Putting the puzzle pieces together

This article first appeared on LinkedIn on July 26, 2016.

By Jerry Penso, MD, MBA, Chief Medical and Quality Officer at AMGA

During a recent meeting of the AMGA-AHA Learning Fellowship focused on Clinical Integration in San Diego, Dr. Craig Samitt, EVP and Chief Clinical Officer of Anthem, presented a visual image that resonated with the group of physician and administrative leaders present. Each part of an integrated system―medical group, hospital, and health plan―was represented as a piece of a puzzle, all fitting together to create a complete picture. It was a perspective that challenged those in attendance to find ways to create a more organized, coherent system of care that provides value to patients.

A clinically integrated system has been defined by the AMA as “the means to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, and patient-focused.” This means all stakeholders―hospitals, physicians, and health systems―coordinate and align care for patients regardless of the setting where they receive care―inpatient, ambulatory, or community. Clinical integration also must result in the desired goal of improving patient care, meaning better quality of care and patient experience, reduced cost of care, and increased access to care.

Successfully creating a level of integration that achieves this goal is hard. Those attending the Fellowship agreed that physician and administrative leadership working as a team is essential to navigate the myriad of issues that come up when aligning different organizations.  As one leader expressed, technical and adaptive changes will be required.

Technical challenges are those that can be solved by applying existing knowledge or systems. They might include creating care information and measurement systems, meeting legal and regulatory requirements, successfully negotiating contracts, and redesigning care processes. Though complicated, these challenges are usually solvable.

The adaptive challenges—or people issues—loom much larger. The different parts of the integrated system will need to agree who makes key decisions, how to divide responsibility for specific processes, and what changes in clinical practice need to be accomplished. It requires trust on all sides. Adjusting to these changes may provoke fear or even a backlash, and leaders must be capable of helping those affected adjust to the new ways of providing care. One participant described that her role in leading providers through change initiatives sometimes feels like being a “grief counselor.”

The puzzle metaphor is particularly apt because a puzzle is incomplete without each piece, and no piece is more important than the other. Over the next year, participants in the AMGA-AHA Fellowship will be working to achieve true clinical integration where every piece has a place. I am confident that they will find a way, piece by piece, to put their puzzles together.


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