Clinical integration can be defined as the implementation of, the correlation of patient welfare along with conditions, providers, settings, and time so as to realize care that is safe, time-conscious, effectual, structured, equitable, and patient-oriented. The belief of Clinical Integration is to fulfill patient care experience, improve the health of the population and reduce the cost of healthcare.
Physicians and hospitals share many ideas, but their priorities are often different. It is of importance that clinical integration is based on frameworks that align aims and incentives across the whole scope of providers. Physician reimbursement is of utmost importance as a tool. There is a need for Clinically Integrated institutions to come up with an incentive plan framework that will not only boost productivity but remunerate the physicians’ work to attain shared goals in care, quality and cost control.
The compensation framework is not sufficient to guarantee optimum performance. Institutions need to form support structures to aid physicians to comprehend and work to achieve production goals:
- Come up with a plan for communication techniques and choices to the entire organization.
- Assign staff and resources to physician education and office staff training.
- Develop a provider scorecard that keeps physicians oriented toward improving clinical outcomes and controlling costs.
Supporting these endeavors, pioneers need to fabricate a monetary foundation to direct by and large dynamic. One key need is to build up a hazard-based cost model that joins tolerant consideration expenses to mediations and quality results. Account pioneers will likewise need to start drawing in with payors to investigate and arrange chance-based agreements and build up a doctor execution impetus support. (Helmers & Harper, 2019)
ORGANIZATIONAL CULTURE CHANGES
Organizational culture change according to the case study is what Clinical Integration entails. It brings about the idea of administrative and medical personnel working as a team to carry out as system collecting, safe-keeping, and making retrievable elaborative medical information on each patient and then examining the information on all the patients so as to form protocols that aid medical providers to establish the appropriate medical solutions for each patient and increase efficiencies.
In as much as organizational culture change does not require anyone to follow protocols to the latter, it was criticized and termed a Taylorist system. This is because it was seen as a hindrance towards the independence that people practicing medicine had. But according to James, organizational culture change would bring about the interdependence between physicians and the healthcare team. While many physicians allied to Intermountain Health Care were ready to give a shot at Clinical Integration the big elephant was how to convince the non- employee physicians to join the bandwagon.
By mid-2002, five of the Clinical Programs ( CV, Neuromusculoskeletal, Women & Newborn, Oncology, and Primary Care) were already running; the remaining four would be in line by 2007. Four out of 500 conditions ( acute myocardial infraction, bronchitis, CAP, and total hip replacement) in the Patient Care Management Strategy were active, although on paper. The IT department hoped to have 35 conditions charted by end of 2002 and 75 by end of 2003. James realized it would take at least ten years to fully put up clinical management structure and get all components of Clinical integration working; however, equally important was how long it would get the physicians to accept and support the concept. He reiterated on how Deming once a lecturer said that if you want to convert the culture of an organization that contains n people you start by converting the square root of the number n.
DR JAMES\OVERALL STRATEGY AND HIS SHORT-TERM SUCCESS
Dr. James’ overall strategy was to use Dr. Deming’s “crazy” idea: higher quality could lead to lower cost as the basis of his investigation on how to bring to life Clinical Integration. He tested the idea of pre-existing IHC clinical-trials. This was achieved by adding cost outcomes to traditional clinical trials. James and Stat built an activity-based cost accounting system and implemented that on all facilities in the IHC system. He was able to assign costs to individual clinical activities and come up with a cost profile of different strategies for managing a specific clinical condition.
One of the short term success that Dr. James achieved was finding out that 62 out of 600clinical work processes made up 93% of inpatient clinical volume and about 30 processes comprised about 85% of outpatient clinical volume. In 1996, the strategic plan “Clinical Integration” was approved by the IHC board of trustees. Its goal was to realize quality as IHC’s major business approach and extend full management accountability. The plan rolled out over the next four years. In 1997 Burton and James tested whether it was practical to build clinical-outcomes-tracking data systems. In 1998 they began to use outcomes data. In 1999 they aligned financial incentives. They also came up with techniques to retain part of the savings generated by clinical improvement to the payers.
IMPACT OF COVID
Prevention and treatment services for non-communicable diseases (NCDs) have been severely disrupted since the COVID-19 pandemic began, according to a WHO survey. The survey, which was completed by 155 countries during 3 weeks in May, confirmed that the impact is global, but that low-income countries are most affected. This situation is of significant concern because people living with NCDs are at higher risk of severe COVID-19-related illness and death.”The results of this survey confirm what we have been hearing from countries for a number of weeks now,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Many people who need treatment for diseases like cancer, cardiovascular disease and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19.”
The main finding is that health services have been partially or completely disrupted in many countries. More than half (53%) of the countries surveyed have partially or completely disrupted services for hypertension treatment; 49% for treatment for diabetes and diabetes-related complications; 42% for cancer treatment, and 31% for cardiovascular emergencies. Rehabilitation services have been disrupted in almost two-thirds (63%) of countries, even though rehabilitation is key to a healthy recovery following a severe illness from COVID-19.
In the majority (94%) of countries responding, the ministry of health staff working in the area of NCDs were partially or fully reassigned to support COVID-19.
The postponement of public screening programs (for example for breast and cervical cancer) was also widespread, reported by more than 50% of countries. This was consistent with initial WHO recommendations to minimize non-urgent facility-based care whilst tackling the pandemic. (M & LN, 2020)
But the most common reasons for discontinuing or reducing services were cancellations of planned treatments, a decrease in public transport available and a lack of staff because health workers had been reassigned to support COVID19 services. In one in five countries (20%) reporting disruptions, one of the main reasons for discontinuing services was a shortage of medicines, diagnostics and other technologies.
Unsurprisingly, there appears to be a correlation between levels of disruption to services for treating NCDs and the evolution of the COVID-19 outbreak in a country. Services become increasingly disrupted as a country moves from sporadic cases to community transmission of the coronavirus.
Globally, two-thirds of countries reported that they had included NCD services in their national COVID-19 preparedness and response plans; 72% of high-income countries reported inclusion compared to 42% of low-income countries. Services to address cardiovascular disease, cancer, diabetes and chronic respiratory disease were the most frequently included. Dental services, rehabilitation and tobacco cessation activities were not as widely included in response plans according to country reports. Seventeen percent of countries reporting have started to allocate additional funding from the government budget to include the provision of NCD services in their national COVID-19 plan. (POLAT, 2020)
WHO recommends member states provide universal access to public hand hygiene stations and making their use obligatory on entering and leaving any public or private commercial building and any public transport facility. It is also recommended that healthcare facilities improve access to and practice of hand hygiene. The other regulation is to wear masks such as surgical ones which do not allow transmission of saliva while sneezing or talking so as to prevent the spread of the virus. It is also advisable not to hug, kiss or shake hands as those are the major ways of transmitting the disease.
Masks should be provided to all citizens for free this is because no one should benefit from an outbreak such as this one. All citizens should be treated equally in medical institutions this is because it has been reported that people are being racially discriminated when it comes to treatment. The government should hire more health workers as it is becoming more pressuring to the current number of health workers to treat patients. The government need to support medical research entities so as to realize the conception of a vaccine quickly in conjunction with other countries. (Lauriault, 2020)