Integrated Health Care Delivery Systems' Challenges

There are more than 850 integrated health care delivery systems in the United States today, and they face many unique challenges and loss exposures. In our experience, it makes sense that one insurer would  manage both the hospital and the physician group better than two insurers.  Theoretically, two insurance defense companies could be at ‘odds’ conflicts of interest and different purposes and priorities would define the medical malpractice defense process.   The  integrated group would benefit from one unified defense, the physicians, the allied healthcare and technician staff as well as the hospital admissions, staff and owners would be on the same page.

The Doctors’ Company has an active Integrated Delivery System department, with experienced underwriters, dedicated to patient safety representatives bringing specialized services to these models of HCO’s…claims managers dedicated to this type of business model and underwriters closely reviewing the unique practice profile of integrated delivery models to look for opportunities to consolidate, reduce premium redundancies.

Given the size and focus of The Doctors’ Company, it is  particularly true that one Carrier can do both of these specialized jobs of preventing, mitigating and defending the loss of professional liability claims against hospitals, facilities and physicians.    The Doctors’ Company is the nation’s largest physician owned medical malpractice insurance company. Recently, we partnered through acquisition with Ohio Hospital Insurance Company.  We now have the insight of strictly hospital professional liability insurance combined with our years and breadth of experience providing physician medical malpractice insurance.  The Doctors’ Company goes beyond defending g and paying for the costs associated with the claim.  This is such a competitive time in this business, we have to bring more knowledge and price.  These are just one year contracts.  If we are going to earn a long term relationship with our insureds, we need to invest in understanding the risk, and bring those lessons to our insureds.  The Doctors’ Company, Professional Liability Insurance is investing in training lawyers and junior members in law firms to learn about the process of a claim; we are teaching the ‘second chair attorneys’ to come along to become the next leaders in the industry.  Additionally, we are investing in teaching our physicians about the realities, at times harsh realities of the claim.  We host litigation retreats to walk them through every step along the way of a claim, from initial reporting to the very  personal experience of being cross examined and questioned about your medical judgment and records.  

There are close to 850 integrated health care delivery systems (IDS)s  in the United States today. Currently, most systems are considered to be in an evolving state of integration as they attempt to provide a full continuum of services in a user-friendly, one-stop-shopping environment that eliminates costly intermediaries, promotes wellness, and improves health outcomes.

On the positive side of the Integrated model, There are some signs of the strengthening integration with strong physician-hospital links, coordinated systems of care, geographic partnerships and central administration.  There are contractual capabilities, utilization controls, financial economies and organized oversight. However, An honest evaluation of just how integrated each component of a system is will determine the strategies necessary to contain its risks. Recently, The Doctors’ Company Patient Safety completed a study of the exercises within a spread out organization like this that needs to be completed in order to change the culture from separate, solo groups to one integrated model.  The typically large size of organizations, the geographical distances and structural differences among components, cultural managerial differences, the differences in services and staff involved create formidable challenges to those responsible for risk management.

Skeptics have questioned the value of many integration efforts. The financial performance of hospitals affiliated with systems suggests only small gains in many instances. Proponents believe that attention to community health needs has improved but that new risks have been created as health care providers' roles and degrees of authority have changed.  At times, access to health care has been reduced, and providers' freedom of choice has been restricted. The Doctors’ Company may see a rise in the number of claims alleging delayed diagnosis or failure to properly and timely refer in systems like this..  As a result, there are new avenues for potential errors and litigation to occur.  From a risk management perspective, the challenge within the IDS is to institute an integrated risk management plan. A good starting point in the risk assessment of an IDS is to be familiar with determinants of their success. For an IDS to be and remain successful, several actions must be taken by IDS leaders. Specifically, they should be engaging in the following strategies.

  • Identifying and aligning the key economic initiatives and incentives of the participating provider organizations
  • Expanding upon health system choices available to consumers
  • Partnering with inpatient and ambulatory care support services
  • Managing patients' care along a continuum versus treating episodic illnesses
  • Providing strong operational management
  • Recruiting physician leaders
  • Identifying and resolving culture clashes
  • Analyzing financial integrity

As gaps in the potential for success are noted, adjustments in the integrated delivery system can be made,

The Doctors’ Company can work with our physician groups and hospitals to bolster weaknesses.  It is imperative that the risk manager is provided with the authority to effect change and that he or she is fully supported by the board of directors, top administration, and medical leadership of the IDS. Recognition of the risk manager's authority should be stated clearly in a formal, written statement that supports the quality initiatives of the organization and that is circulated throughout the IDS.

While all of the above activities are critical for the success of the IDS and the containment of risks, every integrated system of hospitals and physician group needs to work toward physician support, financial integrity, and information exchange.  We are continuing our efforts in this goal of providing the risk management and claims management services necessary to reduce the premiums where indicated and increase the services where the risk warrants it.

The Doctors’ Insurance Agency, The Doctors’ Company and our partnership of specialty Carriers can bring the array of insurance products necessary to insure and insulate the physicians leading these organizations.

 

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