The move to coordinated, accountable care has brought the importance of primary care to the immediate attention of hospital and health system executives. After all, "primary care equals market share," as Marc Halley, president and CEO of Halley Consulting Group, likes to say. "What we're looking at — population health and managing patients across the continuum of care — that all starts in the primary care office," he says. So, naturally, hospitals and health systems that are gearing up to manage population health or to form an accountable care organization as a reimbursement strategy have to be concerned with building their primary care provider base.
With the focus squarely on primary care providers, it may be easy for hospitals to get distracted and put specialty physician strategies on the back burner. However, specialty physicians are still necessary and important in a coordinated, accountable care model. "If you're going to need to manage the health of a population, you need to have access to [sub-specialties]," Mr. Halley says. "You can't say in an ACO that you don't [offer] general surgery. You can't run an ACO without…sub-specialists."
To make accountable care work, organizations need to find the right set of physicians, including non-primary care physicians, and manage the relationships between and among the physicians and their hospital.
Hospitals and health systems looking for sub-specialists to participate in an accountable care organization or an integrated network, should look for specialists and practices that excel in these three areas, according to Mr. Halley:
1. Clinical quality. First, the physicians should provide top-notch clinical care, measured in ways such as low readmission and infection rates.
2. Service quality. The physicians should provide excellent service to both patients and the referring physicians.
3. Utilization management. The specialists should utilize procedures efficiently, only performing invasive or high-cost procedures when necessary.
Finding or keeping specialty physicians who fit those qualifications will help meet the goals of reducing the cost of care while improving quality and patient outcomes and will make an accountable care model run smoothly.
In particular, hospital CEOs should lead the charge of managing physician relationships. "The CEO should be in the marketplace asking [physicians] how [the hospital] is doing," he says. Overall, managing physician relationships is all about asking questions.
For instance, hospital CEOs need to be asking their primary care physicians, be they employed or independent, if the specialists in the network are meeting their needs: Are they accessible? Do patients say good things about the sub-specialists they get referred to? Overall, hospital CEOs need to find out if primary care physicians are referring to in-network specialists or if there is network leakage and why. If physicians give negative responses, hospital executives need to take steps to make the problems right by speaking with the specialists or possibly bringing in a new group, depending on the complaint.
On the specialist side, hospital CEOs need to ask the physicians whether or not aspects of the hospital are working for them, such as the operating room schedule, the lab or anesthesia. If these areas of a hospital are not making the life of a specialist easier, he or she can easily leave for greener pastures.
All physicians are important when it comes to coordinated, accountable care. Finding the right set of specialty physicians and then managing the hospital's relationships with all of the network's physicians and the physicians' relationships with each other and the hospital can help make an accountable care model more effective and efficient in the long run.
With the focus squarely on primary care providers, it may be easy for hospitals to get distracted and put specialty physician strategies on the back burner. However, specialty physicians are still necessary and important in a coordinated, accountable care model. "If you're going to need to manage the health of a population, you need to have access to [sub-specialties]," Mr. Halley says. "You can't say in an ACO that you don't [offer] general surgery. You can't run an ACO without…sub-specialists."
To make accountable care work, organizations need to find the right set of physicians, including non-primary care physicians, and manage the relationships between and among the physicians and their hospital.
What to look for in specialists
While non-primary care specialists are still important in an integrated accountable care organization, participating hospitals and health systems may need to start thinking about them in a different way. "Focus your energy on specialists of choice," Mr. Halley says, emphasizing quality over quantity. Some integrated delivery networks may even reduce the number of physicians or groups in a specialty to drive referrals to the highest quality, most efficient physicians.Hospitals and health systems looking for sub-specialists to participate in an accountable care organization or an integrated network, should look for specialists and practices that excel in these three areas, according to Mr. Halley:
1. Clinical quality. First, the physicians should provide top-notch clinical care, measured in ways such as low readmission and infection rates.
2. Service quality. The physicians should provide excellent service to both patients and the referring physicians.
3. Utilization management. The specialists should utilize procedures efficiently, only performing invasive or high-cost procedures when necessary.
Finding or keeping specialty physicians who fit those qualifications will help meet the goals of reducing the cost of care while improving quality and patient outcomes and will make an accountable care model run smoothly.
Managing physician relationships
As the ideal specialists are integrated in an accountable care model, it is important for C-suite executives to manage the relationships between and among primary care providers, non-primary care physicians and hospital departments in order to prevent network leakage or losing physicians to another hospital or system. "You cannot leave…referral relationships to chance if you want to survive in an accountable care model," Mr. Halley says. "Relationship management has to occur all along the continuum."In particular, hospital CEOs should lead the charge of managing physician relationships. "The CEO should be in the marketplace asking [physicians] how [the hospital] is doing," he says. Overall, managing physician relationships is all about asking questions.
For instance, hospital CEOs need to be asking their primary care physicians, be they employed or independent, if the specialists in the network are meeting their needs: Are they accessible? Do patients say good things about the sub-specialists they get referred to? Overall, hospital CEOs need to find out if primary care physicians are referring to in-network specialists or if there is network leakage and why. If physicians give negative responses, hospital executives need to take steps to make the problems right by speaking with the specialists or possibly bringing in a new group, depending on the complaint.
On the specialist side, hospital CEOs need to ask the physicians whether or not aspects of the hospital are working for them, such as the operating room schedule, the lab or anesthesia. If these areas of a hospital are not making the life of a specialist easier, he or she can easily leave for greener pastures.
All physicians are important when it comes to coordinated, accountable care. Finding the right set of specialty physicians and then managing the hospital's relationships with all of the network's physicians and the physicians' relationships with each other and the hospital can help make an accountable care model more effective and efficient in the long run.