The Four Pillars of Clinical Integration

| URAC Staff

The road to accountable care and value-based payment is a long one, chock full of obstacles along the way. But there are key checkpoints on the journey.

URAC’s Clinical Integration Accreditation standards address how to best position your organization to achieve success in a value-based economy, including governance, alignment, care coordination, and integrated infrastructure. Here are the top four things you need to know for clinical integration success:

1. Leadership and Governance
Oversight by clinical leaders is critical. This role assures provider acceptance of performance goals, compliance with all applicable federal and state laws, and promotion of evidence-based medicine. Financial sustainability and clinical transformation go hand-in-hand. At its core, the Clinically Integrated Network is market driven.

2. Organizational Alignment
Alignment starts at the top, then branches out all way to the individual patient. Business arrangements must take the consumer into consideration, organized in a way that improves healthcare quality, outcomes and costs. Providers are on the same page. Clinical and financial alignment drive the success of the network. When done right, consumers and providers both win.

3. Care Coordination
Care coordination is the job of every member of the healthcare team. Streamlined care lowers costs and reduces avoidable errors. Daily, integrated collaboration supports patient-centeredness, and better population health management for chronic conditions. Clinical priorities are vital. Physicians and other providers must be at the forefront of setting the priorities, and ultimately, enforcing them.

4. Integrated Infrastructure
Demonstrating and documenting quality is essential. Information Technology systems that effectively power communication, care coordination and documentation of results allows for a strong and sustainable infrastructure. Population management and performance assessment are also key components. Networks exists along a continuum. The organization must have a plan to continue advancing toward full integration, a sign to regulators, payers, the FTC and others that performance management oversight is ongoing.

The time is now. The current market climate and previous attempts to aggregate providers in a region can skew the odds for or against the approval and acceptance of Clinically Integrated Networks. Accreditation can advance the sustainability and acceptance of Clinically Integrated Networks by using the process to solve new challenges. 

Organize systems. Align providers. Improve quality. Benefit consumers.

For more information about URAC’s Clinical Integration Accreditation, click here.

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