Last year, the IPA Association of California transformed itself into the National IPA Coalition to meet the needs of emerging physician organizations across the country. NIPAC now represents more than 203 physician organizations, which, in turn, care for approximately 5.2 million patients. NIPAC's goal is to help physician organizations prepare for the leadership roles they must assume to be successful in today's changing healthcare environment. Below, NIPAC President Nancy Oswald, and Medical Director Richard Dixon, M.D., suggest possible solutions to some of the complexities and problems that face physician organizations today.
NIPAC's goal is to help physician organizations prepare for the leadership roles they must assume to be successful in today's changing healthcare environment.
Below, NIPAC President Nancy Oswald, and Medical Director Richard Dixon, M.D., suggest possible solutions to some of the complexities and problems that face physician organizations today.
On NIPAC's mission to "enhance physician-directed managed care":
Oswald:We strongly believe physicians are the most appropriate people to manage clinical decisions about healthcare. NIPAC's mission is to help physicians retain their ability to do that. We also believe managed care, properly configured, offers a great opportunity to improve the health of Americans, reduce costly inefficiencies and redirect clinical resources to where they can do the most good. NIPAC strives to help physicians do both -- improve care and make it affordable. We believe these objectives can best be met by clinicians working together in physician organizations such as IPAs, PHOs, medical groups and the like. Physician organizations provide an excellent vehicle through which physicians can regain leadership, albeit in a new way.
The changing leadership role of physicians in healthcare:
Dixon: Previously, physicians could have a substantial effect as individuals. Although it is still possible for a physician to be a great clinician, a great teacher and a great role model, many of the most important decisions affecting clinical care are no longer made by individuals. They are made by organizations. Therefore, physician leaders now need to be able to influence organizations. They need to exert leadership in strong physician organizations that successfully manage care while also successfully managing costs. (A physician leader doesn't necessarily need an MBA, but physicians -- or at least physician leaders who have the respect and ear of their colleagues -- need the strategic orientation and basic knowledge necessary to direct their business, which is providing healthcare services.)
Past physician business success was based primarily on the work done in the office:
Oswald: That was before market consolidation. For the vast majority of physicians, their offices are no longer their most important businesses. Increasingly, a physician who is not part of a larger organization cannot compete. She doesn't influence clinical protocols and standards. She may not even have access to large groups of patients. To be successful, physicians need to be a part of a physician organization with managed-care contracts. Physician leaders are those who understand that they have a stake in the success of that larger business, just as they do in their practices.
Characteristics of a successful physician organization:
Oswald: A strong physician organization must possess several core competencies: First is good governance. The organization must be able to make timely decisions -- decisions that benefit patient care and strengthen the overall physician organization. Its governance also needs to retain the confidence and support of clinicians in the organization. Additional core competencies are strong clinical operations (utilization review, quality management, etc.), financial operations, claims, and contract administration and member services. Finally, physicians need good information in order to manage care and costs.
Patients as customers:
Oswald: One of the biggest changes facing physicians is that their former patients have also become consumers, customers and members. Successful physician organizations need to think about customer service, including ways of appealing to and meeting the healthcare needs and preferences of those individuals they serve. Unhappy customers go somewhere else.
The cost (and rewards) of information services:
Dixon: Like it or not, investments will need to be made. Good information is now a cost of doing business. But the investment is not necessarily huge, and it's certainty not unaffordable for physicians and their organizations.
We can't manage care without information about our patients, nor can we manage our financial risk. Moreover, sophisticated purchasers are now demanding reliable, standardized data from organizations with whom they contract. A physician organization that cannot readily respond to those requests for data will fail to compete effectively for that business.
Dramatic improvements in information systems needn't be unaffordable. Physicians already spend enormous sums on information systems. Unfortunately, most of those information systems are very inefficient. My own physician tells me he spends a third of his time simply trying to find information he needs to make clinical decisions. I doubt he's exaggerating. We are increasingly seeing technology that can save time and money for physicians.
Dixon: We help physician organizations in a couple of major, interconnected ways: First, we provide education, training and tools so that individual physician organizations can improve their core competencies. Second, we provide a voice for physician organizations when healthcare policy is being made; we seek to assure that physician organizations get a seat at the table where the rules are being written. We also help physician organizations take the lead in standardizing their own business practices.
Now, we can't do that in a vacuum. So, we do so in collaboration with plans, purchasers and other providers. The rules we help write have to be market-tested. If physicians, through their own organizations, are not intimately involved in writing the rules for how care is managed, others will.
Examples of NIPAC's helping to "write the rules":
Oswald: NIPAC took the lead in establishing market-accepted policies and procedures that physician organizations use in managing clinical operations. Our clinical operations manual provides standard policies and procedures that already have received endorsement from many major health plans; the documents in the manual also are provided electronically so they can be customized to meet local needs. The manual saves both the physician organization and the health plan the pain of having to do it all from scratch.
Similarly, NIPAC created a financial operations manual that provides physician organizations with essential information for implementing a sound financial management structure.
Another example is the lead we have taken in California with the Pacific Business Group on Health, a large employer coalition, to standardize healthcare information. We have gotten buy-in from a critical mass of purchasers, plans and providers to "collaborate on data" so as to "compete on quality." Finally, we are actively involved in developing the solvency standards for provider sponsored organizations. Physician organizations are definitely at the table where the rules are being written.