Whether or not accountable care organizations become a permanent part of the healthcare landscape, most experts agree that hospital-physician integration is a growing trend that has the potential for significant improvements in efficiency, quality and cost savings. Peggy Naas, MD, MBA, vice president of physician strategies at VHA, offers five strategies for successfully aligning physicians with a hospital.
1. Focus on clinical outcomes. Dr. Naas says, "The primary focus [of integration] ought to be clinical outcomes." She says one of the principle goals of hospital and physician leaders should be forming a plan for delivering clinical outcomes efficiently and in a way that benefits the entire organization. She suggests a model where "physicians and administrative leaders are working together to achieve very specific outcomes metrics through improved processes of care delivery."
2. Choose a specific model. "One way people can work with physicians is employing specific models," Dr. Naas says. She says some models are more suited to certain cultures of an organization than others. For instance, a system like the Mayo Clinic, which has a history and culture of employing physicians, may choose an employed physician model for integration, Dr. Naas says. The different models for physician integration include:
3. Foster physician leadership. Physicians should assess, develop and utilize their leadership skills regardless of the integration model, according to Dr. Naas. "Skillful physician leaders will be important in reaching out to physicians," she says. She suggests seeking out leadership opportunities for physicians to collaborate with hospital administrators and gain experience in managing the hospital's and heath system's services. "Look for physician leaders who can participate in committees; listen to them and start nurturing their understanding of the broader organization's work and the perspective of the board," she says. Physician leadership can take various forms in an integrated hospital. Two options include election, in which physician leaders are elected by their peers, and appointment, in which hospital leaders choose physicians for specific positions based on an application process.
4. Be visible and transparent. Dr. Naas says a useful strategy for physician integration is "getting hospital and health leaders out, visible in the halls of care. Make leadership rounds, talk to doctors where they're working in the hospital and the community" She suggests asking physicians their opinion on what improvements are needed and then reporting back on the hospital's or health system's progress towards those improvements. Dr. Naas says, "Make the feedback loop more specific. If it's something the organization is not going to pursue, say that." Being transparent about the health system's or hospital's performance and outcomes, whether negative or positive, is important to integrating with physicians, according to Dr. Naas. Honesty and transparency will also facilitate physician engagement with hospital and health system leaders in decision-making.
5. Create a culture conducive to alignment. Committing to an integration model will not successfully integrate physicians in the hospital without a culture that is open to collaboration and partnership. "Having a framework does not build the culture. And that is going to move at different rates depending on the preexisting culture and the focus of leadership of both physicians and lay leadership of the hospital and health system," she says. Dr. Naas defines culture as shared experiences that predict behavior. One strategy for creating an integrative culture is to offer experiences involving collaboration. "Provide a different experience of physician leaders working with administrative leaders; provide shared experiences that are shaped and molded to create a different culture," Dr. Naas says.
In addition to shared experiences, physicians and hospital leaders should have shared incentives, according to Dr. Naas. "It doesn't have to be money. It can be a shared value held by each [group.]," she says. Shared incentives will help the hospital and physicians work together to reach a common and valued goal.
To assess whether a culture is conducive to alignment with physicians, she suggests health system and hospital leaders ask themselves if they are being honest and transparent, listening to and learning from others, providing clear feedback on the system and hospital's agenda and performance and then delivering on their promises.
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1. Focus on clinical outcomes. Dr. Naas says, "The primary focus [of integration] ought to be clinical outcomes." She says one of the principle goals of hospital and physician leaders should be forming a plan for delivering clinical outcomes efficiently and in a way that benefits the entire organization. She suggests a model where "physicians and administrative leaders are working together to achieve very specific outcomes metrics through improved processes of care delivery."
2. Choose a specific model. "One way people can work with physicians is employing specific models," Dr. Naas says. She says some models are more suited to certain cultures of an organization than others. For instance, a system like the Mayo Clinic, which has a history and culture of employing physicians, may choose an employed physician model for integration, Dr. Naas says. The different models for physician integration include:
- Employment. Hospitals can employ physicians as a step on the way to align them with the organization. Certain states, such as California, cannot employ physicians due to its prohibition of corporate practice of medicine.• Contracting. Hospitals can develop contracts with independent physicians for specific services, such as in radiology or anesthesiology and build in expectations for aligned efforts.
- Co-management. In co-management, physicians are employed or otherwise paid for administrative roles or clinical leadership tasks, according to Dr. Naas. Physicians and other administrative leaders would have or preferably share outcome-based incentives for a service line for which they are mutually responsible.
- Clinical integration. Clinical integration involves health systems and hospitals partnering with health system-employed and self-employed physicians on specific performance metrics.
"The overwhelming majority [of healthcare organizations] have a mixed medical staff," Dr. Naas says. In this arrangement, the hospital would work with employed, contracted and independent physicians. "Most of our members need to work across the continuum of physicians, irrespective of their employment status. Models that reflect that reality are very useful," she says.
3. Foster physician leadership. Physicians should assess, develop and utilize their leadership skills regardless of the integration model, according to Dr. Naas. "Skillful physician leaders will be important in reaching out to physicians," she says. She suggests seeking out leadership opportunities for physicians to collaborate with hospital administrators and gain experience in managing the hospital's and heath system's services. "Look for physician leaders who can participate in committees; listen to them and start nurturing their understanding of the broader organization's work and the perspective of the board," she says. Physician leadership can take various forms in an integrated hospital. Two options include election, in which physician leaders are elected by their peers, and appointment, in which hospital leaders choose physicians for specific positions based on an application process.
4. Be visible and transparent. Dr. Naas says a useful strategy for physician integration is "getting hospital and health leaders out, visible in the halls of care. Make leadership rounds, talk to doctors where they're working in the hospital and the community" She suggests asking physicians their opinion on what improvements are needed and then reporting back on the hospital's or health system's progress towards those improvements. Dr. Naas says, "Make the feedback loop more specific. If it's something the organization is not going to pursue, say that." Being transparent about the health system's or hospital's performance and outcomes, whether negative or positive, is important to integrating with physicians, according to Dr. Naas. Honesty and transparency will also facilitate physician engagement with hospital and health system leaders in decision-making.
5. Create a culture conducive to alignment. Committing to an integration model will not successfully integrate physicians in the hospital without a culture that is open to collaboration and partnership. "Having a framework does not build the culture. And that is going to move at different rates depending on the preexisting culture and the focus of leadership of both physicians and lay leadership of the hospital and health system," she says. Dr. Naas defines culture as shared experiences that predict behavior. One strategy for creating an integrative culture is to offer experiences involving collaboration. "Provide a different experience of physician leaders working with administrative leaders; provide shared experiences that are shaped and molded to create a different culture," Dr. Naas says.
In addition to shared experiences, physicians and hospital leaders should have shared incentives, according to Dr. Naas. "It doesn't have to be money. It can be a shared value held by each [group.]," she says. Shared incentives will help the hospital and physicians work together to reach a common and valued goal.
To assess whether a culture is conducive to alignment with physicians, she suggests health system and hospital leaders ask themselves if they are being honest and transparent, listening to and learning from others, providing clear feedback on the system and hospital's agenda and performance and then delivering on their promises.
Related Articles on Physician Integration:
Recruiting Statistics Show More Physicians Seeking Hospital Employment
Strategic Medical Staff Development Planning: Going Beyond the Numbers
Trends Unfolding in Physician-Hospital Alignment