Furthering Our Missions: Physician Strategy as the Foundation to Improving Community Health

Physician strategy is top of mind for many hospital leaders. As Lewis Carroll once wrote, "If you don't know where you are going, any road will get you there." This is true for hospital and health system strategy and especially true for physician strategy. Physician strategy is the foundation around which health systems are built. Hospitals and health systems without a strong physician strategy aren't going to be able to play a significant role in the marketplace in the future. After all, physicians — together with their patients — ultimately control healthcare market share, volume and, as a result, financial success.

Imran Andrabi discusses physician strategyToday the "buzz word" around physician strategy is clinical integration. Although a few prominent health systems have long been clinically integrated, others are just beginning their efforts to more formally align their hospitals, physicians and other providers. Clinical integration can mean a lot of things, but generally it refers to managing the entire continuum of care for our patients — from preventing disease, to treating them in the office, and coordinating their care during and after a hospital admission.

To me, as a family medicine practitioner for the last 20 years, this is simply what most primary care providers do every day. Now, healthcare leaders are working to make this type of coordination the industry standard. We must formally develop it among all types of providers through truly putting the patient at the center and developing clinical protocols enabled by infrastructure that provide the right care at the right time, in the right setting with the right overall experience for the lowest cost. This, of course, is where healthcare is heading, and it's being directed there by new healthcare practices that prioritize value over volume.

Beyond primary care
To be successful, physician strategy must consider how the hospital will strengthen relationships among its organization and among all physicians. Primary care strategy and specialist strategy should be considered holistically. When I hear healthcare leaders ask if they should develop a primary care strategy or a specialist strategy, as a physician, I scratch my head. A primary care physician cannot take care of a patient alone, and neither can a specialist. A health system's physician strategy must find the right balance in the development of primary care and specialty care networks. Focusing on one or the other doesn't fit with the future of healthcare delivery we face.

Primary care providers, though, are surely the foundation upon which healthcare delivery is built. They coordinate care among various specialists and facilities to ensure the best care for their patients. Because of this important role, Mercy is developing a medical home model for our primary care practices. Through this, we will help build the systems and infrastructure — human, technological and structural — needed to coordinate care.

Beyond employment
Hospitals and health systems today seem to be in an ongoing race to employ physicians, for reasons driven by both the hospitals and physicians. But, there are many ways to achieve integration outside of employment. At Mercy, we anticipate significant growth in the number of physicians we employ in the next two to three years. However, we do not have a mindset of driving physicians solely into an employment structure. Rather, our goal is to partner with our physicians by providing them options to set them and their patients up for success. Other alternatives that are frequently utilized include but are not limited to: joint ventures, clinical co-management models, shared savings models, and utilization of clinical and practice management tools to name a few.

For the physicians we do employ, we are a currently implementing a new governance model that gives them even more control over their practice and setting strategy for their group. A governing board of representative physicians will oversee all aspects of the operations of the employed physicians, through physician-driven committees tasked with guiding the day-to-day operations, strategy, business development, quality, IT, finance and  leadership development. When we started this process I really wasn't sure about how we would get physicians excited about participating, but the reality is that more and more physicians are interested in being part of designing the solutions to a complex healthcare delivery model rather than  be passive, sitting on the side lines and reacting to what comes  next.

We've also launched a clinical integration oversight group with representation from our hospitals, employed and independent physicians, which has been tasked with exploring how we might develop a clinically integrated organization that is capable of adapting to the changing landscape of the new healthcare delivery and payment system.

One thing that is important to remember, though, is successful clinical integration is achieved through a lot more than physician employment. An employed physician is not automatically an engaged physician. Physicians also have to be activated and motivated for the right reasons to play an active role in the creation of the right models of care. Hospitals can't simply hire physicians or contract with them and expect for care to magically be coordinated and value-driven. Instead, organizations must be careful to provide the infrastructure needed to achieve this. For example, Mercy has invested heavily in implementing an integrated electronic health record that allows for a single chart per patient irrespective of where care is delivered — be it in a physician office, a hospital  or an emergency department. This type of information sharing, we hope, will help to break down the silos that can exist among the various sites of care, that reduce duplication, improve quality of care, improve patient safety and lower costs for our patients and the healthcare system overall. We are also exploring the development of technological infrastructure for data mining. We want to be able to provide analytics to our physicians that help them understand their work against certain outcomes and benchmarks and inform sound high quality clinical decision making.

Linking back to our mission
This type of data, reporting and transparency is necessary not only to show the impact we have on our individual patients but also to show our impact on the communities we serve. Have we truly been able to improve care of the diabetic patient? Better controlled hypertension? Reduced the incidences of coronary artery disease? The list goes on and on. At Mercy, our mission is to "extend the healing ministry of Jesus by improving the health of the communities we serve, with a special emphasis on those who are poor and underserved." How can we improve the health of our communities without population health management? It's clear a future of value-based, population-driven care is where healthcare is headed, and in my opinion, where it must head.

Any health system's two most important customers are their patients and physicians. Any health systems greatest asset is its people that provide care to the patients that seek it from them. We live in interesting times. We have been here before in healthcare. It seems difficult and overwhelming at times but we are a resilient group. We have come up with innovative ways of facing these challenges before and I am sure that even though it might seem difficult at times our industry has the intelligence, the drive and the desire to create new solutions that we never thought possible. Our healthcare, and our country, will be better because of it.

More Articles Featuring Imran Andrabi:

Creating an Outcomes-Based Culture: How to Engage Front-Line Staff in Process Improvement
A Culture of Continuous Improvement is Necessary for Success Under Value-Based Care

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