The Value Journey: Aligned Integrated Systems

Aligned integrated systems with established building blocks of coordinated care delivery seem especially well positioned for a shift toward value-based payment. Their challenge is to demonstrate the value of integrated care delivery in a more transparent, value-driven environment.

An aligned integrated system has most of the following characteristics:
     • Physicians play key leadership roles on board(s) and management.
     • Organizational structure promotes coordination of care.
     • Primary care physicians are economically integrated, and their practice sites provide geographic coverage.
     • The system owns a health plan, offers single-signature contracting, or has a strategic relationship with a health plan.
     • Financial incentives within the organization are aligned.
     • Clinical and management information systems tie the elements of the system together.
     • The system has the ability to shift financial resources among its various elements.

Seven organizations representing various regions of the country and types of markets participated in interviews for this report. In terms of size, the participants’ physician base ranged from 280 physicians to more than 1,000 physicians. The number of primary care sites maintained by these organizations varied from seven to 70. With the exception of Cleveland Clinic, all of the aligned integrated systems in the cohort have their own health plans. Billings Clinic’s plan represents a small proportion of its revenue; the other organizations’ health plans generate a substantial proportion of revenue and are viewed as extremely important in the transition to value-based payment.

Physicians play key leadership roles in all systems in this cohort. A leadership structure that pairs physician leaders with administrative partners is common. Additionally, all but Spectrum Health and Group Health Cooperative have physician CEOs. All participants in this cohort are engaging physician leaders in strategic discussions and decisions.

Aligned integrated systems with established building blocks of coordinated care delivery seem especially well positioned for a shift toward value-based payment. Their challenge is to demonstrate the value of integrated care delivery in a more transparent, value-driven environment.

An aligned integrated system has most of the following characteristics:

     • Physicians play key leadership roles on board(s) and management.
     • Organizational structure promotes coordination of care.
     • Primary care physicians are economically integrated, and their practice sites provide geographic coverage.
     • The system owns a health plan, offers single-signature contracting, or has a strategic relationship with a health plan.
     • Financial incentives within the organization are aligned.
     • Clinical and management information systems tie the elements of the system together.
     • The system has the ability to shift financial resources among its various elements.

Seven organizations representing various regions of the country and types of markets participated in interviews for this report. In terms of size, the participants’ physician base ranged from 280 physicians to more than 1,000 physicians. The number of primary care sites maintained by these organizations varied from seven to 70. With the exception of Cleveland Clinic, all of the aligned integrated systems in the cohort have their own health plans. Billings Clinic’s plan represents a small proportion of its revenue; the other organizations’ health plans generate a substantial proportion of revenue and are viewed as extremely important in the transition to value-based payment.

Physicians play key leadership roles in all systems in this cohort. A leadership structure that pairs physician leaders with administrative partners is common. Additionally, all but Spectrum Health and Group Health Cooperative have physician CEOs. All participants in this cohort are engaging physician leaders in strategic discussions and decisions.

Download full report >