Organizational Development for Health Care

This article discusses the concept of an integrated physician model, importance of clinical integration in the strategic planning process, dynamics and controversies surrounding ACOs, and advantage and disadvantage of the equity based joint ventures in health care. It also highlights the benefits and challenges of each model and provides insights into the changing dynamics of the US healthcare system.

Running head: ORGANIZATIONAL DEVELOPMENT FOR HEALTH CARE
Organizational development for health care
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Answer 1: (Concept of an integrated physician model)
The physician-hospital alignment process has been integrated in health care system by
adaption of various models of physician integration. Integrated physician model has been
developed after series of partnership with patients and physicians over a brief time period. It is a
joint venture which is connected with each other through congruent goals. It is a value-based
business model which includes wide range of programs, contractual ventures and equity
arrangements. The main advantage of shifting to a value based-integrated physician model is that
it can enhance the likelihood of success of health care providers by offering best possible quality
and at the lowest possible cost across the continuum of care (Harrison, 2016). Hence, health
systems in US must seek to achieve hospital-physician alignment to deal with future healthcare
needs.
Answer 2: (Importance of clinical integration in the strategic planning process)
Strategic planning in health care organization is a stepwise process carried out to identify
future goals for the organization and develop appropriate pathway for decision making and
fulfillment of future goals and objective (Ginter, Duncan & Swayne, 2018). Clinical integration
is one of the important tenets of the strategic planning process that looks to bridge the hospital
and physician gap and provide a process for coordination of care between hospital and
physicians across the care continuum. The importance of clinical integration is realized in the
health care organization also because it sets put necessary process to provide high quality and
affordable care. It also enables implementing clinical practice in multiple setting which increases
the likelihood of meeting diverse health needs of patient and providing care in different setting as
per the convenience of patient (Reiss-Brennan et al., 2016). In case of U.S., the introduction of

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the Medicare is regarded as an important initiative that has facilitated clinical integration by
means of administrative task, technology and care practices. It has played a role in modifying the
health care environment and practice within the US health care system and providing better
service at an affordable and lower price. This will also address the problem of care inequities and
irregularities in the distribution of care.
McWilliams et al. (2016) also mentioned about an example of clinical integration by the
development of Accountable Care Organization (ACO). It is the most suitable example of an
effort to coordinate services across continuum of wide array care services available. ACO is a
type of care delivery and coordination model that aims to addressing the issue of fragmented care
delivery and high quality of care. The success of ACO itself is dependent on higher level of
collaboration and coordination and clinical integration is the pathway to achieve the same.
During the process of clinical integration, ACOs strive to coordinate with other health care
provider to develop standards of care and employ tool to promote compliance with the standards.
This process of clinical integration ultimately leads to transformation of health care delivery to
ACO model that focuses on leadership, governance structure as well as physician hospital
alignment to improve the quality of care.; Hence, moving towards multiple setting to deliver care
increases the prospective of quality care and increase patients experience and satisfaction with
the care received too. Harrison (2016) also supports the fact that ‘Clinical integration facilitates
access to expensive medical technology, allows for greater economies of scale’.
Answer 3: (Dynamics and controversies surrounding ACOs)
ACOs are those type of care organization in which doctors, hospitals and other care
providers come together voluntarily to coordinate and deliver care to Medicare patient. The main

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purpose of such coordination is to ensure that that right people get the right care at the right time
(Harrison, 2016). In this way, it aims to prevent duplication of services and prevent medical
errors. Hence, it can be said that ACO is a changing dynamic within the American health care
system where health care providers are responsible for financially bearing the cost and quality of
care for a defined. population group. The enactment of the Affordable Care Act was the trigger
behind the development of ACOs. It lead to the emergence of new payment models and gave
health organization the possibility to move towards sustainable and profitable organization in the
future. O’Halloran et al. (2015) justifies that ACOs are the most significant change or
transformation in the US health care system that is increasing the value of service provided by
improving patient outcomes. The U.S health care system was struggling due to lack of
standardization of care and high cost of services. Fragmented care service also resulted in
mounting medical expenditures and waste of human and medical resources. However, with the
advent of the ACO, it has shifted the dynamics of US health care system from being an
uninvolved payer to the one seeking a return on investment. Seamless care experience has
become a reality with the development of ACOs.
Despite the contribution of ACOs in providing a unique care delivery model to improve
patient care and reduce medical cost, there are several controversies surrounding ACOs. The fisrt
major controversy is that many ethical challenges within ACOs have been identified. For
example, DeCamp et al. (2014) revealed that physicians express concern about ACOs because it
violates their professional autonomy. For example, ACOs has reduces physicians ability to
customize care. Some also argue that guidelines and quality standards developed by ACOs may
not be appropriate for all patients. This reflects the gap in the conceptualization of ACO. To
minimize this type of controversy, there is a need to develop mutually shared goals with

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clinicians. Evidence also suggests that going ahead with the goal of ACO would increase the
need to protect professional’s ethical obligation.
Apart from this, the most crucial issue surrounding ACOs is increasing the likelihood of
patient autonomy and patient’s right issues in care. This is because in order to go ahead with the
cost savings, ACOs will take control over the referral process. This would lead to ethical
challenges because of violation of patient autonomy and choice (DeCamp et al. 2014). Hence,
finding good balance between the goal of ACOs and patient autonomy is a challenging task that
will require key stakeholders to cautiously consider fair decision making element and take
appropriate steps to alleviate any disagreements. In view of these challenges, many other
alternatives have also emerged to fulfill similar goals as that of ACOs. These includes the
development of medical foundation model, the hospital owned group practices and different
types of joint ventures (Harrison, 2016).
Answer 4: (Advantage and disadvantage of the equity based joint ventures)
Different types of model exist for appropriate hospital-physician integration. Some of the
models that has been developed so far for hospital-physician integration includes the medical
foundation, the hospitalist the joint venture initiatives and the hospital owned group practices.
The equity based joint venture is one of the new business models, which is a shift from the
traditional mentality of profit and loss. Instead, it focuses on creating a system that promotes
complementary relationship among physicians, hospitals and suppliers. The main philosophy of
this model is to embrace and welcome those individuals into the organization who would serve
to eliminate the threat or risk imposed by challenging groups (Harrison, 2016). Hence, the
involved hospital and the participating physician play a major role in equity based joint ventures.

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They collaborate with each other to establish a new organization and contribute funds and
facilities equal to their ownership proportion. Hence, the success of this venture is dependent on
developing positive relationship between owners and mutual benefits.
One of the advantages offered by the equity based joint venture initiatives is that by
giving up the traditional win loss model, it reduces the pressure of hospital to generate profit.
This is because two involved parties share risk and cost. In addition, the process provides the
opportunity for growth of business by exploring untapped markets. Physicians get the chance to
sustain their practice for a long time and hospitals get the opportunity to increase physician
recruitment, increase the rate of hospital admissions and increase access to managed care
contacts. Evidence has also revealed that the use of equity based joint ventures during hospital-
physician integration result in improved communication process and increase in the quality of
treatment provided (Robinson 2015).
Despite the numerous benefits, there are several disadvantage of the equity based joint
venture model as lack of successful collaboration between hospital-physician also creates many
roadblocks. Lack of trust and disagreement on overall control between two parties disrupts the
whole purpose of coordination. Two parties may come with different cultures and management
styles and setting unrealistic objective can lead to many risks instead of profit and growth from
the venture. Therefore, coping with different cultures and management styles will be a barrier
that managers need to overcome. Involvement in poor tactical decisions can seriously affect the
outcome of the venture and it is necessary that the two involved parties seeking to go ahead with
this venture agree on the strategic direction and goals before proceeding with the venture
(Harrison, 2016).

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References:
DeCamp, M., Farber, N.J., Torke, A.M., George, M., Berger, Z., Keirns, C.C. and Kaldjian, L.C.,
2014. Ethical challenges for accountable care organizations: a structured review. Journal
of general internal medicine, 29(10), pp.1392-1399.
Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). The strategic management of health care
organizations. John Wiley & Sons.
Harrison, J. P.. (2016). Essentials of strategic planning in healthcare (Vol. 19, No. 3). Chicago,
IL: Health Administration Press.
McWilliams, J.M., Hatfield, L.A., Chernew, M.E., Landon, B.E. & Schwartz, A.L., (2016). Early
performance of accountable care organizations in Medicare. New England Journal of
Medicine, 374(24), pp.2357-2366.
O’Halloran, K., Depalma, A., Joseph, V., Cobelli, N., & Sharan, A. (2012). The role of
accountable care organizations in delivering value. Current reviews in musculoskeletal
medicine, 5(4), 283-289.
Reiss-Brennan, B., Brunisholz, K. D., Dredge, C., Briot, P., Grazier, K., Wilcox, A., ... & James,
B. (2016). Association of integrated team-based care with health care quality, utilization,
and cost. Jama, 316(8), 826-834.
Robinson, J. C. (2015). Biomedical innovation in the era of health care spending
constraints. Health Affairs, 34(2), 203-209.