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Working Together


Charles T. Frock
Chief Executive Officer
FirstHealth of the Carolinas

Even as Congress inches toward finalizing the most significant changes to American health care since the Medicare Act of 1965 (something that could be decided by the time you read this), FirstHealth of the Carolinas and its physicians are investigating new ways of working together that could be equally important for our communities.

In our quest for greater collaboration in the delivery of high-quality health care, we are researching the concept of an Integrated Health System (IHS) or, as it is known in some circles, an Integrated Delivery System (IDS).

By definition, an IHS combines health care providers (i.e. physicians and other practitioners) and organizations (i.e. hospitals) into a comprehensive network to provide a full range of medically and financially appropriate health care services. By some definitions, an IHS may also own or be closely aligned with an insurance product.

There’s nothing new about this concept of combined hospital-delivered/physiciancoordinated health care. The Mayo Clinic was conceived as an integrated system, an organizational umbrella, as it were, that allows physicians to do what they are trained to do—practice medicine—without the hassle of practice administration. As a result, the Mayo concept is historically ingrained in everyone involved with that organization as the accepted way of doing business.

Less well-known is the idea of a merged group comprised of parties that have traditionally functioned symbiotically (in a mutually beneficial relationship) but as functionally separate entities that are financially as well as organizationally independent.

For more than 80 years, the latter has been our organizational model. If we decide to adopt an IHS model, that would change and hopefully for the better. Ideally, greater physician-hospital coordination should ensure that patient care is more timely, more efficient and less costly.

Is an IHS feasible for FirstHealth and its physicians? Well, that’s what we are trying to determine.

There are many reasons why an IHS might be practical for us. The major ones center on cost, access, outcomes and physician workforce shortages (especially among primary care providers). Because these are challenges that we share with organizations throughout the country, members of a FirstHealth/physician committee formed to investigate IHS feasibility have visited several other systems that have chosen to go the IHS route. Most recently, our group visited St. John’s Health System in Springfield, Mo., an organization so successful in its IHS implementation that it has twice been recognized as the nation’s top integrated health care provider.

The FirstHealth group was impressed by what it learned, and found a number of similarities between the Missouri experience and our own situation. Still, there is much to be learned and even more to be considered before any kind of decision can be made here.

The FirstHealth Board of Directors and the Mid Carolinas Physician Organization (MCPO), which includes physician representation from almost all area medical practices, are spearheading the investigation.

What happens next will depend on the recommendations of a newly created workgroup, the actions of our Board and, of course, physician evaluation.

Rest assured that any decision will be values-based and, most importantly, patient-centered. Our core purpose is based on the value of “working together.” This current investigation simply builds on that notion.