But one of the key points from my story is that integration doesn't always equal alignment. The reverse is also true: Alignment doesn't have to be achieved through hospital or health system ownership of physician practices.
Brown and his board, as well as, presumably, Iowa Clinic's 140 providers in 37 specialties, are staunchly independent simply because they place a high value on autonomy, and don't see any reason they can't remain financially viable far into the future. But the independent streak at Iowa Clinic only runs so far—its relationship with the health system to which it refers the majority of their inpatients, Iowa Health System, is extremely collaborative.
A few years ago with IHS, "we were very open and candid with one another about the future we faced," Brown says, which was a future that meant even though Iowa Clinic would remain independent, it would have to develop an interest in Iowa Health System's long-term survival and success. The reverse was also true.
"We looked at it from a perspective that we needed a strong health system to have a strong clinic," he says. "It was as much in our interest to help reduce costs as it was theirs."
Over the past 10 years, the two organizations have developed a foundation to work together in care coordination and cost reduction strategies, first in cardiovascular services, and then in oncology and outpatient services.
"Both of those have been the foundation to help us work together," Brown says.
Also facilitating that close relationship have been joint ventures and strategic business alliances.