the U.S. is such a dramatic outlier that it’s nearly comical: We spend far more on our health per person but see far worse results than many other developed and developing countries. We spend $9,237 per person compared to the U.K.’s $3,749. And yet, among the 12 most developed economies in the world, the United States ranks dead last for life expectancy.

The why behind this embarrassment is a complicated mess of political and cultural factors, but nobody’s arguing we can’t do better. Clinically integrated networks have the potential to fix some of these uniquely American problems.

What Are Clinically Integrated Networks?

As discussed, the existing paradigm for health care in America — with all of our health providers and insurers seemingly pulling in separate directions by rent-seeking, colluding and doling out reimbursements for tests and procedures — is completely unsustainable. As Atul Gawande noted in The New Yorker back in 2009, like capitalism as a whole, American medicine “… rewards doing more over doing right.” It creates and effectively rewards the sort of duplication of effort that has resulted in America’s grotesquely overinflated health care costs, which have been rising inexorably for a couple of generations now.

The answer to these problems might be something called clinically integrated networks. This paradigm emphasizes collaboration over competition. Here, in brief, is how it works.

A clinically integrated network is less of a physical structure and more of a process. It describes a system where insurers, providers and regulators share information and collaborate on an open playing field. Since data has already become the most valuable commodity on planet Earth, it just makes good sense to apply the collection and sharing of data to the world of medicine, where quality information can literally make the difference between life and death.

So, no — a clinically integrated network isn’t something one joins and then forgets about. It’s a process for sharing information and effort. What kind of information and effort? It’s things like:

• The development of common goals and incentives to improve the quality of care for all involved parties and to establish patient-focused, rather than profit-focused, benchmarks.
• The use of modern IT infrastructure to build newer and more efficient workflows and to ease the sharing, and bolster the security, of electronic health records.
• The creation of a medical culture that puts physician leadership first and rent-seeking entities second, by emphasizing team-based care and meaningful, actionable reporting.

That probably sounds a little bit wonky, so let’s put things into practice with some real examples.

How Does This Help?

In Florida, Flagler Hospital in St. Augustine helped build an integrated network of more than 80 medical practices in what became the region’s first jointly owned physician-hospital organization.

This is significant because each of these practices will now draw from peer-reviewed improvement benchmarks rather than arbitrary growth metrics favored in an unfettered capitalistic approach to medicine. Just as importantly, such a network also emphasizes the easy and secure exchange of patient data to help improve and speed up health care outcomes.

It also helped develop a more transparent compensation model for doctors and other providers. It trims away some of the waste we’ve already discussed, such as organizations compensating themselves — or, more accurately, billing the federal government — for unnecessary tests and procedures.

In Washington County, Penn., an integrated health care network unified providers like Washington Physician Hospital Organization, St. Clair Hospital, Excela Health Systems and Butler Health and made it easier to study and address trends across communities suffering from similar ailments. The most immediate application is studying diabetes patients as a whole. When patients must be appraised and treated without this kind of commingling of critical data and resources, making substantive progress in improving our treatment models — and ultimately developing cures for some of our most troublesome illnesses — can be far more difficult.

Along with the procedural and outcome improvements made possible by data-sharing comes, of course, a healthier return on investment and lower costs overall.

The bottom line is that clinically integrated networks help to renew our commitment to effective communication. It also forces us to readdress some of our longstanding assumptions about what competition really brings to the world and whether we want it to hold sway in medicine for even one moment longer.

Conventional wisdom as applied to health care outcomes results in a situation where, when somebody wins, somebody else must lose. Back in reality, health care isn’t a zero-sum game and human beings aren’t mindless Darwinian beasts. We owe it to the generations that follow to build something worth being proud of.

Kate Harveston is a freelance political writer and blogger for her site, Only Slightly Biased. Her writing mainly focuses on social justice issues, both in the United States and internationally.

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