Now more than ever, the competitive priority for hospital and health system leadership is focused on value – improving quality while controlling costs. As the industry rapidly transitions to value-based care models, the approach an organization selects will determine its fate.
To address today's demands, some organizations have reorganized into clinically integrated networks (CINs) – physicians, hospitals and post-acute care (PAC) providers collaborating to improve value. CIN development has been proven to enhance an organization's value, but as Einstein said, "The definition of insanity is doing the same thing over and over and expecting different results." In other words, providers must understand and accept that developing a CIN requires transformative changes in how they deliver care.
In multiple sessions, 50 healthcare executives from across the country convened to discuss the role of clinical integration in helping providers excel in today's value-based environment. While all markets are different, executives identified physician engagement as a key determinant of successful CIN development. Based on their interaction, following are four strategies for engaging physicians in a successful CIN environment.
Expectations and Incentives
As a successful CIN needs to be physician-led and professionally-managed, participation and collaboration among all physicians across the care continuum are essential ingredients of any high-performing CIN. As such, executive leadership should consider detailing physician expectations in an upfront provider agreement, to include measures based on performance and an understanding that collaboration among physicians across specialties is required. Physicians that do not maintain the standard should not be able to remain in the CIN, and physician leaders will need training in governance and leadership to help sustain these expectations.
Developing appropriate incentives is another necessary initial step to get physicians on board.
Physicians will be asked to work in new and unfamiliar ways, and they'll need to be rewarded for their time and flexibility. While there's no perfect incentive approach, demonstrated improvements in patient care and elimination of services that don't provide patient value need to be at the center of the incentive plan. After all, patient care is why physicians went into medicine in the first place and represents a meaningful way to engage them.
Alternative Payment Model Participation
Bundled payments – single, fixed payments for services by two or more providers during an episode of care or specific time period, to include acute and post-acute care – represent a key opportunity to engage physicians in a CIN strategy and better connect care across the continuum. The goal of bundled payment programs, such as Medicare's Comprehensive Care for Joint Replacement (CJR) and Episode Payment Models, is to create an aligned model that improves the value of care, addresses a significant portion of the total cost of care and provides physicians with better visibility into their performance.
Organizations engaging primary care and specialist physicians are using bundling as a successful strategy through commercial contracts, Medicare programs or virtual bundles within shared savings contracts by creating episodes of care within their attributed populations.
Virtua Health's Senior VP of Clinical Integration, Stephen J. Kolesk, M.D., suggested that since a successful bundling initiative starts with physician engagement and buy-in, management will need to identify physician leaders and influencers that can effect change while ensuring physicians – particularly specialists – are engaged in the development of bundled programs from the onset. Use of data to show physicians who the key players are and the variations in care that exist is also essential, as is having regular meetings and education sessions to communicate metrics and ongoing opportunities, Dr. Kolesk said.
The Medicare Access and CHIP Reauthorization Act (MACRA) also presents an impetus for physician CIN participation. MACRA aims to curb physician spending by rewarding better care, not more care. The carrot-or-stick approach has physicians facing payment increases or decreases of up to 9 percent, with enhanced care coordination a central theme to MACRA success. Support of a sophisticated organization to meet MACRA reporting and performance goals will be welcomed by most physicians.
Multidisciplinary Approach
Organizations taking physician engagement to the next level are engaging a multidisciplinary clinical team of mid-level practitioners, care managers, performance improvement personnel, data analysts and other office staff. This type of collaboration helps to drive performance by embedding the CIN program within the office workflow, supporting key initiatives with the proper personnel and providing insights on where physicians should focus based on robust analytics.
Data Transparency
Transparency in data analytics – allowing doctors to see the difference that the practice is making and how each doctor's performance compares to that of their peers'– is another important element to getting buy-in. Each physician needs to know how they can be accountable to the needs of payers, providers and patients. Getting transparency even in limited amounts of data is important to give physicians something to act on.
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