Building Clinically Integrated Networks
For a long period, the American healthcare system has relied heavily on a fee-for-service model. However, this model is slowly coming to an end following the need to improve service delivery and ensure that majority of the people have access to healthcare. Although this is good move especially at this point in time, majority of physicians and hospital leaders have not been able to form clinically integrated networks (CINs) because of the challenges they encounter as they try to collaborate with one another (Morrissey, 2014).
Although some of these challenges are structural, some of them are compounded by the current laws that do not promote formation of CINs. Based on this understanding, it is an opportune time for the government to address this issue even if some people do not acknowledge the critical role that the government plays in reforming healthcare. Indeed, anything less other than systematic changes in health regulation will not achieve significant changes in healthcare in terms of improving care coordination and quality, as well as controlling costs (Taylor, 2008). Accordingly, Mr. Senator, as one of the people in the government, you are in a better position to transform the healthcare industry for the benefit of the people you represent.
Stakeholders, risks, and benefits
The major stakeholders in our health system include physicians, hospitals and patients as well as government and well-wishers. Hospitals are responsible for providing medical facilities as well as employing physicians. The government, on the other hand, is responsible for regulating the health system as well as providing other services as the need may be, while physicians provide medical services to patients. The patients seek medical services from hospitals while well-wishers such as faith-based organizations help in ensuring that medical services are accessible for all people that need them.
In terms of risks, all these stakeholders are at risk if something does not operate as it should in the healthcare system. As a result, each of these stakeholders benefits significantly when everything in the healthcare system operate the way it should operate. The government on its side does not face challenges from a collapsing health system while hospitals benefit from the money they make from offering services to patients (Belmont et al., 2011). Physicians, on the other hand, enjoy good salaries for the services they render to patients while patients benefit from high quality services. Finally, well-wishers pride in a strong healthcare system capable of delivering services to the people that need them most.
Impact of the issue on macro-system
If the formation of NICs will be enhanced, there is no doubt that the following will happen. First, majority of the people that utilize hospital services will enjoy quality services. There is no doubt about this issue because health practitioners will share the responsibility of caring for patients. Accordingly, they will share patient information for the sake of fulfilling this responsibility. In particular, patients that seek medical attention from various health practitioners for the same medical problems will enjoy optimal outcomes if health practitioners will collaborate with one another. Mostly, they will share limited medical tools at their disposal with an aim of influencing their practice patterns for the benefit of the people they serve (Morrissey, 2014). In so doing, the people that you represent, Mr. Senator, will be the beneficiaries of quality services because there will be no duplicative diagnostic testing. In addition, there will be no conflicting care plans, and if they will be there, they will be minimal.
Secondly, medical costs will be reduced significantly. At the same time, wastages will be eliminated in the system. Accordingly, the government will save money, and it will be able to finance the healthcare system. Thirdly, medical practitioners that are not ready for hospital employment will be able to practice independently. In addition, as they do this, they will not fragment the healthcare industry as some practitioners have done in the past. Briefly, there will be an improvement in care quality and coordination, innovation will be promoted and cost will be controlled. Given that hospitals that seek to promote clinical integration must start by overcoming legal hurdles related to Stark, antitrust and anti-kickback laws, Mr. Senator, you will be an important person in this process (Taylor, 2008). Accordingly, your effort in ensuring that these hurdles are overcome will be of great importance.
Majority of the people that advocate for the formation of CINs acknowledge the importance of leadership in this process. According to Morrissey (2014), leadership is an important aspect in promoting the formation of CINs. In this case, those in leadership should start by acknowledging the fact that the old systems are not sustainable. Upon acknowledging this fact, leaders should be willing to make changes to the current federal laws. As for your case Mr. Senator, you should be willing to propose changes to the current laws so that new laws that promote formation of CINs can be developed. There is no doubt about this issue given that some laws hinder the formation of the same. For example, even as antitrust law aims at prohibiting joint negotiations among healthcare providers to protect national interests, it discourages healthcare providers from sharing information on the account of unintended consequences (Taylor, 2008). In your case, Mr. Senator, you are in a better position to propose changes to this law so that some issues addressed by this law can be clarified. As for the Stark law, you should also look at the various ways of changing this law to promote clinical integration.
Other people claim that the nature of the current healthcare system affects significantly the formation of CINs. Majority of the people in this group believe that US healthcare system is fragmented. Accordingly, it does not promote formation of CINs in anyway. If anything, it discourages formation of the same by encouraging health practitioners to practice independently. In order to address this challenge, Kaufman claims that there is need to align medical staff coming from independent health providers with employed ones (Kaufman, 2011). This will not only bring health practitioners together, but it will also bring value to the services they render to patients.
Some people believe that clinical integration facilitates coordination of care among patients across different settings, conditions, and health providers for the sake of achieving care that is efficient, safe, patient-focused, and timely. In order for our nation to achieve sustainable clinical integration, these people claim that there is need to modernize federal laws, redesign payment methods, and promote changes among health providers (Gosfield, 2011). In this respect, reviewing the current federal laws that govern the US healthcare system will be an achievement towards promoting formation of CINs.
In order to address the various challenges facing US healthcare as it moves towards value-based care, it would be important to build clinically integrated networks. For a general definition, these networks involve bringing various stakeholders healthcare together for the purpose of improving the quality of care provided to patients as well as reducing cost (Gosfield, 2011). Although this is a new mechanism in the USA, it has been implemented and proved workable in the United Kingdom. Therefore, the US healthcare providers should not encounter many challenges implementing this strategy. However, the government needs to do the following. First, it should encourage stakeholders in healthcare to collaborate with one another in building CINs even if it might not be possible to do so without uniting those stakeholders. As a result, the government should start by uniting stakeholders through various reforms in the industry. Secondly, it would be important to evaluate the current laws that govern the formation of CINs. The purpose of evaluating these laws should be to understand how these laws impede formation of these networks. After evaluating these laws, the focus should be shifted towards developing laws that promote the formation of CINs.
In order to facilitate the formation of clinically integrated networks, the government should start by reviewing the current medical laws. The purpose of reviewing these laws as stated earlier on should be to understand how these laws hinder formation of CINs (Morrissey, 2014). For example, the government with the help of lawmakers such as you, Mr. Senator, should evaluate how antitrust laws hinder stakeholders in healthcare from collaborating with one another. It should also evaluate how Stark law, among other laws, hinders the formation of these networks. Upon understanding the way these laws hinder formation of CINs, the government with the help of its various organs should consider changing medical laws that do not promote formation of CINs. For example, Mr. Senator you can propose some amendments to the current laws so that it can be easy for health practitioners to collaborate with one another. Inasmuch as this might appear to be an insignificant step towards promoting formation of CINs, it will be one of the major steps that we require in promoting the same. Accordingly, Mr. Senator you are one of the critical people in the transformation of our health system even if you might want to downplay your role on this issue. That is why this brief note is addressed to you.
Mr. Senator, while many people do not acknowledge government’s role in reforming healthcare, there is no doubt that government’s involvement by amending the laws that regulate health system will speed up the process of forming CINs in the USA. The government in this case, in collaboration with certain medical bodies, should come up with certain changes to the current laws. Upon coming up with these changes, the government, with the help of people such as you, Mr. Senator, that make laws, should propose amendment to the current laws. The aim of doing this should be to promote formation of CINs in our current healthcare system, as well as promote unity in the system. Accordingly, stakeholders in healthcare system will be able to collaborate with one another, and in so doing, transform our health system for the benefit of members of the general public (Belmont et al., 2011). This will not only improve the quality of services in our healthcare system, but it will also reduce cost, and thereby enable the government to save money.
Belmont, E. et al. (2011). A new quality compass: hospital boards’ increased role under the affordable care act. Health affairs, 30(7); 1282-1289.
Gosfield, A. (2011). Making clinical integration work. Medical economics; 50-70.
Kaufman, N. (2011). Three “brutal facts” that provide strategic direction for healthcare delivery systems: preparing for the end of the healthcare bubbles. Journal of healthcare management, 56(3); 163-168.
Morrissey, J. (2014). Success factors and barriers on the journey to clinically integrated networks. Trustee, 67(10); 8-12.
Taylor, M. (2008). Working through the frustrations of clinical integration. Hospitals & health networks, 82(1); 34-38.