Memorial Health System CEO Dr. Larry McEvoy wants to switch to integrated medical care. So what is integration, and what does it mean for patients?

To understand the potential value of integration, consider the current lay of the land at Memorial. The hospital has about 850 physicians on staff — that’s everyone with privileges at the hospital — but directly employs only 24 doctors, not including McEvoy and other senior staff.

One common method of integration would make most or all those hundreds of physicians salaried employees of the hospital. That could streamline health care delivery by cutting waste and duplication, improve care through better coordination between primary care doctors and specialists, and help the hospital’s bottom line.

For patients, it would mean less paperwork, more follow-up care and better coordination between primary-care doctors and specialists.

It’s not, however, an easy sell for traditionally independent physicians. Even local cardiologist Dr. David Greenberg, who chairs the Memorial Foundation and generally supports integration, isn’t on board with becoming a hospital employee.

“Personally, I’d hate to be considered an employee of the hospital,” Greenberg said. “I want to be my own boss. That’s what I’ve done for 35 years.”

Still, in one form or another, integration is creeping into every aspect of American medicine.

In a 2008 paper titled “An Agenda for Change, Improving Quality and Curbing Health Care Spending,” the Dartmouth Institute for Health Policy and Clinical Practice lauded integrated care for its ability to improve outcomes and reduce costs — by as much as 40 percent for acute and chronic illnesses.

“Not all health care in America is alike,” the authors of the paper wrote. “There are islands of excellence in the sea of high cost mediocrity — hospitals and physician practices that are delivering high-value health care that is less costly, more efficient, and produces better health outcomes. What’s so special about these hospitals and physician practices? They are organized systems of care — group practices and integrated hospital systems.”

Integrated care has worked in Utah, where Intermountain Healthcare operates 22 hospitals, has 4,700 physicians and delivers the lowest health care premiums — and some of the best care — in the country. The benefits to care and to costs have earned Intermountain shout-outs from President Barack Obama and a glowing profile in the New York Times Magazine. In Intermountain’s approach, teams of doctors review data and create protocols on procedures from diabetes treatments to coronary-bypass surgery that have proven to significantly improve patients’ treatments and to reduce costs.

“When you look at data, when you look at the mission and the purpose behind the effort, people come around and people see what the mission is and you work together,” said Jason Burgess, an Intermountain spokesman. “There’s give-and-take — that’s how you develop the best practice and create the teams that are supportive.”

Traditional health care is fraught with “perverse incentives” said Patricia Urosevich, a spokeswoman for Geisinger Health System, a century-old integrated-care hospital in Pennsylvania.

“Many doctors are rewarded for widgets — the more procedures you do, the more you get reimbursed. So, there’s an incentive to see as many patients as possible,” she said. “We believe you should be reimbursed for the outcome and not for the amount of things that are done to the patient.”

She argues that through its health insurance, Geisinger can create incentives for patients to quit smoking or lower their blood pressure. Likewise, its 800 physicians have their salaries tied to performance and patient health, rather than a traditional fee-for-procedure system.

Memorial isn’t waiting for doctors to sign on before it institutes aspects of integrated care, said Dr. Manoj Pawar, Memorial’s chief medical officer. The hospital has implemented protocols and checklists, much like those that have been successful at Intermountain, and they are producing results, he said. For example, heart bypass mortality rates are lower than Intermountain’s (very good) numbers, at 1.47 percent.

“When you talk about these standardized protocols, they’re not rocket science,” Dr. Pawar said. “These are things that everybody is using. They’re achieving high-level improvement.”

Memorial has developed protocols on sepsis, cardiac alert and congestive heart failure that are making strides in improving care — and they’re driven by integrated teams of physicians and nurses, Pawar said.

“It’s not about ownership, it’s about how well docs work together,” Pawar said. “We’re doing a lot of the things Intermountain does, we’re just being very quiet about it.”

For example, Memorial is saving $300,000 a month on orthopedic implants. How? Hospital administrators sat down with orthopedic surgeons, and they agreed to push the implants’ supplier for a price cap.

Seventh-graders at Eagleview Middle School helped with the installation of fabric art on the fence of the tennis courts Friday afternoon in celebration of Arts Day. The art was inspired by the works of Christo and Jeanne-Claude. Each class worked on what the previous class left. This class wanted to frame Pikes Peak with the fabric. The Bemis School of Art co-hosted the event with the Academic Arts Academy classes. Photo by CAROL LAWRENCE, THE GAZETTE