How about this for a paradigm shift: Don't make a career decision based purely on what's best for your pocket. Instead, think about what's best for your patients. If you put yourself in a position to optimally treat them, the invariable byproduct is healthy, happy patients, and that leads to more referrals. However, if you desire to have your cake and eat it too, you may want to consider joining a clinical network.
In a clinical integration network, independent or group-practice physicians collaborate with health care systems to maximize the efficiency of care and costs. In 1996, the Federal Trade Commission reported on how clinical integration is characterized by "an active and ongoing program to evaluate and modify practice patterns," in order to "control costs and ensure quality." In such a model, the health care system equips the doctors (i.e., the clinical network) with the resources to be successful (e.g., technology, facilities, etc.). This in turn allows the health care system to develop market-specific partnerships with health plans and employers, as well as incentive-based delivery models.
According to Dr. Robert Lerman, vice president of physician integration at Dignity Health, "joining a network gives the physician a strategic advantage for health care reform and more efficient patient-centered care." This is largely attributed to the fact that clinical networks are physician-led and physician-driven. In the case of Dignity Health, for instance, clinical integration systems are organized in the following fashion:
- Dignity Health establishes the clinical integration program as a wholly owned subsidiary.
- An operating agreement is created to outline the relationship between Dignity Health as the parent company and the network.
- A subsidiary of Dignity Health (MedProVidex) provides continued back-office support for the network.
- The network is governed by a board of managers, which is composed primarily of participating physicians.
- The board is supported by several physician-comprised committees (e.g., an initiatives or quality committee, a payer-relations committee, and a remediation and education committee).
This organizational framework clearly puts the control in the hands of the physicians, but it also comes with a big responsibility: Physicians are not only held accountable for care but also for compliance with the network's rulings. This is easily achievable, however, through a willingness to measure, share, disseminate, and benchmark data. Thus, when looking to join a clinical network, Dr. Lerman believes it's imperative to choose one that both "aligns with your personal goals for providing excellent patient care" and "has initiatives and benchmarks you agree with and can contribute to."
Such ongoing quality optimization and accountability guidelines prepare and enhance the physician's capability to produce quality care. Foreshadowing the future, Dr. Gary Greensweig, vice president and chief physician executive for physician integration at Dignity Health, believes that this clinical-integration model will continue to "be more robust and less fragmented" due to continued improvements in "communication between providers, the sharing of medical records and other clinical information, care and case management, and disease-management programs."
The basic idea behind clinical networks is that patients are best served when doctors of all specialties are working in a single integrated network to cohesively optimize care. Doctors also benefit from quality-optimization standards, as well as from the resources and support from the health care system. By maintaining control through such physician-driven clinical networks, doctors are able to instill change in both patient care and health care reform.
In the end, these networks are set up in an attempt to improve overall patient outcomes, so go ahead: Make your decision regarding whether you should a join a clinical network. It may be to your benefit to build a reputation on quality care through integrating with other top physicians. Otherwise, someone may steal that cake right out of your hands.