Demystifying clinical integration
November 3, 2010

We’re wrapping up our fall series of evening medical staff business meetings, which are hosted by the GHP Board twice a year. Many of you who attended wanted to know more specifics about how new relationships with other medical organizations will actually work.

Clinical integration is the key, so let’s define what that phrase means. Here’s a mouthful to start with— this definition was circulating at the American Medical Group Association’s Institute for Quality Leadership:

"Clinical integration is an active and ongoing program to evaluate and modify practice patterns of the network's physician and hospital participants, and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality."

It’s a pretty big-picture concept. In order to pursue this at Group Health, there has to be a sustainable business model for our Enterprise and for our medical group. This means it has to make strategic sense. Operationally, we have the key components: care management, fully developed electronic medical records, a solid and comprehensive primary care base, and aligned, high quality specialty care through the continuum.

Clinically, we have medical management principles and unwavering dedication to evidence-based, patient-centered care. Anyone who is going enter into a care-giving relationship with Group Health has to be ready and willing to embrace all of the above. So in addition to a strategic rationale, there needs to be a values match with any clinical partners we wish to partner with.

How we’re using clinical integration now

We already have a few examples of successful clinical integration here at Group Health. These have evolved organically, over time.

• Mixed anesthesia at Virginia Mason, Seattle. In the past we had Group Health anesthesiologists working with Group Health surgeons on Group Health patients in Virginia Mason hospital. The same was true for the VM anesthesiologists—they only worked with their own doctors and patients. Now we have a mixed anesthesia pool. We share our best practices and care together for our patients getting surgery at Virginia Mason.

• Neighborcare Health Nurse-Midwifery Services. Non-members can receive care and give birth at our Family Beginnings birthing center at Capitol Hill with the certified nurse midwives of Neighborcare Health (formerly Puget Sound Neighborhood Health Centers). Neighborcare provides prenatal, labor, delivery, and postpartum care. Their back-up physicians are Group Health obstetricians.

• Pulmonary care at Overlake Hospital. The intensive care unit at Bellevue’s Overlake Hospital is staffed by Overlake and Group Health pulmonologists. They share rotation and take care of both Group Health and non-member patients.

Branching out—technology gets us started
Practically speaking, clinical integration can really take hold when the parties involved are able to share data about utilization and care practices. Then they need to agree on goals, roles, and how to judge performance. An important unifying tactic is to have a single, common medical record that we and our partners can use to get performance data. In the case of The Everett Clinic, we’ll both be using Epic’s Care Everywhere. We’ll soon start discussions with The Everett Clinic about what each of us does well, and which outcomes can be improved—for both parties.

In truth, there are very few—if any—fully developed clinical integration models in the country. We’re breaking new ground, with the goal of bringing well-coordinated, cost-effective care to many, many more people in our region. We’ll do this by partnering with the delivery systems, individuals, and hospitals who share our goals and principles, and only in settings where it makes strategic sense.

I wish everyone in our region could have the benefit of having a Group Health Physician in a Group Health Medical Center. If we’re successful, more communities—large and small—will experience and understand how Group Health is well beyond medicine.