Articles

Accountable Clinical Management: Driving Service Line Success Through Shared Leadership

by Mike Farris, Stuart Baker, MD, and Saad Allawi

When Congress passed the 2010 bill ushering in the most sweeping health care reform package since Medicare was introduced fifty years ago, it signaled the end of the world as providers know it. Integration, alignment and, more importantly, engagement of physicians has increasingly become a strategy-critical imperative for health systems seeking to create high-performing, future-ready organizations. Now, with the passage of The Patient Protection and Affordable Care Act (PPACA), the new “accountable” economics of healthcare reform will demand that providers work collaboratively toward innovative models that emphasize longitudinal management of care and costs as opposed to episodic treatments of acutely ill patients. Over the past decade or so, many models have been tried – some successfully, others not so much. In the search for the holy grail of physician integration, most hospitals have concluded that a pluralistic approach, pursued in the context of an over-arching framework for clinical care and performance transformation, will be required to address the rapidly evolving world under healthcare reform.

The Five"R's": A Framework for Physician Alignment

by Stuart Baker, M.D., Mike Eaton and Jeff Miller

The financial and clinical success of hospitals and health systems has long been dependent on the quality and structure of medical staff relationships. With the introduction of health care reform, new payment systems and increasing accountability for managing both quality and cost efficiency of patient care, having a master plan for physician alignment has never been more imperative. Creating a dynamic physician enterprise requires strategic thinking about possible and preferred alignment scenarios, and a data-driven action plan to bring vision into reality. By focusing on five Rs – recruitment, retention, redirection, redeployment, retirement – health leaders can assess
opportunities and employ a robust set of initiatives to build a successful physician enterprise.

Clinical Co-Management: Driving Service Line Success through Shared Leadership

by C.B. Rebsamen, MD, FACHE, Rachael Schad and Karen Corrigan

Clinical co-management is an integration structure gaining renewed interest from both hospitals and physician organizations.  Under the co-management arrangement, hospitals contract with an organized group of physicians to provide day-to-day management services for inpatient and outpatient components of a specialty service line such as cardiac, oncology or orthopedics.  The first generation of co-management was an outgrowth of gainsharing where physicians benefitted from cost-savings arrangements.  Most of these early models, however, faded quickly once savings reached a point of diminishing returns.  And many failed when financial rewards didn’t materialize because cost improvements weren’t achieved.

This article describes how a new generation of clinical co-management ventures offers substantially more value in that agreements between hospitals and physician organizations provide for and reward physician engagement and leadership in a broad spectrum of activities that improve patient care and outcomes, generate cost efficiencies and make the clinical service more competitive in the market – and how patients become the real winners when aligned hospital-physician incentives have a positive impact on patient care.

Building a High Performing Physician Enterprise

by Mike Eaton

More than a few health system CEO’s committed millions of dollars in employment contracts to specialty physicians and in the process, raised expectations of clinical, programmatic, and market gains that would translate into an ROI. The return on those investments, though, is turning out to be more elusive than imagined. More than a few boards are beginning to pointedly ask the question: “when are we going to see some wins?” The answer may be “not anytime soon” unless health systems have a solid game plan for converting a collection of employed practices into a high-performing business unit.