Chesterfield, Mo.-based Mercy recently realigned into three divisions, a decision that represents a rapidly growing health system under the crunch of industry pressures.
The health system employed about 250 physicians in the St. Louis area in 2005. Now, it employs more than 1,100 physicians in the same region. This created organizational challenges as the health system weathered rising costs and flat rates; it was time to pivot, Jeff Ciaramita, MD, Mercy's president of specialty service lines, told Becker's.
"Within Mercy, we felt the pinch," Dr. Ciaramita said. "The pinch that I'm referring to is an operational efficiency pinch, meaning we didn't believe we were structured enough to deliver the access and high level of care while continuing to focus on the strategies that would set us up for success."
Last August, the system's senior leadership team — including Dr. Ciaramita, who was president of the integrated provider organization Mercy Clinics East at the time — developed this plan to move the organization in a new direction. The goal was to realign existing resources and place the patient "in the middle of everything," per Dr. Ciaramita.
"That wasn't just fancy speak," Dr. Ciaramita said. "We had a structure that was highly matrixed, was complex, was in many areas redundant, and our structure didn't follow the flow of a patient through Mercy. We didn't think it was easy for patients to come to us based upon the structural way we were designed."
An "extremely small" number of operations positions were eliminated, according to Dr. Ciaramita. Some leaders were re-interviewed and shifted to new roles within the enterprise.
The new structure became operational in April, and consists of three divisions:
1. Primary care/population health: Members of this division will strategize population health as a whole, from senior-focused care to traditional primary care. Approximately 47 percent of the health system's revenue comes from population health or value-based arrangements.
"We carry some level of risk with that, so segregating it into its own hyper-focused strategic division just made sense," Dr. Ciaramita said.
2. Operations: Hospital and clinic operations were combined into one entity. Rather than having a separate vice president overseeing operations of each area, such as imaging or orthopedics, one overarching division will now work to "keep the lights on."
3. Specialty service lines: This division, overseen by Dr. Ciaramita, will be composed of six specialty "brand managers": not in a marketing sense, but in a mission sense.
"Service lines was the commitment to invest in a structure — new leaders, new experts, utilization of outside consultants, aggregation of analysts and data sets — to ultimately create from scratch a bigger division focused on who Mercy wants to be in the near future, to really fulfill all of the needs of the patient in each of those specialty areas," Dr. Ciaramita said.
The health system has named presidents to two of its six specialty service lines — orthopedics and sports medicine, and cancer — but is still searching for professionals to helm women's and children's, cardiovascular, neuroscience, and surgery and GI.
Mercy has already seen upticks in patient volume and access, according to Dr. Ciaramita. The system expects its streamlined approach to improve both patient and staff experience and continue to drive financial performance, according to Dr. Ciaramita.