Collaborating to build an aligned, high-performing physician enterprise

During his 20 years in healthcare, Chris has focused on the physician enterprise as a leader in both practice plan and consulting environments. His experience includes administering practice plan operations as well as overseeing the delivery of comprehensive engagements at academic medical centers and health systems throughout the United States. He has specialized expertise in the areas of physician solutions, children's hospitals and cancer centers.

CS: Traditionally, when considering how affiliated or acquired medical groups can deliver a return-on-investment, most health systems have weighed three components: investment or average loss per physician, provider productivity and compensation alignment, and downstream revenue generation (i.e. ancillary services, referrals, etc.).

Understanding the value of an employed or affiliated medical group in today's environment is like looking through 3D glasses. One lens provides a glimpse into the fee-for-service world, where everything is measured in terms of access, volume and enhancing productivity to rationalize the investment. The other lens looks at population health, where quality of care, utilization, costs and patient outcomes are key. These two views work toward vastly different goals, and looking at both simultaneously can be overwhelming.

Organizations that have demonstrated success in defining and measuring the value of the medical group have gone beyond traditional measures. They are embracing quality and service metrics, measures around physician and staff satisfaction, and indicators of patient satisfaction. And to make all of this happen, health system leaders have invested in business intelligence that helps them not only standardize measures and metrics but produce actionable data to enable meaningful discussions with physicians to shift culture, align goals and incentives, and measure success.

CS: Integration with physicians in medical groups requires training, cultural adoption of new management structures and pacing – which can all add on to a practicing clinician's never-ending list of things to do. Burnout is a widespread phenomenon across healthcare that more than 54 percent of physicians are experiencing. While concerted efforts are being made to address the symptoms of burnout through support and wellness programs, few organizations have addressed the root cause of the problem. We know some physicians often spend two hours of desk time documenting information in their electronic health record (EHR) for every hour of patient care. With the increase in administrative and regulatory demands, physicians are finding it increasingly difficult to fit more than eight hours of direct patient care and the requisite follow-up activities into a single work day. A spike in EHR logins on weekday and weekend nights has been coined “pajama time” for physicians as they catch up on record intake and documentation.

To address this problem, practices are looking at strategies to optimize workflow, staffing and skill mix; EHR documentation; and office layouts so that physicians can spend more time doctoring patients than they do recordkeeping. The improved throughput often translates to increased volume and net patient revenue (cash collections of billing activity) for fee-for-service patients. Ultimately this means a professional net patient revenue margin improvement ranging from 5 to 7 percent. These changes can also have a dramatic impact on patients, who often experience enhanced access to care and streamlined operations.

To help navigate this difficult terrain, Premier is bringing health system and clinical leaders together to challenge perceptions and practices related to medical group performance. Premier's Physician Enterprise Collaborative leverages the power of peer-to-peer learning, data-enabled decision making and innovation to develop, pilot and evaluate new cost, quality and service-related improvement solutions.

CS: The shift to managing populations involves redefining the care team structure along with the associated roles and responsibilities. This requires careful planning, education, physician buy-in, targeted pilots, and close monitoring prior to rolling out broader changes in care delivery. Careful consideration of the economics and payment models between health systems and medical groups is important to ensure financial solvency.

Without an at-risk contract in place between a health system and their employed or affiliated medical groups to reflect care transitions, there will likely be a negative financial impact as more proactive care keeps patients out of the hospital. Physicians are often in the middle trying to attend to the needs of the patient while navigating changes in care coordination and delivery.

The lesson here is to put physicians in the driver's seat. Traditionally, healthcare leaders are very good at assessing the financial impact of healthcare decisions, but can underestimate or underappreciate the potential impact to patients. By empowering clinicians to drive more informed choices, we can minimize the associated operational and financial risks.

To learn more about Premier Inc., please visit www.premierinc.com/pec.