International: Greater Rochester, New York, United States
Geography type: Mixed urban/rural
Population covered: Not provided.
Professional group/type of organisation involved e.g. acute, CAMHS, voluntary sector, primary care
Around 800 member physicians serving a mixed urban/rural population in upstate New York. The doctors mainly work in small, independent practices, like GP practices in England but, unlike the UK, include specialists as well as primary care doctors.
Details of initiative
GRIPA’s clinical integration work started when it was prevented from negotiating with insurers on behalf of its members unless it met the characteristics set by the Federal Trade Commission (FTC) of a ‘clinically integrated system’. In order to comply with this definition, GRIPA used the improvement tools and processes that it had established during the previous decade to support ‘risk contracting’. This is where it received an annual sum per patient to provide full care, dividing any savings made between member doctors. GRIPA received FTC approval as a ‘clinically integrated’ organisation in 2007. Since then, GRIPA has implemented a clinical integration programme to improve and standardise the quality of care provided by the Independent Practice Association’s member doctors.
For the patients of GRIPA’s member doctors, clinical integration has resulted in more standardised care, since participating doctors work to shared, evidence-based clinical standards and actively seek to address gaps in care for each patient. For those patients with complex health problems, GRIPA’s case managers work to coordinate care from different providers and avoid the duplication and confusion that is often associated with transfers between services.
The clinical information system used to support clinical integration allows clinicians to share information between generalists and specialists. This has permitted new forms of virtual consultation in which the patient may not need to be physically present in the clinic.
Type of integration (vertical, horizontal, population)
Vertical integration between generalists and specialists.
Challenges, successes, lessons learned and advice
Enablers of integration:
- Development of a web-based clinical portal accessible to clinicians and patients, and a central data repository to synthesise and analyse clinical data
- Tools such as point-of-care alerts to support and prompt best clinical practice
- Governance and incentive arrangements to support clinical practice, in line with agreed guidelines and pathways
- Respected medical leaders and a high trust in GRIPA that is based on its past track record of delivery
- Multi-professional team supporting care coordination, case management and pharmacy management
Challenges to successful integration:
- Time and resources needed for Federal Trade Commission approval
- Benefits to doctors are limited until at-risk clinical integration contracts have been negotiated with insurers and employers
Cost benefit information
Information taken from a report by the Nuffield Trust, (2011)