Each toolkit includes a definition of the area being addressed, a checklist of recommended activities for that area an organization should consider in their move from fee-for-service to pay-for-value, and tools and resources associated with each line item.
For the purposes of this HIMSS Alternative Payment Model Infrastructure Toolkit, the definition of Clinical and Administrative Integration is as follows. Clinical and Administrative Integration is the compilation of all of those administrative infrastructure activities that enable the provision of information necessary for leadership to make decisions regarding management of finances, human capital, provider relationships, and supplies. Clinical and Administrative Integration contributes to the management of risk-bearing arrangements with commercial and government payers. It reflects the vital connection between clinical and administrative activities, and highlights the impact decisions made in the clinical realm can have on an organization’s financial health, and the impact administrative decisions can have on a clinician’s ability to do their job well.
Components of Clinical and Administrative Integration may include (in no particular order):
- Examples of Best Practices/Potential Benchmarking Strategies
- Clinical Documentation
- Personnel Management
- Referral Patterns/Care Coordination
- Supply Chain Management
- Tracking/Reporting Quality Outcomes