Hospital and health system executives realize collaboration with their physician partners is crucial for operational and financial success.
The continued shifting to value-based care, along with financial pressures from dwindling reimbursement, deteriorating payer mix and other factors, is certain to make this collaboration even more crucial moving forward.
With this in mind, Becker's Hospital Review asked readers to share their organization's physician alignment strategy. Read about the physician alignment strategies below, in the leaders' own words.
Note: Responses have been edited lightly for length and style
Sam Bagchi, MD
Senior Vice President, CMO and CMIO of Christus Health (Irving, Texas)
"Christus Health, [with more than 15,000 physicians], has many different markets with many different approaches to physician alignment. [Therefore], we really are committed to meeting our physician community where they are in terms of their desire to engage with us and their desire for employment or more autonomous independent practices.
"Where we have large employed platforms, we work hard to optimize the employed physician experience and think about how we can design our compensation and workload models to minimize burnout and make it as easy to practice as an employed physician as possible. A big part of that is our shared physician-led governance of those groups. We're careful to make sure we have physician input, physician leadership involvement and physicians driving the clinical mission of those employed physician groups that we have.
"In other markets where we have fewer employed physicians, we work hard to make sure that we're the easiest health system to work with in the community, that they understand we're committed to the safety and quality of care we provide together, and we really try to be innovative and creative in how we can be the preferred health system for them to work with."
Gary Fulbright
CFO of Citizens Memorial Healthcare (Bolivar, Mo.)
"We have gradually over time employed more and more physicians, and at this point practically all of our [96] physicians are employed. We've not really forced that issue. They just kind of came to us one at a time. And then most of the physicians we recruit do want to be employed, so it worked [out] that way.
"I feel like we do a great job of communicating with physicians, and our physicians have been around the 90th percentile the last four years on surveys of how satisfied they are with the organization. We work hard at that, and I think we are very aligned here."
Arthur Klein, MD
President of the Mount Sinai Health Network (New York City)
"At Mount Sinai Health Network, [which consists of nearly 9,000 physicians], the physician alignment strategy is multifaceted because we don't believe that one model fits all, particularly in the highly competitive environment of the metropolitan New York City area. The alignment strategy can be everything and is everything in our system from direct physician employment to creating part-time employment opportunities where appropriate, to creating a different physician practice alignment model, like captive professional corporations [for acquiring and managing medical groups], or purchased service agreements. Also, very importantly, [the alignment strategy includes] the creation of a clinically integrated network where physicians agree we will contract for them in return for our ability to ensure commitment to quality, access, facilitated care and most appropriate care from an expense and utilization point of view."
Rich Liekweg
President and CEO of BJC HealthCare (St. Louis)
"Our patients' needs are met through a comprehensive and diverse physician platform that includes over 300 BJC Medical Group employed physicians; more than 1,000 physicians who are part of the Washington University Faculty Practice Plan, our strategic partner, and a vast number of community-based physicians credentialed and privileged by our hospitals.
"Our alignment strategy includes being an early CMS accountable care organization that has yielded education in outpatient care coordination. We are accelerating expansion of this knowledge across our platforms, including the key role played by nurse practitioners, care coordinators and external partners who work together with our clinicians to better meet the health needs of consumers in various clinical settings. We also have been active in CMS' BPCI [Bundled Payments for Care Improvement] program and have just enrolled to participate in the new BPCI Advanced program with our providers to help us redesign care practices across a number of clinical episodes, while reducing nonvalue-added variation and adopting best practices. We have also established a series of clinical expert councils, led by and composed of physicians, typically within the same specialty, to help us achieve the [healthcare] triple aim."
Gil Peri
COO of Connecticut Children's Medical Center (Hartford)
"Our physician alignment plan is based on meeting the needs of community providers by partnering to provide a seamless care experience across the continuum. We are developing a clinically integrated network with community pediatric primary care providers, pediatric specialists and the hospital to define pediatric quality metrics that improve outcomes and bend the cost curve. Our team works with primary care providers and specialists to support improving access to care and communicating via technology to ensure the providers have the necessary information to provide care in the medical home. We consistently survey our [more than 1,200] physicians to assess engagement and challenges and use that information to improve our alignment and address gaps."
Debbie Schiff
Senior Vice President and Executive Director of Ambulatory Strategy and Business Development at Northwell Health (New Hyde Park, N.Y.)
"Our ability to strengthen and expand relationships with physicians remains the cornerstone of the health system’s ambulatory network build. Northwell offers a multitude of physician alignment models, ranging in degree of affiliation, in order to meet physicians' needs and support our clinical programs. We continue to align with physicians throughout the region, filling market and clinical gaps through focused growth of the medical group and expansion of the Northwell Health IPA. Additional alignment approaches include physician partnerships in clinical joint ventures such as ambulatory surgery centers and strategic affiliations that offer opportunities to align based on collaborative quality initiatives.
"Currently, Northwell employs more than 4,000 physicians, with an average of 500 physicians hired into the medical group (formally called Northwell Health Physician Partners) each year. With over 670 ambulatory locations offering primary, medical and surgical specialty care, as well as urgent care, imaging, cancer, dialysis and ambulatory surgery centers, our health system remains committed to promoting wellness and managing the health of the population in the communities where our patients live and work."
Allison Suttle, MD
CMO of Sanford Health (Sioux Falls, S.D.)
"Over the past 20 years, Sanford Health has created a physician-driven, integrated delivery system. We have developed physician alignment through employment and a physician governance structure that creates one clinical practice across our footprint in North Dakota, South Dakota, Minnesota, Iowa and Montana.
"Physicians across state lines of the same specialty create one systemwide department to work on clinical standardization, quality dashboards, reducing unnecessary variation, recruitment, retention, market share expansion, research and education. Sanford physicians get the data they need and the administrative resources necessary to make the best clinical decisions to deliver on the value proposition. In addition, we continue to educate on the changes happening in healthcare. We have implemented pilots around compensation based on access, efficiency, per member per month and quality to prepare physicians for future value-based payment programs."
Warner Thomas
President and CEO of Ochsner Health System (New Orleans)
"We remain focused on trying to align more physicians through multiple ways. We believe a common IT platform and medical record, along with integrated clinical information among our entire Ochsner Clinic group [practice] and community physicians, is critically important to deliver coordinated, organized care for our patients. This strategy aligns more physicians to not only integrate care, but have a more consistent delivery of care, and in how we look at ambulatory metrics across all our [1,100-plus] physicians within the system."
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