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Clinical Integration Accreditation Transformation: A URAC Case Study

Friday, December 4th, 2015

When the leadership of St. Vincent’s Health Partners (SVHP) sought to develop their clinically integrated network, they contacted URAC for help in building a stable organization that could be more effective in its delivery of care while avoiding the risk of violating antitrust laws.

Accreditation helped St. Vincent’s to do exactly that.

A new case study – available now through the URAC website – details the goals, methods, and results involving the Bridgeport, Connecticut-based SVHP as it became the first organization to receive URAC’s clinical integration accreditation.

Commenting on URAC’s clinical integration accreditation program, the first of its kind, SVHP Chief Medical Officer Dr. Michael Hunt said: “We chose the URAC accreditation program because it aligned most closely with the FTC’s guidance. It allows us to operationalize the concept of clinical integration and prove to our state leaders at large that we are aware of what it takes to be a clinically integrated network.”

Even though it is a critical step in the transition toward more value-based care because it builds toward the assumption of financial risk, there is inherent risk that a clinically integrated network could be cited by the government for engaging in anti-competitive practices. This concerns providers considering clinical integration, and it actually happened not far from SVHP in Danbury, Connecticut in 1996. Keeping this potential pitfall in mind, SVHP leaders knew they needed to follow a plan that created a strong foundation for their network, safeguarded its physicians and facilities, and met state and federal antitrust guidelines.

URAC clinical integration accreditation standards, which SVHP leaders closely adhered to in developing their organization, are deeply rooted in the four recognized “pillars” that are considered necessary for sound network structure:

  • Strong leadership and governance
  • Organizational alignment
  • Care coordination
  • Integrated infrastructure (particularly information-sharing)

In the process of achieving their accreditation, the network developed its own innovative approaches to care delivery. This includes “The Playbook” – SVHP’s authoritative reference manual for care coordination and best practices. This manual and more are described in greater detail in the URAC case study.

Commenting on how the accreditation process aided SVHP in building its clinical integration network, St. Vincent’s President and CEO Dr. Thomas A. Raskauskas said: “We’ve been able to transform our hospital and physician partners into a cohesive organization that benefits from clinical integration in a way that surprises our network of providers.”

To download a copy of URAC’s St. Vincent’s Health Partners clinical integration accreditation case study, click here.

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