The House of Gastrointestinal Medicine: How Academic Medical Centers Can Build a Sustainable Economic Clinical Model  Anil K. Rustgi, John I. Allen  Clinical Gastroenterology and Hepatology  Volume 11, Issue 11, Pages 1370-1373 (November 2013) DOI: 10.1016/j.cgh.2013.08.003 Copyright © 2013 AGA Institute Terms and Conditions

Figure 1 Three options for IDNs. There are 3 general types of hospital-based IDNs. A closed or restricted network (far left column) is composed of fully employed providers, a single enterprise-wide EMR, and tight business and clinical integration. An affiliated model (middle column) usually is composed of a health system that owns hospitals and other delivery sites (transitional care units or skilled nursing facilities, for example) plus some providers (usually primary care). Independent specialists are affiliated closely but may not be fully employed. Often there is an EMR within the core business units (hospitals and primary care provider offices), but specialists may have their own systems that must interface with the health system EMR. This model has additional inherent costs and must make itself a “must have” with unique services or demonstrated quality. Academic medical centers (far right column) have additional costs (teaching and education) but are under the same pressures to demonstrate their added value. The height of each column represents total cost of care paid by payers. HIT, health integration team. Clinical Gastroenterology and Hepatology 2013 11, 1370-1373DOI: (10.1016/j.cgh.2013.08.003) Copyright © 2013 AGA Institute Terms and Conditions

Clinical Gastroenterology and Hepatology 2013 11, 1370-1373DOI: (10 Clinical Gastroenterology and Hepatology 2013 11, 1370-1373DOI: (10.1016/j.cgh.2013.08.003) Copyright © 2013 AGA Institute Terms and Conditions