Process of Professional Integration in Hospitals and Expansion of Managed Care Health Insurance

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Table of Contents

Implementation of the Integration Process
Process of Implementation
Works Cited

Physician-hospital arrangements have been found to facilitate the expansion of managed care health insurance (Cuellara and Gertlerb). It is imperative that health care organizations form strategic physician-hospital arrangements to align the interests of the physicians with that of the healthcare institutions engaging their services (Benoff and Grauman). In many of the instances because of poor implementation, the physician-hospital arrangements have not delivered the required results (Bolinger).

However, in the case of MaineHealth (Portland, ME) a Clinical Integration and Community Health Improvement organization a perfect integration has resulted in profound success in extending services to the community. The ranking of the hospital has been increasing consecutively. Through a survey, the institution has been recognized as one of the best performers in the healthcare industry by a healthcare data and services information-consulting firm – Verispan.

MaineHealth has been placed at rank 40 out of the 580 healthcare organizations assessed by the annual survey in terms of operations, quality, scope of service, and efficiency in operations. The consulting firm lists the top 100 healthcare organizations chosen based on the different criteria. The organization has improved its position from 86 last year, to 40 this year (MaineHealth).

Implementation of the Integration Process

The institution could enhance its performance to this level based on two initiatives followed by the physicians and other healthcare professionals attached to the hospital. These initiatives were in the areas of clinical integration and community health improvement. In the clinical integration process, a team of physicians and associated healthcare professionals formulate a framework of best practices that can be adopted as best practices for the delivery of healthcare services to patients.

On completely verifying the suitability and benefits of such practices, these practices are put into operation through several healthcare settings including the offices of the physicians. Similar integration efforts are followed in respect of community health improvements, In the case of community health improvements, the practices pertaining to the treatment of particular ailments like asthma, diabetes, and other diseases to which the community is often subjected.

Process of Implementation

The hospital followed the process of integrating the clinical services and community improvement programs in a unique way. The organization formed a Clinical Integration Division, which was made responsible for the implementation of the integration process. The team consisted of a group of clinicians and members from the management team, which is called a Steering Committee. This process was undertaken based on the observation for several years of the best practices in the industry and scrutinizing the actions of governing boards and several committees having thorough professional background and experience.

The function of the Steering Committee was the development of process plans, identifying the integration initiatives beneficial to the organization, and overseeing the actions of many other teams involved in the implementation of integration initiatives. Physicians, administrators, nurses, Compliance and Information Services Specialists, and other pare-professionals took part as members of the Clinical Integration Steering Committee. The main functions of the Committee are:

developing clinical process plans for implementation,
forming the required work teams and approving leadership and membership for such teams,
reviewing and approving the plans for the functioning of the teams,
setting the goals and performance outcome measures for the teams and monitor the actual performances of the work teams.

The Clinical Integration Steering Committee through its efforts has changed the scope and nature of the clinical and other services provided by the hospital and this has helped it to increase its ranking at the national level (MaineHealth, Clinical Integration Steering Committees).

Works Cited

Benoff, M and D M Grauman. “Mastering the physician integration challenge.” Healthcare Financial Management (1997).

Bolinger, J E. “Effective physician integration strategy.” Healthcare Strategic Management (1999).

Cuellara, A E and P J Gertlerb. “Strategic integration of hospitals and physicians.” Journal of Health Economics 25.1 (2006): 1-28.

MaineHealth. Clinical Integration Steering Committees. 2009. Web.

—. MaineHealth Named among Nation’s Top 40 Integrated Health Networks. 2009. Web.

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Process of Professional Integration in Hospitals and Expansion of Managed Care Health Insurance

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