Clinical integration continues to gain momentum both nationally and in Michigan. Why? Because it facilitates coordination of patient care across conditions, providers, and settings to achieve care that is safe, timely, effective, efficient, and patient-centered.
How does clinical integration make a difference? In an effective clinically integrated network, primary care physicians, specialists, hospitals, and other providers share collaborative clinical goals. Providers communicate and cooperate with each other so patients receive coordinated care that improves quality and timeliness of care and reduces duplication of services.
Care teams create a “home base” for patients, providing access to primary care physicians and others on their team. This model places patients in the position to actively participate in their own care. Patients access their team for preventive and chronic care services; the team then coordinates with specialists and others to meet patients’ needs. Those needing higher levels of communication and coordination have access to care managers (often RNs) who help with the management of multiple or complicated conditions. Care managers also actively coordinate care for patients who have been hospitalized, making sure that patients receive follow-up appointments, medications, and other services.
How do we know that clinical integration makes a difference? Metrics. Together Health Network measures performance in areas of cost, access, and use of services along with an ongoing commitment to improving both quality and patient experience. Improvement is driven by shared clinical goals of Together Health Network providers across the systems of care, creating an expectation for excellence.
As Michigan’s first clinically integrated network, Together Health Network exemplifies collaboration with a foundation comprised of what some might view as industry competitors. Michigan’s two largest Catholic health systems, Ascension and Trinity Health, teaming with Michigan Medicine, chose to work “together” to improve population health. Their shared goals are increasingly aligned. And, by collaborating with physician practices and physician organizations, these independent institutions have created a team that is reshaping how health and care are delivered in Michigan.
Success in a health ecosystem that is shifting rapidly relies on pooling knowledge and sharing resources. Clinically integrated networks, like Together Health Network, offer providers and patients a unique advantage: patient-focused, high-quality care that is timely, effective, and efficient, enabled by care coordination and performance improvement.
Stacey Duncan-Jackson, RN, MPA
Director Population Health, Together Health Network