benefits were expected to be increased access to care (in terms of a greater range of services for both DoD and VA beneficiaries); better quality of care (in terms of coordination and continuity of care and access to a greater range of specialties for consultation and referral); lower operating costs (because of reduced duplication of both administrative and clinical functions and economies of scale); greater patient and staff satisfaction; and more research and training opportunities.

In this section of the chapter, the extent of integration—defined as the blending of previously separate entities into a cohesive whole—is explored. The degree of integration will be analyzed along three dimensions: (1) functional integration, (2) physician integration, and (3) clinical integration.

  • Functional integration is “the extent to which key support functions and activities (such as financial management, human resources, strategic planning, information management, marketing, and quality improvement) are coordinated across operating units so as to add the greatest overall value to the system” (Shortell et al., 2000, p. 31).
  • Physician integration is “the extent to which physicians and the organized delivery systems with which they are associated agree on the aims and purposes of the system and work together to achieve mutually shared objectives” (Shortell et al., 2000, p. 67).
  • Clinical integration is “the extent to which patient care services are coordinated across people, functions, activities, and sites over time so as to maximize the value of services delivered to patients” (Shortell et al., 2000, p. 129).

Functional Integration

Administrative services are combined and integrated to some extent at the Lovell FHCC, although the need to adhere to the different business rules and procedures of the DoD and the VA requires a certain amount of duplication and limits the realization of optimal operating efficiencies. In addition, some services, or product lines, are provided at the regional or the national level by one department or the other. For example, human resources (HR) services for the NCVAMC were provided by the Veterans Integrated Service Network (VISN) 12. In that case, the FHCC was able to establish an integrated local HR office. In other cases, integration was not possible. For example, the DoD has a national contract to provide appointment call center services at the military treatment facilities (MTFs), which means that there are separate call centers at the FHCC for DoD and VA beneficiaries. In any case, under the terms of the National Defense Authorization Act of 2010 (NDAA 2010), the FHCC cannot cut staff, even though



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