Clinical Integration and Pay-for-Value

Managing the health of populations depends on access to accurate, timely, actionable information about the population, and a well-coordinated response by an integrated team of care givers and providers. Starling is working with the health plans to understand the data that can be gleaned from claims. However, the best source of information is our own medical record- enhanced to include information from health plans, providers outside Starling, and patients themselves.

According to the Advisory Board, a self-described “best practices firm that uses a combination of research, technology, and consulting to improve the performance of health care organizations around the world” (also the consultant that helped plan for the creation of Starling), in a clinically integrated organization, “physicians collectively invest in IT infrastructure, such as disease registries and clinical performance management systems, as well as funding staff dedicated to performance improvement.”

The selection and implementation of an electronic health record (EHR) is the cornerstone of becoming a more fully integrated group.

Not only does a common EHR allow for the direct sharing of clinical information and with it the potential for enhanced coordination of care, it also provides a way for staff to alert providers when a patient is determined by their insurer to be “attributed” to a Starling provider in a performance-based contract.

Health plans which are prepared to pay us for better coordination of care attribute patients to Starling providers either because the patients selected one of our PCPs or because claims suggest that one of our specialists is the “captain” of a patient’s care team. It is Starling’s challenge to coordinate the care these patients receive.

In addition to the costs of an EHR, in the most successful organizations, physicians also commit “sweat equity” to improving performance—serving on committees as well as changing their day-to-day clinical practice.” These investments in technology and thought leadership are essential to our success. In my next post I’ll discuss how the healthcare environment is evolving to make these investment increasingly valuable.