• Clinical Integration Supports Population Health Management

    Nov 17, 2016

    Effective population health management requires continuous integration of clinical services across providers, care settings, and medical conditions—but not necessarily an integrated delivery system under single ownership.

    “I have been continually struck by the failure to grasp that clinical integration doesn’t require full financial integration or complete administrative integration,” says Kenneth W. Kizer, MD, MPH, founding director of the Institute for Population Health Improvement at the UC Davis Health System.  

    An example Kizer knows well: the Veterans Affairs Healthcare System, which he headed during his tenure as Under Secretary for Health in the U.S. Department of Veterans Affairs from 1994 to 1999. Upon his arrival, it was unquestionably an administratively and financially integrated delivery system—but was not delivering integrated patient care.

    To address that issue, Kizer reorganized VA’s clinical care operations into regional Veterans Integrated Service Networks, which he describes as prototype accountable care organizations. He also introduced a systemwide performance management system and launched the biggest electronic health record (EHR) deployment in history as part of a turnaround of the VA system. Based on that experience, he sees the relentless consolidation of healthcare providers as sometimes distracting from the work of truly integrating clinical care.

    Kizer identifies seven core functional capabilities and characteristics required for integrated patient care, regardless of how providers are organized.a

    • Shared values and a shared vision of healthcare delivery that is both patient-centric and population health-focused
    • A governance structure that establishes goals, policies, and procedures to ensure that clinical care is coordinated across the continuum of services
    • Strong clinical leadership that promotes a culture of teamwork, collaboration, transparency, continuous improvement, and accountability throughout the organization
    • Information management resources—including an EHR, health information exchange, and clinical decision support and data analysis tools—and the human capital and administrative resources needed to use them effectively
    • Care delivered by multidisciplinary teams
    • A performance management system that defines goals, measures results, and supports continuous improvement
    • Shared financial risks and rewards for clinical outcomes

    Lola Butcher writes about healthcare business and policy topics for several HFMA publications (lola@lolabutcher.com).

    Interviewed for this article: Alan Greenglass, MD, CEO, Christiana Care Quality Partners, Newark, Del. (agreenglass@christianacare.org); David Posch, MD, executive vice president-population health, Vanderbilt University Medical Center, Nashville (David.Posch@ Vanderbilt.edu); Scott T. Roberts, MD, partner, Christiana Spine Center, Newark, Del. (scottrobertsmd@yahoo.com); Scott Eathorne, MD, president and CEO, Together Health Network, Southfield, Mich. (seathorne@togetherhealth network.org); Kenneth W. Kizer, MD, MPH, director, Institute for Population Health Improvement, UC Davis Health System, Sacramento (kwkizer@ucdavis.edu).


    Kizer, K.W., “Clinical Integration: A Cornerstone for Population Health Management,” Journal of Healthcare Management, May-June 2015.