Physician Alignment Models: Are All Created Equal?

We’ve heard this before: Healthcare is a continuously evolving landscape in how care is delivered. This timeless statement is true from the time of the phase-in of DRGs in 1983 through today. Even now we have mandatory and voluntary bundles designed to manage patients well beyond the time of their date of discharge. As a 1983 graduate with my MHA, I went through this evolution. I watched the resistance to the gradual acceptance of the DRG program and how hospitals adjusted to the new payment limits.

Today, CMS continues to create payment-incented initiatives designed to ensure a longitudinal view of patient care. We are now seeing the transition from “siloed” healthcare delivery from one provider to the next to an extended care continuum. This care continuum is intended to bring providers into a stronger model designed to reduce duplicity of care (e.g. multiple imaging study’s) and place shared compensation for networks of providers who meet certain quality and process outcomes over a specific period of time.

A critical and essential piece in the puzzle for success in today’s care continuum model is a strong mutual relationship between all providers. This relationship should involve pre-emptive to acute to post-acute providers whose key performance indicators (or KPIs) are intended to keep the patient out of the acute care environment.

Over the past 8 years, I have moved from Service Line operations management to a Service Line advisory role. This has afforded me the opportunity to become acquainted with the various ways to create strong relationships between physicians and those charged with ensuring the clinical and technological infrastructure supports the best clinical results.

To this end, I have learned that not all physician alignment models are created equal. Whether it’s a Pioneer ACO, a gain-sharing, shared-savings, Payer-driven PMPM program or Co-Management, success relies on certain common characteristics. These characteristics create the successful short and long-term relationship, which is so critical to our continued healthcare evolution:

  1. Transparency. Traditional hospital executive team relationships provide a limited amount of information on the overall performance of the Service Line. (Because of familiarity, we will use a Service Line as our model.)  Typically, information shared focuses on growth and productivity statistics.  Transparency today should delve into everything that can contribute to giving the physicians and support team the knowledge needed to apply new approaches to care delivery.  Something as simple as First Case On Time Starts (FCOTS) in the OR Suites, Cath, Electrophysiology or Specials Labs that only looks at physician delays versus other aspects which may be upstream of the back end output will distort the problem and may cause us to arrive at a partial solution. This process measure is only one example among the many ways that transparency needs to exist and move forward in adopting new approaches to the daily operations of the Service Line. Blinding physician data and withholding Service Line financial performance should be a thing of the past.
  2. Governance and Structure. The first suggestion is to evaluate the current Service Line structure. The overall objective is to have a multi-disciplinary group who can affect the change of performance within a Service Line.  This Performance Team should consist of physicians who are expert in sub-specialty clinical areas (e.g. heart failure, interventional cardiology, electrophysiology, non-invasive, surgery). They should lead the effort and have the full support of the Service Line and C-Suite leaders to assist with the task at hand.  Assessing ways to eliminate overlapping or redundant meeting venues with a Performance Team (working through the issues) and Executive Team (supports the Performance Team via removal of barriers to increase the likelihood of success) will benefit all through this streamlining exercise.  Integration of medical staff executive committee and bylaws related activities is not recommended.
  3. Prioritize Opportunities. When establishing the key performance indicators (KPIs) for the Service Line, unless pre-defined per ACO or Bundles or other Alternative Payment Model requirements, engage external advisory support with expertise in the national perspectives surrounding best practice or top decile measures/indicators. Using these as potential areas of prioritization, meet with the multi-disciplinary team members of the Service Line. The objective is to refine and prioritize a finite set of annual indicators. Keep the indicators to a manageable number and set tiered performance targets.
  4. Leverage Consultants. When I think about the successful physician alignment models, a common characteristic is the synergy that comes from maintaining a routine cycle of performance updates from the Performance Team leadership.  Using third-party consultants to develop draft action plans, assist with the scorecards, provide national insights into best practice and remove some of the coordination and orchestration burden while supporting the physician leaders, optimizes the entire process.  The creation of the physician alignment model in the absence of consultant support can leave the Performance Team floundering.  Accelerating the learning curve has immeasurable value to the process.
  5. Patient Focus. Keep in mind that achieving high quality leads to solid financial performance.  While some would argue that soft dollars are just that, avoiding costs are just as important in today’s value-based payment environment as the hard dollars savings.  Both can be accomplished within a model that satisfies the OIG’s opinion on acceptable arrangements. Quality, Safety, Patient Experience, Operational Efficiencies and meeting Community Needs will create a tangible environment along a broader care continuum and take the focus where today’s model of care needs to go.

At Dynafios, I am fortunate to be able to take my years of experience to help healthcare organizations align physicians, enhance patient outcomes and improve financial performance. As a healthcare consultant, I can bring a fresh perspective to the Service Line and offer real-life, attainable solutions. I know what works and most of all, I know what doesn’t work. I know how to create a successful physician alignment model that achieves positive change through a transparent, structured, patient focused approach that thrives in an environment of collaboration and bears both individual and group success.

If you’re interested in how to create a physician alignment strategy that really works, give me a ring at 425.392.3887. I would be honored to share my experience with you.

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