Best Practices for Evaluating Clinical Strategy

Truly successful integration and coordination of clinical care is essential to bridging the gap between the quality of care the U.S. healthcare system is capable of achieving and the quality of care it delivers. To bridge this gap, healthcare providers must continue to transform the way they approach healthcare delivery—then measure, innovate, refine and measure again to ensure they’re having a maximum impact on the populations and key stakeholders served.

It’s an extraordinarily complex logistical challenge, but breaking it down into three major steps can help providers navigate the process.

Assess Capabilities Along the Continuum

To move toward more fully integrated models of care, hospitals and health systems must first understand where they are on the continuum of integration. An analysis of the community’s healthcare needs, completed within the context of the hospital or health system’s responsibility to serve them, should be three-pronged and include:
  • Community outreach to truly understand the population’s current and future needs
  • An evaluation of the coordination of care across settings to determine where elements of the healthcare system are still operating in isolation and identify opportunities for better coordination across silos
  • An assessment of current patient access points to ensure the necessary ambulatory, primary care, and home health and chronic disease management services are established to promote healthy behavior and reduce hospitalizations and emergency room visits for non-emergent and acute services
Look At Delivery Models

Healthcare leaders should next establish their hospital or health system’s long-term goals within the contexts of the capabilities assessment and healthcare reform. This goal-setting process requires healthcare leaders to first evaluate current care delivery models, looking specifically at their sustainability within the context of healthcare reform. They must then identify required future-state delivery models, considering the hospital or health system’s desired:
  • Financial position
  • Market position
  • Drivers of innovation
  • Culture and workforce characteristics, including incentives
  • Payment and reimbursement models, and
  • Networks, partnerships and collaborations across the healthcare system
Analyze Gaps

With the analysis of both current and future state completed, healthcare leaders should proceed to identifying gaps in their desired future-state delivery models. This gap analysis process will inform the critical next step: creating a roadmap to guide implementation and transformation toward future-state delivery models, starting at the desired future state and working backwards.

This roadmap should not only address clinical integration within the hospital, but also areas including:
  • Cost structure, which must be fully aligned with the long-term vision and future strategy of the hospital or health system
  • Information technology infrastructure, which is critical to delivering fully coordinated, quality care, given the information sharing and data analytics new technology platforms enable
  • Physician engagement, which is crucial as the core of this transformation must be clinical and therefore physician-led
  • Clinical guidelines to help caregivers assess their effectiveness in delivering appropriate, quality care
  • Performance and quality metrics that are standardized across providers to ensure alignment with long-term objectives
  • Legal and regulatory considerations, which must be addressed when moving toward more fully integrated care models. These include antitrust and anti-kickback laws and IRS provisions regarding tax-exempt organizations, among others.
  • The full continuum of care, which must be coordinated between inpatient, ambulatory and post-acute providers
While the transformation of clinical strategy and care models is among the most urgent needs facing healthcare providers today, it is critical that, during the implementation process, healthcare organizations continue to also focus on their day-to-day operations. This will ensure they do not lose any gains that have been made in terms of the transition period, cost structure alignment and performance improvement. Often this can be accomplished by having dedicated resources to help drive the required changes, while other resources focus solely on day-to-day operations.