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GE Healthcare Camden Group Insights Blog

How to Engage Physicians in Leadership

Posted by Matthew Smith on Nov 7, 2016 4:18:57 PM

First published November 3, 2016 by Physicians Practice

Creating good governance structures and providing leadership training can increase physicians' engagement in medical groups, according to Marc Mertz, vice president of GE Healthcare Camden Group, a healthcare consultancy with offices around the country. 

Mertz teamed up with Peter Valenzuela, chief medical officer of the multispecialty Sutter Medical Group of the Redwoods, a multispecialty group of 125 providers in Santa Rosa, Calif., at this year's Medical Group Management Association (MGMA) annual conference, held at the Moscone Center in San Francisco, Calif. Together the two explained how physicians can take more important roles in running medical groups.

More and more physicians are employees rather than owners of their practices, said Mertz, and this is causing them to feel less invested in the practices' success. Mertz cited a 2006 survey by Jackson Healthcare in which 36 percent of internists and 51 percent of surgical specialists were "actively disengaged" from leadership.

"This is just a recipe of disaster," said Mertz. "We'll never be able to respond to the opportunities and the challenges of the market if you have this level not only of non-engagement but active disengagement."

Addressing the problem requires involving physicians in the vision, strategy, operation, and oversight of the practice so they develop a sense of ownership, even if they don’t have legal or financial control, Mertz said.

Where physicians legally own a practice, they may have a role in the governance through a board of directors. But as employees physicians either have no formal place in medical practice governance or may only serve on advisory boards with no real power.

Instead, physicians should take leadership positions near the top of the organization. "You can call it what you want," Mertz said. "It could be a joint operating committee of a physician leadership council. The key is the physicians are at the table with the administrators dealing with high-level issues."

The physician leadership council or committee can then delegate to subcommittees nitty-gritty decisions, such as finance and technology. These subcommittees can offer an opportunity for young physicians to get involved in some issue they feel passionate about, and this experience will help develop their leadership skills, Mertz said.

Physicians should also help make decisions throughout the medical group, Mertz said. He recommended dyad structures in which a physician is paired with an administrator.

But creating a structure for physicians to participate won't help the organization unless physicians have leadership skills, said Valenzuela.

Sutter Medical Group of the Redwoods drew up a list of leadership skills from the book "FYI: For Your Improvement — Competencies Development Guide" by Heather Barnfield and Michael M. Lombardo. The top leadership asked physicians and their administrator partners to choose the leadership skills they wanted to improve.

The administrators and physician leaders identified 10 skills to work on, and chose coursework from the Harvard ManageMentor online curriculum that focused on those skills. For example, one module coached the leaders on how to run better meetings.

It can be challenging to justify the time physicians take away from clinical care and the money spent on such training, Valenzuela said. But the group has seen a 25 percent increase in work relative value units (WRVUs), a 41 percent increase in total patient encounters, and 28 percent increase in internal referrals from 2013 to 2015, suggesting that this work has paid off.

To learn more about how you can engage physicians in leadership, please click the button below.

Engage Physicians in Leadership

Topics: Physician Engagement, Marc Mertz, Physician Leaders

Clinical Integration Via Strategic Physician Engagement: 7 Approaches

Posted by Matthew Smith on Jan 26, 2016 3:19:40 PM

New payment models make it more important than ever for hospitals to collaborate with physicians. From readmission penalties to bundled payments to Accountable Care Organizations ("ACOs"), providers have a growing economic incentive to pool resources, share information, coordinate care and services, and cooperate on quality improvement.

But while the incentives are strong, the obstacles to clinical integration are daunting. Hospital-physician collaboration is operationally complex. Although physician employment can smooth out some of the bumps, practice acquisition is expensive. While a handful of large health systems have devoted extensive resources to launching clinical integration initiatives, most smaller organizations are still sorting out their options.

How can hospitals integrate with physicians without creating political and financial problems? The solution is to focus on building mutually beneficial relationships and use existing resources wisely.

The following practical approaches will help healthcare leaders achieve clinical integration by engaging physicians, strategizing collaborative programs, and making targeted investments.

1. Understand Physician Motivation

Convincing physicians to collaborate more closely with a hospital can be challenging. Physicians are trained as autonomous decision makers. Perfectionism and the need for control can make it difficult to weave physicians into an integrated organization. But there is a positive side to the medical personality: No doctor wants to be an outlier.

Engage physicians by presenting data on their patient outcomes. Most physicians will discover at least a few areas in which their performance falls short of their peers.

Talk to doctors about their patients’ flu vaccination rates, medication reconciliation rates, performance on diabetes control measures, etc. This is easiest for hospitals that have access to physician claims data through a physician-hospital organization ("PHO") or that offer physicians a subsidized electronic medical record ("EMR") with built-in Clinical Quality Measure ("CQM") templates that facilitate reporting.

Most physicians do not track and evaluate their own performance, let alone measure their performance against peers. Relevant patient statistics will earn physicians’ attention and generate interest in working more closely with hospital staff to improve outcomes.

It is also important to educate physicians on the evolving healthcare market. Explain how payers are creating incentives for clinical integration though bundled or global payments and per patient/per month care coordination fees. As physicians become more aware of these payment trends, many will embrace the opportunity to increase their salary by partnering with the hospital.

2. Create True Physician Governance

To gain the most under new payment models, physicians and hospitals have to play nice in the sandbox. The key is establishing a governance body that allows physicians to guide the development of care strategies and clinical protocols. Physician-led governance will create physician awareness and support for clinical integration initiatives and make a positive impact on the overall success of the program. Make sure the clinical integration governance committee includes physicians from solo practices and small partnerships as well as large groups. Include representatives from a range of specialties.

Most important, the governance body should include physicians who are critical or even negative about the clinical integration initiative. Often these “difficult” physicians simply want to be heard and provide their input. Making these physicians feel included will go a long way toward smoothing the transition to integration.

3. Focus on Quality, Not Finances

Physicians are concerned about productivity and payment, but concentrating exclusively on financial metrics will disenchant many providers. Focus instead on clinical quality and performance improvement. After all, this is the main reason physicians entered medicine — to provide quality care to the patients they serve.

The clinical integration committee should establish quality benchmarks and treatment protocols that define performance standards. Benchmarks can be based on evidence-based standards and care plans developed by national quality organizations and disease associations. Micromanaging clinical decisions will be unpopular, so care protocols should be broad guidelines that allow room for individual judgment.

To choose initial improvement goals, review admission and inpatient reports to identify areas of low quality and high cost. For which conditions does the hospital see the greatest number of admissions? Which conditions have the longest length of stay? Physicians using an EMR may be able to report on certain quality measures. For example, what is the percentage of hypertensive patients with adequate blood pressure control? How many heart disease patients have an up-to-date lipid profile?

Begin the clinical integration outreach with physicians in specialties linked to poorer outcomes and higher costs. Another logical starting point is primary care. Family practice physicians and internists often have the greatest impact on chronic disease management.

4. Concentrate on Care Coordination

One of the biggest opportunities in clinical integration is better coordination of care. Focus on high- and medium-risk patients who are responsible for the highest costs or who will likely increase costs in the near future. Target care transitions between the hospital and admitting specialists or primary care physicians. Involve physical therapy, home health providers and long-term care facilities in clinical coordination planning.

Physicians need to ensure that discharged patients complete follow-up visits. The hospital can assist by sponsoring a care coordination team for the entire organization to help manage follow-up appointments, referrals and home health services. To help guide care coordination, stratify hospital discharges by risk of readmission, complication or care plan non-compliance.

5. Use Technology to Get Providers Talking

Clinical integration is nearly impossible without an EMR system, but many medical practices are not far along in EMR adoption. Most practices cite expense as the main obstacle.

To overcome the cost hurdle, consider subsidizing EMR systems for practices that agree to join the integrated organization. Relaxation of the Stark laws allows hospitals to subsidize as much as 85 percent of the purchase and support costs of an EMR system. Subsidy agreements can require physicians to report quality measures and meet quality performance thresholds.

However, do not expect physicians to acquire the same EMR system as the hospital. Many small practices can do very well with free and low-cost alternative systems. The hospital should build interfaces for exchanging information with the EMR systems used by the majority of integrated physicians.

Many physicians who have implemented EMRs have participated in the Medicare and Medicaid EHR Incentive Program. As part of demonstrating Meaningful Use under the program, these physicians have already begun tracking clinical quality measures. Clinically integrated organizations should use the EMR to create aggregated quality reports and share them with physicians. Weekly or monthly reports can track disease management data such as HbA1c levels, cholesterol, blood pressure and preventive screenings. Giving physicians the chance to view quality performance metrics will engage both their competitive personalities and their collaborative spirit.

6. Build Financial Incentives

Clinical integration will require physicians to invest time and money into patient education, technology and additional staff. The problem is that methods of compensating providers for care coordination are still being developed and tested by payers. Given the costs being shouldered by physicians, financial incentives are critical.

Regardless of how incentives are distributed, hospital leaders should reward physicians either for controlling costs, achieving quality benchmarks or both. Focus on achieving care management quality metrics early on, since reduced costs tend to follow well-managed patients. Establish and re-assess these performance targets annually.

One important note: Make sure primary care physicians get a piece of the pie. Although surgical specialists might be responsible for most of the hospital’s costs and revenue, primary care doctors have the most frequent patient contact and are also responsible for most of the work of chronic disease management.

7. Invest Early for Healthy Returns

Even hospitals without the resources of a large medical system can achieve clinical integration by focusing on strategic investment and engaging community physicians through quality improvement. Hospital leaders need to allow physicians to establish the quality benchmarks and evidence-based protocols for the organization’s costliest conditions. Leaders can then concentrate on linking doctors through technology, assisting with care coordination, and negotiating with payers on bundled payments or pay-for-performance incentives.

Topics: Clinical Integration, Clinically Integrated Networks, Physician Engagement

7 Ways to Achieve Clinical Integration Through Strategic Physician Engagement

Posted by Matthew Smith on Aug 19, 2015 12:11:58 PM

New payment models make it more important than ever for hospitals to collaborate with physicians. From readmission penalties to bundled payments to Accountable Care Organizations ("ACOs"), providers have a growing economic incentive to pool resources, share information, coordinate care and services, and cooperate on quality improvement. 

But while the incentives are strong, the obstacles to clinical integration are daunting. Hospital-physician collaboration is operationally complex. Although physician employment can smooth out some of the bumps, practice acquisition is expensive. While a handful of large health systems have devoted extensive resources to launching clinical integration initiatives, most smaller organizations are still sorting out their options.

How can hospitals integrate with physicians without creating political and financial problems? The solution is to focus on building mutually beneficial relationships and use existing resources wisely.

The following practical approach will help healthcare leaders achieve clinical integration by engaging physicians, strategizing collaborative programs and making targeted investments.

1. Understand Physician Motivation

Convincing physicians to collaborate more closely with a hospital can be challenging. Physicians are trained as autonomous decision makers. Perfectionism and the need for control can make it difficult to weave physicians into an integrated organization. But there is a positive side to the medical personality: No doctor wants to be an outlier.

Engage physicians by presenting data on their patient outcomes. Most physicians will discover at least a few areas in which their performance falls short of their peers.

Talk to doctors about their patients’ flu vaccination rates, medication reconciliation rates, performance on diabetes control measures, etc. This is easiest for hospitals that have access to physician claims data through a physician-hospital organization ("PHO") or that offer physicians a subsidized electronic medical record ("EMR") with built-in Clinical Quality Measure ("CQM") templates that facilitate reporting.

Most physicians do not track and evaluate their own performance, let alone measure their performance against peers. Relevant patient statistics will earn physicians’ attention and generate interest in working more closely with hospital staff to improve outcomes.

It is also important to educate physicians on the evolving healthcare market. Explain how payers are creating incentives for clinical integration though bundled or global payments and per patient/per month care coordination fees. As physicians become more aware of these payment trends, many will embrace the opportunity to increase their salary by partnering with the hospital.

2. Create True Physician Governance

To gain the most under new payment models, physicians and hospitals have to play nice in the sandbox. The key is establishing a governance body that allows physicians to guide the development of care strategies and clinical protocols. Physician-led governance will create physician awareness and support for clinical integration initiatives and make a positive impact on the overall success of the program. Make sure the clinical integration governance committee includes physicians from solo practices and small partnerships as well as large groups. Include representatives from a range of specialties.

Most important, the governance body should include physicians who are critical or even negative about the clinical integration initiative. Often these “difficult” physicians simply want to be heard and provide their input. Making these physicians feel included will go a long way toward smoothing the transition to integration.

3. Focus on Quality, Not Finances

Physicians are concerned about productivity and payment, but concentrating exclusively on financial metrics will disenchant many providers. Focus instead on clinical quality and performance improvement. After all, this is the main reason physicians entered medicine — to provide quality care to the patients they serve.

The clinical integration committee should establish quality benchmarks and treatment protocols that define performance standards. Benchmarks can be based on evidence-based standards and care plans developed by national quality organizations and disease associations. Micromanaging clinical decisions will be unpopular, so care protocols should be broad guidelines that allow room for individual judgment.

To choose initial improvement goals, review admission and inpatient reports to identify areas of low quality and high cost. For which conditions does the hospital see the greatest number of admissions? Which conditions have the longest length of stay? Physicians using an EMR may be able to report on certain quality measures. For example, what is the percentage of hypertensive patients with adequate blood pressure control? How many heart disease patients have an up-to-date lipid profile?

Begin the clinical integration outreach with physicians in specialties linked to poorer outcomes and higher costs. Another logical starting point is primary care. Family practice physicians and internists often have the greatest impact on chronic disease management.

4. Concentrate on Care Coordination

One of the biggest opportunities in clinical integration is better coordination of care. Focus on high- and medium-risk patients who are responsible for the highest costs or who will likely increase costs in the near future. Target care transitions between the hospital and admitting specialists or primary care physicians. Involve physical therapy, home health providers and long-term care facilities in clinical coordination planning.

Physicians need to ensure that discharged patients complete follow-up visits. The hospital can assist by sponsoring a care coordination team for the entire organization to help manage follow-up appointments, referrals and home health services. To help guide care coordination, stratify hospital discharges by risk of readmission, complication or care plan non-compliance.

5. Use Technology to Get Providers Talking

Clinical integration is nearly impossible without an EMR system, but many medical practices are not far along in EMR adoption. Most practices cite expense as the main obstacle.

To overcome the cost hurdle, consider subsidizing EMR systems for practices that agree to join the integrated organization. Relaxation of the Stark laws allows hospitals to subsidize as much as 85 percent of the purchase and support costs of an EMR system. Subsidy agreements can require physicians to report quality measures and meet quality performance thresholds.

However, do not expect physicians to acquire the same EMR system as the hospital. Many small practices can do very well with free and low-cost alternative systems. The hospital should build interfaces for exchanging information with the EMR systems used by the majority of integrated physicians.

Many physicians who have implemented EMRs have participated in the Medicare and Medicaid EHR Incentive Program. As part of demonstrating Meaningful Use under the program, these physicians have already begun tracking clinical quality measures. Clinically integrated organizations should use the EMR to create aggregated quality reports and share them with physicians. Weekly or monthly reports can track disease management data such as HbA1c levels, cholesterol, blood pressure and preventive screenings. Giving physicians the chance to view quality performance metrics will engage both their competitive personalities and their collaborative spirit.

6. Build Financial Incentives

Clinical integration will require physicians to invest time and money into patient education, technology and additional staff. The problem is that methods of compensating providers for care coordination are still being developed and tested by payers. Given the costs being shouldered by physicians, financial incentives are critical.

Regardless of how incentives are distributed, hospital leaders should reward physicians either for controlling costs, achieving quality benchmarks or both. Focus on achieving care management quality metrics early on, since reduced costs tend to follow well-managed patients. Establish and re-assess these performance targets annually.

One important note: Make sure primary care physicians get a piece of the pie. Although surgical specialists might be responsible for most of the hospital’s costs and revenue, primary care doctors have the most frequent patient contact and are also responsible for most of the work of chronic disease management.

7. Invest Early for Healthy Returns

Even hospitals without the resources of a large medical system can achieve clinical integration by focusing on strategic investment and engaging community physicians through quality improvement. Hospital leaders need to allow physicians to establish the quality benchmarks and evidence-based protocols for the organization’s costliest conditions. Leaders can then concentrate on linking doctors through technology, assisting with care coordination, and negotiating with payers on bundled payments or pay-for-performance incentives.

Topics: Clinical Integration, Population Health, Physician Engagement, Governance, Care Coordination

Population Health Alliances: Rethinking the Business Model

Posted by Matthew Smith on Mar 26, 2015 12:01:00 PM

By Tara Tesch, Senior Manager, MHSA, The Camden Group

PopHealthAlliance3Healthcare systems are increasingly choosing to partner with other provider organizations to pursue population health initiatives on a more regional and sometimes state-wide basis. These “alliances” are often viewed as alternatives to more traditional mergers and acquisitions, and are created through the collaboration of more than one health system, hospital, or physician group. This emerging collaboration model provides opportunities to share common infrastructure, expand geographic reach, and increase access to additional clinical and support resources. These alliances also face additional challenges associated with sponsorship by multiple organizations that in some cases have historically been competitors.

The Next Generation of Physician Engagement Strategies

The healthcare environment is changing at a rapid pace and the path toward population health requires committed physicians, administrators, and clinicians at all levels and across the continuum of care. These leaders must commit to taking accountability for clearly communicating the transformational vision, goals, and objectives of the population health alliance to unite its members around this effort. Success in engaging the providers will be around demonstrating a true desire and understanding of the critical importance of integrating physician and clinicians into all levels of the alliance’s governance and operations.

Key to meeting this strategic imperative is to engage dynamic, knowledgeable physician leaders with creditability among the broader physician network to proactively meet with the front-line physicians and build support and engagement. Do not assume that established structures (e.g., medical staff meetings, etc.) will always be an effective means to distribute information and build engagement.

Additional strategies that have proven successful for alliances include:

  • Ongoing education for community-based providers in clinical integration, innovative care models, and tracking of clinical quality and outcomes aimed at increasing their understanding of the value of participation in the alliance network. Education requirements should be included in all physician agreements, and dedicated staff and resources assigned to support these efforts.
  • Leadership training and support to empower the next generation of physician leaders to jointly problem-solve and collaborate in achieving the tenets of population health. Set the tone that this is a transformational journey that will have successes and mistakes; jointly learning from them will offer new insights and promote future efficiencies in ongoing value-based care delivery planning and implementation.
  • Transparency in communication and evolving metrics are necessary to keep providers informed and engaged, and to elicit critical behavioral change. Adjustments in reimbursement, care models, coding requirements, IT systems and capabilities, and alliance-wide goals should be distributed regularly followed by timely educational sessions. Physicians can no longer focus only on their individual performance; rather, focus must shift to the care of their patients across the network continuum, and feedback on how appropriate interventions and utilization of care can improve the health of the populations served.

Adding Value to Physicians

Another critical concept in understanding best practices in physician engagement and network development is the realization by alliance and member system leadership that physicians only practice one model of care; they do not change that approach based on what payer or “bucket” the patient may be attributed. Where alliances can add true value to physicians and actively engage providers is in support services such as care management and IT platform/analytics – areas to support efficiency and provide actionable information in real time.

  • Create a centralized care management institute at the network level that includes performance improvement and care management resource support that can be accessed by other organizations if they do not have their own resources for local work efforts.
  • Establish an ongoing monitoring process, overseen by the alliance clinical committee to measure and track improvement in a clinical indicators over time. This active monitoring and validation helps to test whether or not the data is accurate, the metric(s) is (are) appropriate, and if the process in place actually impacts performance/outcomes.

A consistent challenge remains around providing meaningful data at the point-of-care to educate and engage providers around their performance on clinical quality and financial outcomes. As value-based care delivery relies on care model transformation, physicians rely more and more on receiving actionable information around their clinical outcomes, adherence to evidence-based guidelines and protocols, and value-based metric performance to impact behavior change and operational tools to support practices in care redesign.

The new care models and payment methodologies associated with population health management will require more tightly aligned financial and clinical incentives between hospitals and physicians. Initiatives in these areas must be physician-led to achieve sustained success clinically and financially.

One final consideration: employment does not guarantee physician alignment or integration. The same principles of engagement hold true whether employed or independent, and incentives that align with targeted behavioral change become increasingly important for longer-term success and transformation. Design incentive plans that not only encourage productivity, but reward physician efforts to achieve shared goals in care, quality, and cost control.

Parts two and three in this series will focus on Care Redesign and Data Governance, respectively.


 

taraMs. Tesch is a senior manager with The Camden Group in the clinical integration practice with more than 18 years of experience as a healthcare leader and strategist. Ms. Tesch specializes in value-based care delivery strategic planning, CIN development and implementation for commercial, Medicare, and Medicaid populations, health information technology data governance and analytics strategy, as well as care management strategy, design, and implementation. She has worked with a variety of healthcare providers, including integrated delivery networks, academic health centers, regional referral centers, rural community providers, and national non-profit and faith-based health systems. She may be reached at ttesch@thecamdengroup.com or 312-775-1700.

Topics: Clinical Integration, Population Health, Clinically Integrated Care, Physician Engagement, Population Health Alliance, Tara Tesch

Six Clinical Integration Articles Available as PDF Downloads

Posted by Matthew Smith on Jun 20, 2014 8:52:00 AM

Clinical Integration, Health DirectionsAs part of our ongoing commitment to our clients, social media followers, and the healthcare industry, Health Directions authors original content that is published regularly in national publications as well as on our HD Insights Blog. We create this content to educate and inform, as well as stimulate important conversation around these key topics. 

You may have read one, or all, of these articles, but we've re-packaged them for you into individual PDFs that may be downloaded and printed out at your convenience.

We hope that you receive some valuable insight from these articles and invite you to subscribe to the HD Insights Blog and comment on the articles in the Comments section, below. 

To download each article, simply click on the respective button which will automatically direct you to an online PDF. To download, right click on the page and save to your device.

Clinical Integration, Health Directions, Population HealthFunding Clinical Integration, Population Health, Health Directions

Clinical Integration, Health Directions, Population Health, Regional Clinically Integrated Networks, CINs, Health Directions, Population Health, Clinical Integration

Clinical Integration, Hospital-Physician CollaborationClinical Integration, Franchise Model, Health Directions

 HD Insights Blog, Health Directions, Blog Subscription 

Topics: Clinical Integration, William K. Faber MD, Physician Engagement, Daniel J. Marino, Download

7 Steps to Achieving Clinical Integration Via Physician Engagement

Posted by Matthew Smith on Jun 2, 2014 11:18:00 AM

Clinical Integration, Physician EngagmentNew payment models are making it more important than ever for hospitals to collaborate with physicians. From readmission penalties to bundled payments to ACOs, providers have a growing economic incentive to pool resources, share information, coordinate care and services and cooperate on quality improvement. 

But while the incentives are strong, the obstacles to clinical integration are daunting. Hospital-physician collaboration is operationally complex. Although physician employment can smooth out some of the bumps, practice acquisition is expensive. While a handful of large health systems have devoted extensive resources to launching clinical integration initiatives, most smaller organizations are still sorting out their options.

How can hospitals integrate with physicians without creating political and financial problems? The solution is to focus on building mutually beneficial relationships and use existing resources wisely.

The following practical approach will help healthcare leaders achieve clinical integration by engaging physicians, strategizing collaborative programs and making targeted investments.

1. Understand Physician Motivation

Convincing physicians to collaborate more closely with a hospital can be challenging. Physicians are trained as autonomous decision makers. Perfectionism and the need for control can make it difficult to weave physicians into an integrated organization. But there is a positive side to the medical personality: No doctor wants to be an outlier.

Engage physicians by presenting data on their patient outcomes. Most physicians will discover at least a few areas in which their performance falls short of their peers.

Talk to doctors about their patients’ flu vaccination rates, medication reconciliation rates, performance on diabetes control measures, etc. This is easiest for hospitals that have access to physician claims data through a physician-hospital organization (PHO) or that offer physicians a subsidized electronic medical record (EMR) with built-in Clinical Quality Measure (CQM) templates that facilitate reporting.

Most physicians do not track and evaluate their own performance, let alone measure their performance against peers. Relevant patient statistics will earn physicians’ attention and generate interest in working more closely with hospital staff to improve outcomes.

It is also important to educate physicians on the evolving healthcare market. Explain how payers are creating incentives for clinical integration though bundled or global payments and per patient/per month care coordination fees. As physicians become more aware of these payment trends, many will embrace the opportunity to increase their salary by partnering with the hospital.

2. Create True Physician Governance

To gain the most under new payment models, physicians and hospitals have to play nice in the sandbox. The key is establishing a governance body that allows physicians to guide the development of care strategies and clinical protocols. Physician-led governance will create physician awareness and support for clinical integration initiatives and make a positive impact on the overall success of the program. Make sure the clinical integration governance committee includes physicians from solo practices and small partnerships as well as large groups. Include representatives from a range of specialties.

Most important, the governance body should include physicians who are critical or even negative about the clinical integration initiative. Often these “difficult” physicians simply want to be heard and provide their input. Making these physicians feel included will go a long way toward smoothing the transition to integration.

3. Focus on Quality, Not Finances

Physicians are concerned about productivity and payment, but concentrating exclusively on financial metrics will disenchant many providers. Focus instead on clinical quality and performance improvement. After all, this is the main reason physicians entered medicine — to provide quality care to the patients they serve.

The clinical integration committee should establish quality benchmarks and treatment protocols that define performance standards. Benchmarks can be based on evidence-based standards and care plans developed by national quality organizations and disease associations. Micromanaging clinical decisions will be unpopular, so care protocols should be broad guidelines that allow room for individual judgment.

To choose initial improvement goals, review admission and inpatient reports to identify areas of low quality and high cost. For which conditions does the hospital see the greatest number of admissions? Which conditions have the longest length of stay? Physicians using an EMR may be able to report on certain quality measures. For example, what is the percentage of hypertensive patients with adequate blood pressure control? How many heart disease patients have an up-to-date lipid profile?

Begin the clinical integration outreach with physicians in specialties linked to poorer outcomes and higher costs. Another logical starting point is primary care. Family practice physicians and internists often have the greatest impact on chronic disease management.

4. Concentrate on Care Coordination

One of the biggest opportunities in clinical integration is better coordination of care. Focus on high- and medium-risk patients who are responsible for the highest costs or who will likely increase costs in the near future. Target care transitions between the hospital and admitting specialists or primary care physicians. Involve physical therapy, home health providers and long-term care facilities in clinical coordination planning.

Physicians need to ensure that discharged patients complete follow-up visits. The hospital can assist by sponsoring a care coordination team for the entire organization to help manage follow-up appointments, referrals and home health services. To help guide care coordination, stratify hospital discharges by risk of readmission, complication or care plan non-compliance.

5. Use Technology to Get Providers Talking

Clinical integration is nearly impossible without an EMR system, but many medical practices are not far along in EMR adoption. Most practices cite expense as the main obstacle.

To overcome the cost hurdle, consider subsidizing EMR systems for practices that agree to join the integrated organization. Relaxation of the Stark laws allows hospitals to subsidize as much as 85 percent of the purchase and support costs of an EMR system. Subsidy agreements can require physicians to report quality measures and meet quality performance thresholds.

However, do not expect physicians to acquire the same EMR system as the hospital. Many small practices can do very well with free and low-cost alternative systems. The hospital should build interfaces for exchanging information with the EMR systems used by the majority of integrated physicians.

Many physicians who have implemented EMRs have participated in the Medicare and Medicaid EHR Incentive Program. As part of demonstrating Meaningful Use under the program, these physicians have already begun tracking clinical quality measures. Clinically integrated organizations should use the EMR to create aggregated quality reports and share them with physicians. Weekly or monthly reports can track disease management data such as HbA1c levels, cholesterol, blood pressure and preventive screenings. Giving physicians the chance to view quality performance metrics will engage both their competitive personalities and their collaborative spirit.

6. Build Financial Incentives

Clinical integration will require physicians to invest time and money into patient education, technology and additional staff. The problem is that methods of compensating providers for care coordination are still being developed and tested by payers. Given the costs being shouldered by physicians, financial incentives are critical.

Regardless of how incentives are distributed, hospital leaders should reward physicians either for controlling costs, achieving quality benchmarks or both. Focus on achieving care management quality metrics early on, since reduced costs tend to follow well-managed patients. Establish and re-assess these performance targets annually.

One important note: Make sure primary care physicians get a piece of the pie. Although surgical specialists might be responsible for most of the hospital’s costs and revenue, primary care doctors have the most frequent patient contact and are also responsible for most of the work of chronic disease management.

7. Invest Early for Healthy Returns

Even hospitals without the resources of a large medical system can achieve clinical integration by focusing on strategic investment and engaging community physicians through quality improvement. Hospital leaders need to allow physicians to establish the quality benchmarks and evidence-based protocols for the organization’s costliest conditions. Leaders can then concentrate on linking doctors through technology, assisting with care coordination, and negotiating with payers on bundled payments or pay-for-performance incentives.

Clinical Integration, Physician Engagement, Health Directions

Topics: EHR, EMR, Clinical Integration, Clinically Integrated Care, Physician Engagement, Coordinated Care

New Download: Engaging Physicians In a Clinical Integration Program

Posted by Matthew Smith on May 15, 2014 2:29:00 PM

Clinical Integration, Download, Health DirectionsAs organizations begin to clinically integrate care across their patient care continuum, physician participation and engagement is critical to its overall success. Leaders of CI organizations must be able to effectively present the CI value to physicians and education community physicians.

This presentation draws from the experiences of several Clinical Integration/ACO programs and distills some unique and innovative approaches to engage physicians in achieving distinguished results in the areas of:

  • Clinical Integration Governance
  • Patient Engagement
  • Superior Clinical Results
  • Increased Efficiencies
  • Sustained competitive advantage for the provider organizations

This presentation takes real-world examples from multiple clinical integration programs
to distill best practices in engaging physicians to drive program results,
allowing participants to:

  • Unleash physician creativity to build comprehensive programs
  • Use Clinical Integration to drive product line performance
  • Engage specialists to drive hospital quality and safety performance
  • Develop governance best practices to build a culture of committed physicians
To access this presentation, please click the button below:

Clinical Integration, Physician Engagement, Health Directions

Topics: Clinical Integration, William K. Faber MD, Physician Engagement, Daniel J. Marino, Download

Last Reminder for Webinar Registration: Clinical Integration 2.0: Second Generation Physician Engagement Techniques

Posted by Matthew Smith on Mar 13, 2014 4:00:00 PM

Webinar, Engaging Physicians, Clinical IntegrationClinical Integration 2.0: Second Generation Physician Engagement Techniques

Monday, March 17: 11:00 AM-12:00 PM (CST)

Presented by Health Directions, LLC

Daniel J. Marino, President/CEO
William K. Faber, MD, MHCM, Chief Medical Officer

Join Health Directions President/CEO Daniel J. Marino and Chief Medical Officer, William K. Faber, MD, as they present a fact-filled webinar focusing on engaging physicians in clinical integration efforts.

As organizations begin to clinically integrate care across their patient care continuum, physician participation and engagement is critical to its overall success. Leaders of CI organizations must be able to effectively present the CI value to physicians and education community physicians. This 60-minute webinar draws from the experiences of several Clinical Integration/ACO programs and distills some unique and innovative approaches to engage physicians in achieving distinguished results in the areas of:

  • Clinical Integration Governance
  • Patient Engagement
  • Superior Clinical Results
  • Increased Efficiencies
  • Sustained competitive advantage for the provider organizations

This webinar takes real-world examples from multiple clinical integration programs to distill best practices in engaging physicians to drive program results, allowing participants to:

  • Unleash physician creativity to build comprehensive programs
  • Use Clinical Integration to drive product line performance
  • Engage specialists to drive hospital quality and safety performance
  • Develop governance best practices to build a culture of committed physicians

Areas that will be addressed within the presentation include:

  • Best practices in evidence-based management techniques for increasing physician engagement and driving clinical integration program objectives.
  • Align the objectives of independent physicians with the hospital and other providers such as post-acute and ancillary.
  • Help independent physicians understand value in clinical integration
  • Provide a roadmap to build an organized system of care across the clinically integrated network

Presentation Learning Objectives:

  • Upon participating in this webinar, participants should be able to:
  • Recognize and utilize effective approaches to engage physicians
  • Align incentives of community physicians within the clinically integrated network
  • Integrate new approaches on how to build organized systems of care utilizing data to drive results at the organization and practice level.

Speakers:

Daniel J. Marino, Health DirectionsAs President/CEO of Health Directions, Daniel J. Marino shapes strategic initiatives for healthcare organizations and senior health care leaders in key areas such as population health management, clinical integration, physician alignment, and Health IT. With a broad background in all aspects of practice management and hospital/physician alignment, Dan is nationally recognized as a strategic leader in Accountable Care Organizations and clinical integration development. He frequently speaks at national conferences and regularly authors articles for the nation’s top healthcare industry publications related to current transformations in healthcare delivery.

 

William K. Faber, MD, Health DirectionsDr. William K. Faber, Chief Medical Officer for Health Directions, is a physician executive with progressive senior leadership experience. He most recently served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s Clinical Integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an Electronic Health Records system (Epic). Dr. Faber formerly participated in the governance of the Advocate Physician Partners (APP) Clinical Integration program and directed APP’s Quality Improvement Collaborative.

 

Registration

To register for this webinar, please click the button, below to be taken to an external registration site. Please include your email address when registering. Your Webinar login information will be emailed to you when your registration is received.

Registration for this webinar is $149 per location.

 

Webinar, Clinical Integration, Health Directions,

 

Topics: Clinical Integration, William K. Faber MD, Physician Engagement, Webinar, Daniel J. Marino

Webinar Registration Open for Clinical Integration 2.0: Second Generation Physician Engagement Techniques

Posted by Matthew Smith on Mar 6, 2014 2:29:00 PM

Clinical Integration, Health Directions, Webinar

Clinical Integration 2.0: Second Generation Physician Engagement Techniques

Monday, March 17: 11:00 AM-12:00 PM (CST)

Presented by Health Directions, LLC

Daniel J. Marino, President/CEO
William K. Faber, MD, MHCM, Chief Medical Officer

Join Health Directions President/CEO Daniel J. Marino and Chief Medical Officer, William K. Faber, MD, as they present a fact-filled webinar focusing on engaging physicians in clinical integration efforts.

As organizations begin to clinically integrate care across their patient care continuum, physician participation and engagement is critical to its overall success. Leaders of CI organizations must be able to effectively present the CI value to physicians and education community physicians. This 60-minute webinar draws from the experiences of several Clinical Integration/ACO programs and distills some unique and innovative approaches to engage physicians in achieving distinguished results in the areas of:

  • Clinical Integration Governance
  • Patient Engagement
  • Superior Clinical Results
  • Increased Efficiencies
  • Sustained competitive advantage for the provider organizations

This webinar takes real-world examples from multiple clinical integration programs to distill best practices in engaging physicians to drive program results, allowing participants to:

  • Unleash physician creativity to build comprehensive programs
  • Use Clinical Integration to drive product line performance
  • Engage specialists to drive hospital quality and safety performance
  • Develop governance best practices to build a culture of committed physicians

Areas that will be addressed within the presentation include:

  • Best practices in evidence-based management techniques for increasing physician engagement and driving clinical integration program objectives.
  • Align the objectives of independent physicians with the hospital and other providers such as post-acute and ancillary.
  • Help independent physicians understand value in clinical integration
  • Provide a roadmap to build an organized system of care across the clinically integrated network

Presentation Learning Objectives:

  • Upon participating in this webinar, participants should be able to:
  • Recognize and utilize effective approaches to engage physicians
  • Align incentives of community physicians within the clinically integrated network
  • Integrate new approaches on how to build organized systems of care utilizing data to drive results at the organization and practice level.

Speakers

Daniel J. Marino, Triple Aim, Health IT, HITAs President/CEO of Health Directions, Daniel J. Marino shapes strategic initiatives for healthcare organizations and senior health care leaders in key areas such as population health management, clinical integration, physician alignment, and Health IT. With a broad background in all aspects of practice management and hospital/physician alignment, Dan is nationally recognized as a strategic leader in Accountable Care Organizations and clinical integration development. He frequently speaks at national conferences and regularly authors articles for the nation’s top healthcare industry publications related to current transformations in healthcare delivery. 
William K. Faber, MD Health DirectionsDr. William K. Faber, Chief Medical Officer for Health Directions, is a physician executive with progressive senior leadership experience. He most recently served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s Clinical Integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an Electronic Health Records system (Epic). Dr. Faber formerly participated in the governance of the Advocate Physician Partners (APP) Clinical Integration program and directed APP’s Quality Improvement Collaborative.

Registration

To register for this webinar, please click the button, below to be taken to an external registration site. Please include your email address when registering. Your Webinar login information will be emailed to you when your registration is received. Registration for this webinar is $149 per location.

Webinar, Clinical Integration, Health Directions,

Topics: Clinical Integration, William K. Faber MD, Physician Engagement, Daniel J. Marino

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