Why all the "to do" about physician integration?

Physicians and their role in the delivery and cost of health care have been in the spotlight recently as the health care debate rages on. Much of these early discussions seemed to result from Atul Gawande’s article in the New Yorker called “The The Cost Conundrum, What a Texas town can teach us about health care” and his follow-up, “The Cost Conundrum Redux.” Gawande suggested that physician overuse and the lack of integration in the care continuum are to blame for the fact that McAllen, Texas has the highest per person Medicare costs in the country. This led to explosive debates around the country about physician liability and integration.

But health systems, clinics and other organizations dedicated to delivering care have long understood that physicians and hospitals, while sharing the same goals, may seem pitted against each other. It is for this reason that physician integration is key to success for health systems and the joint delivery of high quality, low cost care.

The following graphic shows how this integration occurs, but the boxes about the differences show why achieving that it so hard.


How might we bring hospitals and physicians together? We may implement the following strategies for change:
• Set expectations for team process
• Train and educate the team together
• Plan together
• Implement and operate together
• Performance goal setting
• A performance appraisal process
• Shared incentive for financial gain

Ultimately, however, I believe we must gather both groups around the common goal of providing high quality, low cost care using evidence-based protocols. Both groups understand that they have a sacred responsibility to care for human life, and most view this as their definitive purpose. This must be what brings us together.