6. Integrated Delivery of Health Care

In the 1980s, the United States saw medical cost inflation that resulted in the advent of managed care.

In response to this development, physician groups and hospitals consolidated into larger groups and multi-hospital systems.

Hospital systems established or purchased physician practices. In the early 1990s,

St. John’s established a network of rural family practice clinics throughout the region. In 1994, the 100-physician multi-specialty Smith-Glynn-Callaway Clinic, as well as the majority of the physician practices located on St. John’s main campus, joined St. John’s Health System.

As was typical across the country, St. John’s Health System then operated predominantly as a hospital-centric system and encountered multiple difficulties in effective management of physician practices.

At a time when many health systems were giving up on integration, St. John’s decided to take a bold path. The health system committed to restructuring the physician practice arm of the organization to create a large multi-specialty clinic, in the tradition of Mayo and Cleveland clinics, with the same standing as the hospital and health plans arms of St. John’s.

“An integrated health system is a collaborative effort between all aspects of health care to supply the health care needs of the community. That includes hospitals, physicians, ancillary services, as well as professionals who help facilitate the care that occurs between hospitals, the physicians and the patients,” says Ronnie Brownsworth, M.D., St. John’s Health Plans senior vice president.

Walter Gaska, M.D., physician president of St. John’s Clinic, describes St. John’s Health System as the “umbrella” organization under which three distinct and equally important entities operate.

“Under the umbrella of St. John's Health System, we have a hospital arm, which is St. John's Hospital, along with five rural hospitals; we have a physician arm called St. John's Clinic; and then we have a health plan component, St. John’s Health Plans, that serves 280,000 covered lives through health maintenance organizations (HMOs), preferred-provider organizations (PPOs) and individual contracts with employers.”

The goal of the integrated model is achieving the best patient care in the most efficient manner.

“In order to affect the quality and the cost-effectiveness of health care, you have to be able to facilitate all aspects of health care. The exciting part of a health system like ours is that all aspects of health care are within our system, so we have the ability to influence and improve the processes that we use to provide care to patients,” Brownsworth says.