1. 2008/05/211 Integrative Specialty Care ： Pursuing a Convergent Path With Medical Staff Professor : Chen-Chung Ma Student Number : 9651001M Student : Chiu-Yin Lai Date : 2008/05/21 Health Care Management

2. 2008/05/212 Introduction To help physicians and healthcare executives decide whether or not to integrate, it is important for parties to determine the following: Is it in their best interest to pursue a path of convergence or of divergence? What are the repercussions of each strategy? What does it mean to integrate? How can such diverse groups merge successfully? P.17

3. 2008/05/213 Is Physician Integration a Win-Win or a Zero-Sum Game? Physician specialists can access this potential in one of two ways: 1.The integrative pathway 2.The competitive strategy P.17

4. 2008/05/214 Financial considerations Many financial considerations make specialized medicine attractive to physicians and hospitals. Operating economics Access to capital Personal incomes Strategic opportunities Ability to control clinical quality and the patient (customer) experience P.17

5. 2008/05/215 What Is Integrative Healthcare? By a business model that allows physicians in all aspects of care management unfettered. And the model which allocates financial rewards based on performance of the integrated service line. The more integrated the model, the easier the management of revenue flow and reward system design. P.17

6. 2008/05/216 What Is Integrative Healthcare? The contractual model tax-exempt participating bonds (PBTs) In the middle range of the continuum are equity and "synthetic equity" joint ventures. On the far end of the continuum is full integration, or the "employment model." P.17

7. 2008/05/217 P.18

8. 2008/05/218 Attributes of an Integrated Health System The following should be included in the design for integrative healthcare partnership ： 1.The patient is at the center of the care system. 2.There is one, common electronic health record. 3.Physicians are partners with health system managers at every point in the care continuum. 4.Economic incentives are aligned. P.18

9. 2008/05/219 Attributes of an Integrated Health System 5.A unified, common approach is taken to clinical care pathways. 6.A unified, common approach is taken to the measurement and evaluation of clinical quality, customer service and patient satisfaction. 7.Common approach is taken to the credentialing and privileging of providers of care within the health system. P.18

10. 2008/05/2110 The Decision-Making Process for Full Integration The following discussion guide provides specialty physicians and healthcare leaders a starting point to navigate these issues. P.18

11. 2008/05/2111 Questions Question #1 What is the rationale for doing things differently? Question #2 How could the new relationship provide a better "product?“ Question #3 Who's in control? Who controls what, How is that control shared? P.18

12. 2008/05/2112 Questions Question #4 How will physicians be assigned to leadership positions? Question #5 How will physicians be compensated? Question #6 How will capital be invested in the specialty programs? P.22

13. 2008/05/2113 Questions Question #7 What about practice assets? Asset classes for sale typically include: Real property Patient accounts receivable Workforce in place Patient records Related businesses owned by the practice(s) Noncompete covenants P.22

14. 2008/05/2114 Questions Question #8 How does the prospective integrative model best apply this opportunity? How will the new integrative model fully develop the specialty programming potential? Question #9 How best should we deploy a regional geographic outreach strategy? Question #10 Are we clinically connected? P.22

15. 2008/05/2115 To Integrate or Not to Integrate? The reasons for this vary but typically are (1) fear of the unknown (2) Satisfaction with the traditional model; (3) a rational but misplaced fear of hiring physicians based on experience in the primary care arenas (4) a reluctance to share leadership and control of a health system with physicians. P.23

16. 2008/05/2116 To Integrate or Not to Integrate? Despite these concerns, healthcare executives have a great deal to lose if they shy away from integration. For larger hospitals, profits are made on a handful of specialty services, which carry the balance of the clinical services portfolio. P.24

17. 2008/05/2117 To Integrate or Not to Integrate? Sometimes it is the physicians who choose not to integrate. But by maintaining the status quo, these physicians are missing out on key quality-of-life opportunities. P.24

18. 2008/05/2118 Integration: Success = Full Commitment The most successful models of integration are those that involve physicians in all aspects of health system planning, operations, policy making and governance. Physicians will need to become part of the leadership and management ranks. Ex: SMDC in Minnesota P.24

19. 2008/05/2119 Conclusion To succeed with integration, physicians must become part of the leadership and management ranks. The full integration of clinical and business models may be the only rational method to cope long term with the economic, political and psychological vagaries of a changing healthcare marketplace. P.

20. 2008/05/2120 ~Thank You For Attention~ P.

21. 2008/05/2121 Proverb 1 * That’s the way it is Allen: Amy, why do you always speak Taiwanese, not Chinese ?! Amy: That’s the way it is!

22. 2008/05/2122 Proverb 2 * Don't give me that! Allen: Mary, you are so beauty, you are so sweet, you are so charming…… Mary: OK, stop!! Actually you are right!! But don't give me that ! What are you trying to say?