Our industry is now in its third year since the passage of the Affordable Care Act and, as leaders we are making choices — indeed, massive bets — that can create a renaissance, albeit through a period of painful transformation. Smart health systems are seeking the transformational edge vis--vis the competition in the evolving consumer-centric environment.

At Trinity Health, we are betting that we will be paid for value in a variety of methods from bundled payment to shared-risk contracting and global capitation. As such, we understand that we are moving toward large-scale, multistate engagement in the health insurance exchange marketplace, where consumers will demand transparency in price, quality and safety. We think clinical integration will be the foundation needed to meet those demands.

Trinity Health understands that the turbulence during this period of transformation requires clarity of direction and preparation for anticipated changes. Through careful and purposeful planning, we are able to create our destiny by leveraging 12 years of experience with a multistate, single-platform, HIT infrastructure. We predicted that our $1 billion comprehensive IT infrastructure would be a critical building block for any call for systemic change. Today, it is a completely integrated, data rich system that undergirds our move to stem-to-stern clinical integration.

We view clinical integration as the construct that positions Trinity Health and its partners for success as accountable care organizations committed to population health management as a primary deliverable to promote value for consumers.

Our first step toward clinical integration was to create a strategic readiness assessment to determine the best way to align our national health system of 48 hospitals in 20 markets with more than 7,000 networked employed physician and patient care professionals, and thousands of caregivers in the traditional models of affiliation and employment. The assessment, which included an evaluation of barriers to clinical integration and took local factors into account, affirmed that while all markets need a core foundational structure, each is unique and will have different approaches and rates of adoption.

Trinity Health is in the process of clinically integrating our networks, covering the spectrum from physician employment to various economic affiliations. And we are now building market-specific networks that rely on continuums of care.

As with every tectonic shift, much is written about managing process, structure and culture. The most powerful and clearly articulated documentation of a work plan for this transformational era is the AHA's, "Hospitals and Health Care Systems of the Future." This playbook spares today's leaders from having to invent a de novo planning model or repeat mistakes from the past.

Undoubtedly, this is a defining moment in which winners will engage in transformation strategies by 2014 and have a completely operational model in all markets by 2019, when the ACA is fully in place. At Trinity Health, we are choosing to navigate carefully the challenges of the "Seven Cs" — culture, consolidation, consistency, coordination, cost, collaboration and consumerism. We understand that clinical integration does not work without successfully managing these challenges. Our end goal is clear: to provide better and safer care at a price consistent with the demands of the marketplace, enabling us to fulfill our mission of service to our communities.

Joseph R. Swedish is president and CEO of Trinity Health in Novi, Mich.

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