Fragmented health care delivery and inadequate systems to support efficient, coordinated, high-quality health care are a challenge to health care providers. In order to be successful in the current healthcare environment, hospitals and physicians need to work together to provide and, importantly, to demonstrate the provision of quality care. The lack of alignment of incentives for collaboration is often a barrier to achieving optimal results in quality patient care. Various initiatives have been implemented to align incentives, e.g., Medicares pay-for performance compensation model tying payment to performance quality measures. Promotion by The Leapfrog Group, a voluntary program focused on health care safety and quality, of practices that are reflected in hospital ratings surveys including computer physician order entry, evidence-based hospital referral, ICU physician staffing, and other risk reducing practices that illustrate the value of hospital and physician collaboration. It is obvious from these experiences, that quality care cannot be achieved without the commitment and collaboration of key providers of care.

Hospital and physician collaboration can occur at various levels, i.e., through full integration (e.g., a Physician Hospital Organization), partial integration (e.g., faculty practice plan, independent practice association), or with no formal structural integration. Examples of successful collaboration will be highlighted, and the reasons for their success will be discussed. One such physician-hospital organization has evolved over sixteen years from a managed care contracting vehicle to a partnership for improving quality through integration.

Steps in collaboration will be presented, addressing the challenges facing organizations involving heterogeneous participants (i.e., hospitals and independent physician practices). Processes for fostering collaboration will be offered. Additional approaches for facilitating and sustaining the collaboration will be discussed. Such tools provide practical strategies for continual process improvement including frontline problem-solving and shared decision-making. The theme is accountability of participants where everyone has a leadership role. The use of technology for communication is discussed.

Collaborative opportunities, i.e., the development of Centers of Excellence are provided as examples embodying best practices to promote efficiency, effectiveness and quality outcomes. Healthcare reform is addressing quality and alignment of provider incentives, meeting these goals will necessitate successful collaboration between hospitals and physicians.