Physician Integration & Alignment: A Survival Guide for Physicians & Hospitals

PHYSICIAN INTEGRATION & ALIGNMENT

A Survival Guide for Physicians & Hospitals

Maria K Todd, MHA PhD Executive Director

The Healthcare Business Institute at the Posner Center for International Development

Š 2013. Healthcare Business Institute, Inc.

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Reality #1

THE TRANSFORMATION INVOLVES PHYSICIAN ALIGNMENT, NOT JUST INTEGRATION WITH HOSPITALS.

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Reality #2

THE CONTINUUM OF CARE HAS CHANGED FROM THE HOSPITAL TO THE AMBULATORY SETTING. The mission of the acute care hospital will be to focus its relationship on accountability for a population or a community and access to safe, high-touch, high-tech, affordable acute care in the inpatient setting. Š 2013. Healthcare Business Institute, Inc.

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Reality #3

PHYSICIAN ALIGNMENT AND INTEGRATION ARE NOT CHARACTERIZED BY MEDICAL PRACTICE OWNERSHIP. The handwriting is on the wall: This time around, merely owning a physician practice will not give rise to a sustainable competitive advantage.

Š 2013. Healthcare Business Institute, Inc.

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Reality #4

PHYSICIANS DIFFER BY SPECIALTY, AGE, GENDER, MARKET, AND BUSINESS MODEL A one-size fits all strategic approach to physician integration and alignment is a strategy for guaranteed failure.

Š 2013. Healthcare Business Institute, Inc.

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Reality #5

THERE IS A COMPLETE DISCONNECT BETWEEN HOSPITAL EXECUTIVES AND THE MEDICAL STAFF To align and integrate the physicians with the hospital, leadership must first reconnect and refocus the lens.

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the ultimate reality check ‌

Value = quality over cost As perceived by the patient, whom both the hospital and the physician serve

Š 2013. Healthcare Business Institute, Inc.

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HOW TO ENGAGE PATIENTS in the coordinated continuum of their personal healthcare?

Š 2013. Healthcare Business Institute, Inc.

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SYSTEMS AND PROCESS ALIGNMENT • Currently, the reimbursement system dictates delivery model • Reimbursement systems must be aligned and integrated

• Systems change with the insurance underwriting cycle • The underwriting cycle will change under health reform

• Align gainsharing, antitrust and other regulations to work under healthcare reform • Currently, if it makes business sense in the market, it is probably illegal in healthcare. © 2013. Healthcare Business Institute, Inc.

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ELIMINATE SILOS • From departmental structure to service-line directed programming • Align all service-line stakeholders, not just the physicians • Integrated accountability for outcomes – clinical, customer service, and financial • Process improvement through innovation & change © 2013. Healthcare Business Institute, Inc.

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LEAN TECHNIQUES BREAK DOWN SILOS To engage and align physicians, executives, revenue cycle, quality, and service line team members

Map the Process

Eliminate disruptions & abnormalities

Determine Capacity & Demand

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Identify waste

Improve workflow

Shorten lead time

Aggressively eliminate remaining waste

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THE HOSPITAL’S PARADIGM Refocus Your Competitive Strategy Reappraise Your Pricing Strategies Reassess Your Referral Assumptions Revise Your Medical Staff Bylaws & Organizational Culture

© 2013. Healthcare Business Institute, Inc.

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REFOCUS YOUR COMPETITIVE STRATEGY • Can’t is “won’t” in disguise – get real • Won’t compete? Game over! Deploy the exit strategy.

• Innovate and adapt • Find the competitive edge and leverage it to the max • Create barriers to competition – eliminate the competition • Re-visit Porter’s Five Forces • Re-read Blue Ocean Strategy © 2013. Healthcare Business Institute, Inc.

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REAPPRAISE YOUR PRICING STRATEGIES • Do they still work?

• Pegged to the right standards?

• Prices strategies transparent and rational?

• Discounts appropriate by consumer type?

• Ready for risk contracting and bundled prices?

• Devised a cash distribution strategy with docs?

• Fully-loaded costs allocated by contract/payer? © 2013. Healthcare Business Institute, Inc.

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REASSESS YOUR REFERRAL ASSUMPTIONS • Once, long ago, referrals came from physicians and MCO directories • Now referrals come from patients, social networking, medical tourism, and employers’ designated provider contracts through direct negotiation with healthcare providers.

© 2013. Healthcare Business Institute, Inc.

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REVISE YOUR MEDICAL STAFF BYLAWS & ORGANIZATIONAL CULTURE • Kick down silos – set them on fire!

• Build teams and champions • Groom future leaders for success with training & professional development • Strike down apathy with natural engagement, not by force

• Reward small, steady improvements to encourage deeper cultural change

© 2013. Healthcare Business Institute, Inc.

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About the Healthcare Business Institute • The Healthcare Business Institute is a nonprofit international development NGO that focuses its efforts on training and skills development for the healthcare industry.

• We arrange hands-on training workshops, leadership retreats and symposia worldwide, led by consultants with practical experience and innovative approaches to tomorrow’s healthcare reform challenges.

© 2013. Healthcare Business Institute, Inc.

All International Rights Reserved.

CONTACT INFORMATION

Dr. Maria Todd Executive Director

Healthcare Business Institute, Inc.

at the Posner Center for International Development 1031 33rd Street Denver, Colorado 80202 +1.800.209.7263 (Mountain Time|GMT-6)

Š 2013. Healthcare Business Institute, Inc.

All International Rights Reserved.