TABLE 5.

Facilitators of Economic and Clinical Integration

Category of Facilitator	Specific Illustrations
Internal hospital factors
	Prior physician-hospital collaboration
	Physicians' compacts with hospital
	Hospital's convenience and operational efficiency
	Adequacy and number of nurses
	Visibility, credibility, integrity of administrators
	Reengineering of hospital work processes
	Reengineering of owned physicians' practices
	Reengineering of hospital medical staff
	Physician leadership development
	Engagement of key specialists
	Hiring of physician extenders
	Promotion of physicians' groups
	Compensation of hospital executives
	Physicians' involvement in decision making
	Investments in clinical information technology
	Trained implementers for certain IT vendors
	Financial information on cost of care provided
	Emphasis on technology assessment and supply chain management
	Reorganization to promote multidisciplinary care: service line management, colocation of interdependent specialties
	Quality of medical staff
	Primacy of quality goals
	Focus on clinical integration goals
	Appraisal and reward systems for meeting goals
	Population-based health planning
	Culture of information sharing
	Culture of commitment to resolving iron triangle
	Opportunities for partners to work together
	Empowerment of physicians
	Improved governance and management of physicians' organizations
	Preparation of physicians' practices for change
	Physicians' compensation models
Market competition
	Hospital's market share and hospital market HHI
	Hospital's economic surplus
	Hospital's leverage with payers
Physicians' external market
	Local market consolidation of physicians
	Local market employment of physicians
Environmental trends
	Payers' interest in P4P, capitation, etc.
	Public pressures to improve safety and quality
	Normative pressures to conform to public pressures
	Possible repeal of whole hospital exemption
	Alignment of hospital's and physicians' payment incentives