The promise of the brand: how health system leaders are guiding the transition to health services integration.

Many regional (and national) not-for-profit community health systems in the United States were formed from asset mergers. By merging, community hospitals exchanged independence and certain rights of decision making for enhanced access to future investment capital, better payer contracting leverage, centralized corporate support services, and enhanced security in uncertain markets ahead. These hospitals often retained a local governing board; a CEO who reported to that board; and a few areas of purview typically relating to the designs and methods for affiliating and integrating with local physicians, clinical services and programs offered, credential ing and privileging of members of the independent medical staff, and - to a certain extent - definitions of quality and efficiency of the care provided.SHIFTING TO INTEGRATED HEALTHSome community hospitals expected to join a system and still be able to "run their own show." This approach worked reasonably well for many health systems through the 1980s and 1990s. Today, however, executives of health systems overseeing such models are rethinking the approach in favor of a transformation to the "next level" of regionalized, integrated, and coordinated community healthcare. They have realized that, to deliver on a brand promise of patient-centered, evidence-based, costeffective healthcare delivery, this next phase of transformative change becomes clear: They need to deliver standardized care models, methods, and practices.This change in thinking by a growing number of health system leaders stems largely from the emerging demands for community healthcare provision that is predictable, reliable, and uniform in clinical approach, outcomes, and total costs of care. So, perhaps the conventional precepts of "all healthcare is local" and "the community standard of care is how we do it here" no longer hold sway in the U.S. marketplace of the future.Factors contributing to this shift in thinking include the following trends:* Hospitals within the same health system have taken very different paths to their affiliation with and integration of physicians, causing clinical care patterns and operational and financial performance results to vary.* Rapid and extensive consolidation of third-party health insurance carriers has led to standardization of definitions and expectations regarding evidence-based clinical best practices, high-quality clinical outcomes, and acceptable total costs of care.* Wide variations are occurring in adoptions and adaptations of information and clinical technologies.* Variations in approach to clinical service line design and delivery are being seen.FOUR LEADERS' EXPERIENCES WITH INTEGRATIONThese new directions and related changes may present substantial challenges. Peter Person, MD, CEO of Essentia Health, based in Duluth, Minnesota, leads a health system with assets and staff in four states. Essentia is several years into its standardization of cancer care services across sites and geographic regions. What drove the strategy? According to Dr. Person, "We can't reasonably call ourselves an integrated system of care when our clinical approach to the same cancer diagnosis differs markedly across sites carrying our brand."Alan Kaplan, MD, FACHE, senior vice president and chief clinical officer of Iowa Health System in Des Moines, has been working for the last three years with employed physician leaders, affiliated hospital presidents, and corporate executives to transform the health system's physician integration strategy from a collection of locally designed and operated physician affiliation models to a unified, systemwide, and fully integrated multispecialty medical group. Eventually, this group is expected to exceed 1,000 physicians, all operating from a singular mission, strategy, clinical services blueprint, and operating platform. According to Dr. Kaplan, "The most important thing we can and should do is to deliver to our patients elevated levels of clinical quality and consistency across sites of care. …