Lisa Farren (Host): Hello everyone, and welcome to Crushing Healthcare, where we explore diverse perspectives regarding the state of healthcare today, and gutsy visions for a more affordable, accessible, equitable, and sustainable healthcare model. My name is Lisa Farren. I'm going to be your host today, and we'll be diving into the concept of clinical integration.

As healthcare consumers, we all touch the healthcare system in one way or another, perhaps as patients receiving care or maybe accompanying a loved one to their appointments. And as we interact with the healthcare system, there are certain words that often come up, many of which we may not be familiar or fully understand.

Information is key. Regardless of who we are, the better we understand our healthcare system, the better equipped we are to ask the right questions, make informed decisions, as we aim to receive the best care possible. So when thinking about clinical integration, what it means for patients and for providers, our guests today are leaders in this area.

I'm excited and honored to welcome today's guests. Spearheading the discussion are two physicians, George Beauregard, DO, and Jim Uberti, MD, both from Southern New England Healthcare, also known as SoNE Health. Dr. Beauregard is the Chief Population Health Officer at SoNE, a clinically integrated network that provides population health management support to its network providers.

In his role, Dr. Beauregard leads SoNE's extensive population health programs, performance improvement, clinical integration, and health equity. His clinical experience in internal medicine spanned more than 20 years in the Boston market, and he also served as Senior VP for Value Based Care and Chief Physician Executive at Catholic Health Physician Partners in Long Island, leading the organization's strategic and clinical initiatives toward a transition to value based care delivery and payment models. Working closely with Dr. Beauregard at SoNE is Dr. Uberti. As SoNE's Medical Director, Dr. Uberti provides leadership to advanced SoNE's population health programs with a focus on clinical integration and performance improvement to optimize clinical outcomes. Dr. Uberti is a recognized leader and advocate for value based care.

His career as a primary care internist spans more than 30 years in the Greater Waterbury Connecticut market. Prior to joining SoNE, Dr. Uberti served in a variety of roles, including partner in a primary care medical practice and Medical Director at Valley Health Alliance. So with that, hello and welcome, Dr. Beauregard and Dr. Uberti. We're looking forward to today's discussion.

James G. Uberti, MD, MPH: Good morning, Lisa.

George Beauregard, DO: Morning, Lisa.

Host: Awesome. So, you know what? Let's dive in and start at the beginning. In layman terms, man on the street terms, if you will, can you explain what is a clinically integrated network?

George Beauregard, DO: The American Medical Association describes clinical integration as the means to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, and patient focused.

It's influence on patient care aside, it's also a construct that allows groups of physicians, like SoNE HealthCare, to negotiate with payers, and not risk those negotiations being characterized as collective bargaining. So there's a clinical aspect to that, a very positive one. And there's also a business aspect to it that's also very positive.

Host: Wow. Interesting. All right. So, from your perspective as physicians, I'm curious, can you explain why is clinical integration important to you as a physician and, or other providers?

James G. Uberti, MD, MPH: So, to answer that question, Lisa, I think we have to look at where we've been and where we are now, frankly. And over many years, healthcare delivery has become more episodic and fragmented. A patient over the course of a year may have few or many encounters with their PCP, specialist, may be seen in an ED, may be hospitalized. May use other facilities or ancillary services, but it's all happening in individual silos. And there's been further disengagement of community providers from the hospitals and specialist colleagues. As you know, we're in the age of hospitalists and intensivists and many community PCPs like myself have not set foot in a hospital for many years.

And it was in the hospital hallways that we had collegial discussions with our hospital based specialist or community based specialist. That doesn't happen anymore. There's also been challenges with access, because providers have been compensated primarily for increased volume. And to do that, they would put a lot of patients into their schedules and it leads to less outside contact with other care deliverers.

So inevitably, this has led to less cost efficiency, unnecessary or duplicative testing, and frankly, numerous surveys have shown less satisfaction for patients and for providers. So clinical integration highlights coordinated, collaborative care across a continuum of care rather than isolated episodes of care.

And that includes primary care, specialists, healthcare systems and their hospitals, outpatient facilities, and even ancillary services like physical therapy, for example. So, when providers can join together in a clinically integrated network, that allows them to do value based contracting, where they're compensated less for volume and more for quality, outcomes, and cost efficiency.

In addition, they acquire the supportive capabilities for team based models of care. Individual practices really don't have the wherewithal, financially or otherwise, to do it on their own. A clinically integrated network allows them to do that. The bottom line is Docs, providers of all types, get to spend more time with their patients, to listen and collaborate with their patients, and that's increasingly satisfying for the providers.

And all this enhanced information and coordination of care, allows information sharing, it allows assurance that the patient's being taken care of between the episodes of care with that provider, and that we're all sharing our best evidence based practices.

Host: Thanks for that explanation. I think, many patients really don't even realize the complexity of you as a provider, a physician, and the interaction and or lack of interaction with other providers, serving and caring for that patient. So, that's really interesting and important, clearly. So, I heard the term population health mentioned earlier.

 How does clinical integration fit in from the POP health perspective?

George Beauregard, DO: Historically, many aspects of health care delivery by primary care physicians and specialty care physicians, practices and hospitals, has happened in silos, where there has not been a lot of information sharing between those different providers of healthcare.

And the result of that is that fragmented, siloed care results in an incomplete understanding of the total clinical picture of that particular patient, which can then lead to duplicative testing, unnecessary testing, and the like. So in population health, the seamless collaboration, the knowledge sharing, and the multidisciplinary and interdisciplinary processes, as well as some other components of a clinically integrated network, lend well to achieving success in a population health management program.

Host: So I want to back up a little because I think many of the people listening, and really everyone listening at some point has touched the healthcare system as a patient. for those who aren't clinicians, physicians, other providers, we can relate from the patient perspective. So can you shed some light on how clinical integration is important to patients?

James G. Uberti, MD, MPH: Obviously, clinical integration is just medical jargon to a patient. They don't have the definition that Dr. Beauregard provided, for example, but they'll experience it. And so first of all, they'l really pick up on the fact there's an increased focus on prevention.

Dr. Beauregard and I talk about getting upstream of disease and dealing with preventive issues so we don't see disease downstream. The patient will get to spend more time with their PCP because they are now the central focus of a team based approach. There's certainly increased coordination and collaboration and transparency. And this amongst the multiple touches that the patient might have with a primary care provider, specialist, with care management, with pharmacists and others.

Essentially, they will be receiving the right care, in the right setting, and at the right time. Certainly, there should be less error risk when there's better coordination, and therefore increased safety for the patient. Medication management, for example, is an example of where there's been a lot of fairly high error rate over the years.

With PharmDs and others involved, and medications being adjudicated and making sure that they're consistent from office visit to office visit; we reduce those errors. There will certainly be a decrease in necessary and duplicative services and therefore more cost efficiency. All of this will lead to decreased visits to the emergency room and fewer hospitalizations for a patient.

Essentially this is a holistic approach and holistic approach will result in increased patient satisfaction. What I want to do is have Dr. Beauregard give an example, a real live example, a real world example of what clinical integration looks like to a real patient.

George Beauregard, DO: Thanks, Jim. I think a patient story here will really highlight what happens on the ground when you have a clinically integrated network and a population health management program working for patients. So I'll call the patient Donald, and Donald is a widowed 72 year old male who lives alone in senior housing complex and has many chronic medical conditions, including adult onset diabetes, advanced arthritis of his knees that limits his ability to walk, obesity and depression.

Donald is on multiple medications, that he doesn't understand and often confuse him, which results in his frequently not taking them. Access to his primary care physician is limited, and Donald is not technology savvy or patient portal savvy, so he has difficulty communicating with the office as needed.

His daughter is his primary caregiver, but she's overwhelmed by her personal and work life and also has difficulty managing a complex healthcare delivery system. His primary care physician referred him to the population health team. Over time, a nurse care manager helped Donald better manage his multiple illnesses. He gained more confidence in self management and also in terms of scheduling and keeping appointments. A pharmacist helped him understand all of his different medications and arranged home delivery of them. So getting his medications was no longer an issue. For his depression, Donald was referred to a behavioral health specialist.

A community health worker helped him obtain transportation when his daughter was unavailable to bring him to his medical appointments. That health worker also arranged meals on wheels, for when his daughter couldn't provide the meals for him. She procured a walker for him to help him with his walking difficulties from the arthritis.

Nutrition counseling, so he could eat healthier and perhaps start losing some weight. And she also made sure that Donald got a flu shot. So there's a real life story of what all the different components of population health being delivered by a clinically integrated network, how it can really benefit what is a rather typical scenario of an American male.

Host: That's a great story. It really demonstrates how clinical integration wraps around the patient in all ways. And not just the patient, but even as you mentioned, Donald's daughter, who was part of his care to really make sure that all of his needs are met and addressing it for a holistic approach. So good example. Thank you.

James G. Uberti, MD, MPH: That's the holistic approach. That's a great example. We'll conclude by talking about, you know, years ago the Institute for Healthcare Improvement published something called the Triple Aim. And they all had these fancy graphic triangles, one side was the individual experience of care, another side was improving the health of populations and groups within those populations, and the third part was decreasing the per capita cost of healthcare.

Over the years, they made that the quadruple aim, acknowledging the importance of enhancing provider satisfaction, essentially their increased joy in their work. So, clinical integration allows for and promotes preventative and proactive care, which enhances the experience and satisfaction of individual patients, managing chronic illness and improving the care of populations and communities with cost efficiency.

And this is the healthcare delivery paradigm that is satisfying to providers. So essentially, clinical integration is making the quadruple aim a reality.

Host: Nicely said. That's great. The team approach and from what I get out of this is the team approach includes the patient as well. Patient is part of the team, it sounds, informing a strong patient provider relationship. So that's awesome. Maybe today's takeaway is for those who haven't visited their PCP recently, that they should make an appointment.

Well, thank you, Dr. Beauregard, Dr. Uberti, thanks so much for sharing your expertise today, I think it was really great education for all of us. As I said, we all touch the healthcare system, so the more informed we are, the better decisions we can make. Thank you so much, and thanks for everyone for joining us today.

I invite you to help us as we look to Crush Healthcare.