Early Lessons Learned in Healthcare Integration

The road to creating a horizontally oriented structure in the face of a well-established vertical business structure model is not typically easily accomplished. The course of constructing the service line, in most institutions, is transformative. Virtually every reporting relationship and decision-making structure is potentially disrupted.

MedAxiom recently completed a survey of more than 150 physician groups across the nation, representing more than 2,420 physicians. When asked what was working in the service line organization, respondents to the survey cited mostly the development of infrastructural elements and culture, often responding that the relationship between the hospital and the physicians had improved. Access to and more purposeful coordination of resources have enhanced the ability to implement projects related to technology, clinical program development and market development, such as outreach — in both the hospital and practice environments. Many respondents stated having had the experience of uncovering, correcting and now improving quality, registry reporting and data and have successfully participated in efforts to perform in a value-based purchasing environment or in response to third-party accreditations and rating programs.  

Many of the groups surveyed reported they are participating in innovative payment model pilots, such as accountable care organizations and bundled payments — initiatives that would have previously been embroiled in negotiating the contract terms between the entities rather than focusing on the development of the model. Most programs have been able to standardize equipment and supply utilization and thus affect per unit cost savings, and many have begun the work of "Leaning" processes within the hospital and practice and — most importantly — between the two.

Successes have been seen through:

  • Physician-driven cost-per-case advances, focused on reducing variation in care.
  • Physician and staff collaborative deploying purchasing strategies based on clinical care standards (e.g., do we really need three high voltage devices?)
  • Strategic deployment of physician resources to effectively manage outreach operations and other program developments.
  • Better deployment and adoption of interoperable information technology platforms.
  • Value creation via data control.
  • Quality improvement in discreet clinical processes.
  • Operations efficiency advances in clinical and non-clinical operations.
  • Physician recruiting and succession management stabilization.
  • Cost reduction via elimination of duplicate services and functions.
  • Improved clinical documentation and coding practices.
  • Consolidated financial statements that clearly reflect the business performance of the entirety of the service line.

Survey respondents reported that the clear, executive leadership support of an articulated shared vision was critical to their success and facilitated the cultural integration and the infrastructure development. It is also clear from the survey responses that cultural integration precedes value creation, but — where programs are working collaboratively — integration value is being created.  

Some of the value being created can be described as:

  • A transformative vision attracts physicians and staff to a new and better future, engendering support and buy-in.
  • Senior leadership support and communication are provided to teach and transform.
  • Understanding that the skills required for a service line leader may not be the same as those of a physician practice leader or a department leader. Leadership of the service line, both clinically and administratively, will have to be carefully selected and developed.  
  • Deliberate and obtuse onboarding tactics to facilitate the physician practice's cultural integration is critical at the outset of the integration.
  • Positive physician energy will fuel the effort; lack of physician energy, regardless of the degree of staff energy, will kill it.
  • Those most powerful will have to compromise. Period.
  • Trust is a series of trustworthy events. Trust is required to overcome the inevitable bumps; start building it now!
  • The three most important aspects to building trust are: transparency, transparency and transparency. Transparency in data, in objectives and in everything is required to build trust and credibility.
  • Leaders will be pushing the snowball up the mountain until the organization adopts a "we" orientation, instead of an "us vs. them" mindset.
Unleashing the physicians' clinical expertise to reconcile and establish clinical standards around which efficient processes, empowered staff and leveraged information technology systems will deliver improved quality and decreased cost. Decision-making models and compensation plan design, giving the physicians the authority and responsibility to create value, are the vehicles to facilitate performance.

Suzette Jaskie is president of MedAxiom Consulting and the executive vice-president of MedAxiom. Ms. Jaskie was the CEO of West Michigan Heart and Wisconsin Heart and Vascular in Milwaukee prior to her current position. She also previously served as the executive director of the Frederick Meijer Heart and Vascular Institute, for Spectrum Health System in Grand Rapids, Mich., that governs and manages the cardiovascular service line for the regional health system. Ms. Jaskie has a master's degree in business administration from the University of Hartford and a bachelor's of science degree from the University of Wisconsin.

More Articles on Hospital Integration:

3 Stages of Hospital and Physician Practice Integration
4 Contemporary Issues in Hospital, Physician-Practice Integration
Survey: 53% of Cardiologist Practices Are Integrated With Hospitals

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