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Do Integrated Health Systems Fit the Future?

by Scott MacStravic

There have been many renowned healthcare experts who have recommended integrated health systems (ISHs), combining hospitals and medical groups, as the best way to deliver health care.  With the current push for health information technology, for example, ISHs are more likely to be able to afford the investments necessary to create and maintain state-of-the-art information, as well as medical care technologies.  They can offer a coordinated source of care meeting almost all of a population’s healthcare needs, and ensure continuity of care over time.

Some of the largest and most successful healthcare providers are IHS, such as Kaiser Permanente, Group Health Cooperative of Puget Sound, and Geisinger Clinic in Pennsylvania, all of which offer HMO health insurance along with integrated care.  Perhaps the most widely known health care “brand” in the world, the Mayo Clinic, is an IHS, with multiple national locations, though no HMO plan, as is true for the Cleveland Clinic as well.

Academic medical centers famous across the world, such as Johns Hopkins, Harvard Medical School and its associated teaching hospitals, are IHSs, combining research and education with their top-notch medical care.  Such systems typically enjoy levels of prestige, market share, and a range of services that enable them to command more generous relationships with health insurance plans, as well as international markets that bolster their national patient draw.

But the relationship between hospitals and physicians has always been a somewhat stormy one, with physicians resenting the diminished power and influence, and often earning power when they are part of an IHS.  Physicians throughout the country have been splitting away from dependence on the community general hospitals where they were members of medical staffs to create their own specialty hospitals and ambulatory surgery centers, and refusing to provide coverage for medical emergencies without substantial income to make it worthwhile.

A recent attempt by Carilion Health System to become an IHS has run into difficulties as dozens of physicians on its medical staff have split from the Carilion Clinic system.  Some have praised the development for stimulating competition in the area, predicted to benefit both patients and payers, calling the development both ugly and beautiful. [“Carilion’s Conversion to a Clinic Heats Up the Market”, ModernHealthcare.com June 18, 2007]

Many healthcare experts have expressed preference for an employment model for physicians, one that would not promote unnecessary provision of services in order to generate added revenue, but focus exclusively on what is best for each patient.  Such a model could reduce the incentives for increasing the number of “procedures” prescribed for and given to patients.  It could even reduce the emphasis on reactive sickness care and promote preventive and proactive health care, arguably better for all stakeholders involved.

The IHS model proposed by Carilion Health System’s CEO a year ago envisions the creation of a new medical school, in partnership with Virginia Tech, which would emphasize research, and promote economic development in the area.  Critics have countered with charges that physicians will lose their independence and personal ties with patients, while patients will be forced to choose other physicians as they split from the new IHS. And by stifling competition, the development could increase the costs of healthcare to local businesses. [“Physician-Based Conversion a Losing Strategy at Carilion”, ModernHealthcare.com June 18, 2007]

Of course, the split between the IHS and dozens of its physicians could also increase the costs of care, as independent practices have to invest their own money to build information and care technology infrastructures that would duplicate what the system already has.  And new physicians are being recruited to replace defecting physicians, who will also have to generate enough revenue to survive.  Moreover, since the new recruits are almost entirely reactive sickness care specialists, this development will necessarily challenge any attempt to increase the proactive/preventive emphasis that most payers are pushing for in healthcare.

The concept of an integrated partnership between hospitals and physicians with a major focus on prevention and proactive health management – to reduce sickness care costs and promote higher worker productivity – has already been promoted by U.S. Preventive Medicine, Inc. in McKinney Texas, with a combination of Centers for Preventive Medicine collaborations aimed at consumers and a Prevention Plan aimed at employers.  The IHS model is well-suited for both, since it combines the comprehensive early detection diagnostic technologies and paraprofessional staff capabilities of hospitals with the personal trusted relationship that patients have with their own physicians.  It would be a shame if battles over who’s in charge scuttled such models as the potential sources of a different kind of medical care, rather than just a different kind of management.


  truthman wrote @ June 20th, 2007 at 5:47 pm

A little off topic, but i wanted to highlight the damage of psycotropic drugs after long term use and was wondering what your view on this is and how should the medical profession deal with it?

Drus such as Paxil are particularly notorious…

I have been documenting the Seroxat/Paxil medical fraud for some time now and it it really quite shocking how dangerosu these drugs can be…

[…] Do Integrated Health Systems Fit the Future? World Health Care Blog, June 20, 2007 […]

  Francisco Lupiáñez wrote @ June 22nd, 2007 at 3:34 pm

Do Integrated Health Systems Fit the Future? I miss ICT in your key question and in your explanation. Don’t you think that ICT are essential as far as those technologies support networks and allow the coordination of the information among all the actors and institutions?

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