More physicians are being tapped to lead health systems, as organizations look to work closely with doctors to limit unnecessary care and reduce variation. Demand is growing for strategists who can align physicians around a clinically integrated network and have the operational expertise to establish vertically integrated service lines, Hafner said.
"If there isn't a strong partnership between clinical and operational, then the organization will fail one way or another," Hafner said.
Physicians also respond better to leaders who share their background and expertise, experts said. Doctors who bring a "granular and frontline understanding of what it means to care for patients" have a built-in credibility with other physicians, Intermountain's Harrison said.
Some see it as acknowledgment of the importance of clinical care. The patient-physician relationship drives the healthcare industry, said Dr. Peter Angood, president and CEO of the American Association for Physician Leadership.
"With the Affordable Care Act rollout, implementation of the Medicare Access and CHIP Reauthorization Act and (its) Merit-based Incentive Payment System, ACOs and new pay models, for success to occur physicians need to be better integrated in the continuum of care, from pre-intake to post-acute," Angood said. "Systems begin to be better, outcomes are better and patient satisfaction is better."
Physicians would like to participate in value-based care models but also want to be paid for doing so. One of the most common issues brought up by AMGA members is changing the physician compensation culture when systems have a foot in both fee-for-service and value-based medicine, said Dr. Ashok Rai, president and CEO of Prevea Health and incoming chairman of the AMGA.
"I see that as the biggest challenge for the CEOs of today and tomorrow," he said. "Health systems need to adapt to physician and specialty groups, which are the centerpieces of care delivery today, not the other way around."
While physician leaders aren't always the best fit for certain provider organizations, several studies suggest that physician-led hospitals have higher-quality care. Hospital quality scores are approximately 25% higher in physician-run hospitals than in manager-run hospitals, a 2011 Amanda Goodall found after examining the 100 best hospitals for cancer, digestive disorders and cardiovascular care.
Conversely, more needs to be done to better prepare physicians in how to lead. "Many doctors are not very well-prepared to lead at all," Angood said. "Physicians understand the clinical model and delivery in a fiscally responsible way. It's why physician-led ACOs do better. But there needs to be more leadership education and professional development."
Healthcare boards are looking for executives who are willing to take drastic steps or bring an outsider perspective to lead their organization.
Patricia Maryland said her goal when she became Ascension Healthcare's chief operating officer in 2013 was to transform an "unsustainable environment." To do so, she wanted to create a culture that delivered "reliable information to monitor quality, cost and population health," said Maryland, who became CEO of Ascension Healthcare in June.
But providers are taking cues from companies outside of healthcare that have undergone successful transformations, said John Driscoll, CEO of CareCentrix, a post-acute care management company. Some of those strategies involve nutrition, transportation and behavioral support, he said.
"Healthcare organizations are looking outside of the industry to accelerate innovation and deliver better patient outcomes," Driscoll said. "It requires a whole-patient view."
Ultimately, healthcare is still local, said Domanico of Marin General. It's up to the CEO to maintain close ties with the community, no matter how big the organization grows, he said.
"The public's trust in us is invaluable," Domanico said. "And I think it's invaluable for all hospitals."
