"Physicians working together, systematically, with or without other organizations and professionals, to improve their collective ability to deliver high quality, safe, and valued care to their patients and communities." -Gosfield and Reinertsen (2011)"
The original Clinical Integration Self-Assessment Tool v.2.0 (CISAT) (http://uft- a.com/CISAT.pdf) was oriented around employed physicians on one hand, whether employed by hospitals or in medical groups, and hospital-centric entities, whether the organized medical staff or a newly forming accountable care organization (ACO) type of entity, on the other hand. In my recent travels around the country, though, I am finding that there are significant numbers of otherwise still independent physicians who would like to consider coming together in a clinically integrated network or affiliation without merging into a single practice entity. In order to help those physicians begin to envision what a truly clinically integrated network that will succeed in the new value-driven environment might look like, I have taken the 17 attributes that Jim Reinertsen and I set forth in v.2.0 and have postulated three scenarios for each focused around a network of otherwise independent physicians.
Even at the "committed and capable" phase, the scenarios acknowledge that there are very few networks or IPAs anywhere in the country that actually have sustained themselves with innovative contracts and so, there are few whose infrastructure manifests the characteristics set forth here. Therefore, even at the "committed and capable" level, the scenarios anticipate yet further work to be done by these organizations as new opportunities for innovative payment and recognition unfold.
As with v.2.0, the attributes cluster around the "Four F's" which we first set forth in "Achieving Clinical Integration With Highly Engaged Physicians" (http://uft- a.com/PDF/ACI-fnl-11-29.pdf).
Also as with v.2.0, we would welcome refinements to this document. I am sure that we have not hit on all of the issues and challenges that physician networks will confront to position themselves for a new future. We would welcome comments from the field. Finally, I would like to thank Jim for his comments on my initial drafting of this v.2.1.
Alice G. Gosfield, JD
January, 2012
Clinical Integration Self Assessment Tool v2.1 (Network/IPA Version) (PDF)
