From clinical integration to accountable care

Area of Science:

• Health Care Management
• Clinical Integration
• Health Policy

Background:

• Healthcare organizations face challenges including small practices, fee-for-service models, traditional medical staff structures, and the need for insurer partnerships.
• Advocate Physician Partners (APP) offers a clinical integration model addressing these issues.

Purpose of the Study:

• To present a clinical integration model as a solution to key health care organizational reform challenges.
• To highlight the success of Advocate Physician Partners (APP) in improving quality, safety, and cost-effectiveness.
• To introduce an innovative contract with Blue Cross Blue Shield of Illinois as a prototype for a commercial Accountable Care Organization.

Main Methods:

• The study describes the clinical integration model of Advocate Physician Partners (APP), involving 3800 physicians and hospitals.
• Strategies implemented by APP to achieve success in a commercial Accountable Care Organization contract are detailed.
• Key strategies include reducing readmissions, avoiding unnecessary admissions and ER visits, expanding primary care, and enhancing quality and patient safety.

Main Results:

• Advocate Physician Partners (APP) has demonstrated successful teamwork between physicians and hospitals.
• The model has shown improvements in quality, patient safety, and cost-effectiveness.
• An innovative contract with Blue Cross Blue Shield of Illinois serves as a prototype for commercial Accountable Care Organizations.

Conclusions:

• A clinical integration model, exemplified by APP, can effectively address major health care reform challenges.
• This model fosters collaboration to improve patient care outcomes and operational efficiency.
• The developed Accountable Care Organization contract prototype shows promise for future healthcare partnerships.