1. Improve relationships between independent and group physicians. According to Ms. Schlichting, Henry Ford Health System recently started the Henry Ford Physician Network, an organization that aims to bring together private physicians and employed physicians from the Henry Ford Medical Group. According to Ms. Schlichting, one challenge in creating the physician network was increasing the trust between different types of physicians. “Within our community, the medical group has been threatening to private physicians. It’s a huge organization and very prestigious, and private physicians weren’t sure what the medical group was about,” she says. “The medical group had been fairly insular for a while, and they weren’t relying on private physicians for significant referrals.”
She says there was a fair amount of misinformation and some mistrust between the two groups because the private physicians had been competing with the medical group in each of Henry Ford’s markets. “Unlike some medical groups that are only specialty-based, our medical group has a significant primary care presence in each of the markets in southeast Michigan,” she says. “They’re competing, and that’s a fundamental challenge as we try to build together.”
She says the first step was appointing a leader that would create a bridge between the two sides. John Popovich, MD, reached out and got to know the private physicians, and the health system appointed a CMO for the physician network who had served as a leader in one of Henry Ford’s community hospitals. “[Appointing those leaders] set up a structure that allows us to be credible with our private physicians,” she says.
Ms. Schlichting says Henry Ford still needs to work at communicating across the private physician world. Historically, she says the health system has relied on connections between hospitals to communicate, but the system will focus more on physician communication going forward. “The medical group physicians are employees of the health system, so it’s much easier to be able to communicate regularly on a whole host of fronts because they work within the system and they’re part of the email network,” she says. “How can we reach out much more effectively [to private physicians]?”
2. Learn from your lean times. According to Ms. Schlichting, the Henry Ford system has been living in the world of pay-for-performance for a while. “In our local market, there’s a significant amount — about $20 million dollars of payment — now at risk,” she says. Because Henry Ford owns a health plan, Henry Ford Medical Group, physicians are used to living in a “world of capitation,” she says, and they understand the importance of using quality metrics and managing cost — a task many health systems are only beginning to tackle. “We believe, and I’ve been saying for several years, that whatever the government and the payors come up with, we should be prepared for that,” she says.
She credits this ability to manage costs to the tough local economy. “Being in the Detroit marketplace has required us to be a lot more vigilant,” she says. “There are many markets that are growth markets and that are economically stronger [than we are]. For us, there’s been no choice.” In the late 1990s, the system suffered through major financial problems, and Ms. Schlichting was forced to cut a significant percent of the workforce. “Whenever you’ve gone through the terrible experience of laying off a large number of people, you become incredibly disciplined around cost,” she says. The health system rewards leaders with annual incentive plans for both financial performance and quality to make sure Henry Ford stays on track.
She says the task of managing costs is made easier by employing 50 percent of the system’s physicians. “When you’re salaried, you’re not trying to increase your own income by doing more,” she says. “That’s why I believe the medical group model is a very positive model, because you’re so aligned on trying to do the right work for patients without having to worry about your income.”
3. Facilitate communication between unit leaders. One of the keys to successful integration, Ms. Schlichting says, is to create a strong leadership system that enables communication between different facilities. A large health system must figure out how to keep each hospital and “business unit” up to date on system goals, policies and direction. Ms. Schlichting says Henry Ford accomplishes this in a number of ways. To begin with, all the system’s business unit leaders congregate every two weeks for a “performance council,” where they develop the system’s strategic plan, review operating performance and engage in real-time discussion on system-wide issues. In addition to the performance council, Henry Ford has a group called LEAP that brings together the top 120 leaders on a quarterly basis.
The system also holds town hall meetings with each leadership group, and the CEOs of every hospital report to the system COO. “We really structure our leadership to enable effective communication around strategic issues that the system is dealing with,” she says. This leadership structure also assists the health system in using quality metrics effectively, as hospital leaders can discuss benchmarking and facility progress with other leaders to compare results and share ideas.
Learn more about Henry Ford Health Care System.
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