10 Tips to Creating a Physician-Led Integrated Care System With Advocate Health's Mark Shields

Advocate Physician Partners has already stepped into the brave new world of integrated care, signing managed care contracts that assume risk. This loosely affiliated group of 3,700 physicians in the Chicago area includes 800 physicians employed by Advocate Health Care, which runs 10 hospitals. Here Mark Shields, MD, MBA, senior medical director of Advocate Physician Partners, shares some tips on forming such arrangements.

1. Set up payor contracts. Advocate Physician Partners manages a clinical integration pool, funded by commercial insurers, covering about 10 percent of physician fees that are distributed to physicians, provided they meet 116 system-wide clinical and efficiency goals, updated yearly. Last year, participating physicians earned $4.9 million in the clinical integration program at just one Advocate hospital, Advocate Good Samaritan.

2. Meet legal concerns. When independent physicians negotiate payor contracts together, as occurs at Advocate Physician Partners, they are at risk of violating FTC prohibitions against colluding to set prices. Advocate Physician Partners can negotiate such contracts because it is integrated clinically and to a lesser extent financially, Dr. Shields says.  

3. Find out what payors want.
"We do a lot of talking with employers and insurers to determine what are the key concerns," Dr. Shields says. "We focus on things that improve employee productivity, such as treating depression, which is a major loss of function at work." For example, heart surgery patients are at risk for depression. "It took a little bit of persuading to get our cardiologists to order a depression screening, but it has been a success," he says.   

4. Create a culture. For an integrated system to work, there has to be a culture of information-sharing and transparency. Dr. Shields says there needs to be a common business goal and physicians need to participate through a governance system. Safety has to be balanced with cost-effectiveness.

5. Get physicians energized. "Physicians need to drive the process," Dr. Shields says. "This would be difficult for hospital executives who have bad relationships with physicians." Dr. Shields urges communicating with practitioners. "Physicians need to understand the financial impact of what they are doing," he says. Advocate uses training programs to get physicians up to speed.

6. Create a chronic disease registry. Disease registries clustered around diseases and conditions, such as asthma and diabetes, help physicians track key patient information. When registries are put on the Web, they can be tracked in real time. The registries are key because "chronic disease drives healthcare costs to a great extent," Dr. Shields says.

7. Perform patient outreach. Patient outreach is crucial to efficient provision of care. Advocate Physician Partners mails reminders to patients about upcoming visits and sends educational material and a telephone reminder. Each physician's office does the same.

8. EHR not necessary. While some healthcare IT is needed for projects like the disease registry, Dr. Shields says an electronic health record is not needed to create the relationships and shared culture at the heart of an integrated system. Advocate is, however, installing an EHR.

9. Provide more information for patients. When insurance exchanges begin under healthcare reform, more patients will opt for individual insurance, and providers will need to direct payor information to the consumer. "Patients expect information to be presented differently than how an employer wants it," Dr. Shields says. For example, patients often don’t understand the importance of measures like use of beta blockers or aspirin after a heart attack. Instead, they want more outcomes data.

10. Shared savings will come. Chicago-area payors are contemplating taking their payment arrangement with Advocate and creating shared savings approaches market-wide, but many local providers are not interested in this approach. "We have been told by consultants that some other systems in Chicago have no interest in clinical integration," Dr. Shields says. "I feel that is shortsighted."

Find out more about Advocate Physician Partners.

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