A full plate of ‘clinical integration’

(L-R) HealthAlliance chief strategy officer Josh Ratner, CEO Dave Lundquist and chief information officer John Finch.

As it struggles with complex survival issues, HealthAlliance of the Hudson Valley, the Kingston-based integrated health-care system, is trying to strengthen its relationships with Ulster County’s physicians. According to its chief strategy officer, Josh Ratner, HealthAlliance has recently reached out to about 60 primary-care physicians in approximately 30 practices to discuss closer ties. Ratner and other HealthAlliance executives met about two weeks ago with the primary-care providers as a group. Ratner said the session was positive and supportive.

The closer ties being discussed are part of a movement to reduce costs and improve quality through coordinated care across the fragmented national health system’s different functions, activities and operating units. The term “clinical integration” has been increasingly used to describe such coordination of care.

Clinical integration is getting a boost from the recently enacted federal health care reform laws, which include support for pilot integration projects and some partial regulatory relief. According to the American Hospital Association, several provisions in the law may help overcome some barriers to integration.

“It’s something we may want to be part of,” said Ratner.

As HealthAlliance moves forward, there’s ample evidence that delays in efforts at integration may not be option. “Clinical integration has vaulted from good idea to a business imperative, thanks in large part to the new health-reform law,” said one recent article in a national health-management magazine.

The combination of Benedictine and Kingston hospitals, under pressure from the state Berger Commission, was a big step in reforming the fragmented local system of health care. The merger and subsequent reorganizations created a smoother, better integrated continuum of care. But dealing with the distractions caused by the consolidation seems to have taken attention away from the urgency of clinical integration. So now HealthAlliance must play catch-up at an awkward time.


Ulster County has been a stronghold of highly independent practitioners of primary care. In an age where the costs of health care are under constant attack, however, Ratner thinks that major change is inevitable — no less for the beleaguered hospitals than for the primary-care providers. As well as helping steady HealthAlliance’s business, a more closely integrated system may offer the most promise in maintaining as much treasured physician independence as can be preserved. “It would be a feather in our caps if we got the docs to work together in a unified way,” Ratner said.

Right now, CEO Dave Lundquist and his management team at HealthAlliance could use a few new feathers in their cap. HealthAlliance’s strategy for creating a coordinated health-care delivery system with the potential to grow into a regional center for excellence has run into economic problems whose severity had been unanticipated. Those who objected to the merger see the dire alternatives presently facing the HealthAlliance administration as vindication of the correctness of their own earlier gloomy predictions. And many of those who supported the merger are appalled by the probability that one of the hospitals could be closed. Success has many fathers, and failure is indeed an orphan.

“The institutions should have been braced for the economic challenges they ultimately faced,” said a press release this past week from Assemblyman Kevin Cahill, who had been instrumental in getting $47.5 million in state support for the creation of HealthAlliance. “I have already heard from many corners that the exclusion of the public from discussions thus far of restructuring the organization is disconcerting and frustrating.”

Cahill expressed concern. “The merger, in theory, should have brought us closer to a coordinated health care delivery system with the potential to grow into a regional center for excellence,” said Cahill.

HealthAlliance’s economic problems come at a time when it needs all the financial resources and management skills it can muster. Its strategy in adopting change after earlier innovators have ironed out the kinks — as chief information officer John Finch puts it, “the second mouse gets the cheese” — is now suspect. The situation is exacerbated by the fact that competing hospitals with direct physician employment already have considerable experience with clinical integration. The form of clinical network model now being proposed by HealthAlliance would take time to build, test and integrate.

The quest to accelerate the pace of operational change through integrating physician-hospital information systems and streamlining administrative processes increases the potential for the delivery of high-quality health care. That unquestionably makes it a move in the right direction. But the road that must be traveled is a long one. In a challenged managerial environment, the execution of the strategy is unlikely to come easily.

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