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Succeeding, Together

Edward Prewitt, for HealthLeaders Media, April 11, 2014
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This article appears in the April 2014 issue of HealthLeaders magazine.

Recently I sat down with leaders from several health systems for an in-depth discussion about hospital-physician alignment (see page 24). These executives, holding a range of business and clinical leadership positions, talked about the current and coming changes in governance, compensation, and cooperation with respect to physicians. They agreed that the sharp increase in physician employment, a trend chronicled by HealthLeaders Media research, is almost beside the point; employment doesn't create integration. "We're not going to employ [all physicians]," says Jonathan Scholl, chief strategy officer for Texas Health Resources. "So to build a system that is pluralistic, that offers the option for well-run employment, but also [considers] how an independent physician relates to the system in a way that provides them benefit and also marches toward the destination of accountable care, is critical."

This issue's cover story (starting on page 10) takes the physician perspective on the changes hitting healthcare. "It's a very difficult time to be a physician. Doctors are facing reduced reimbursement; they have regulatory requirements, increased costs to run a practice," Robert Lerman, MD, vice president and medical director for physician integration at Dignity Health, told Senior Editor Jacqueline Fellows. San Francisco–based Dignity works with 9,000 doctors, 90% of whom are independent. The pressures physicians face, Lerman observes, "really sort of mirror some of the same things the hospitals are going through with value-based purchasing, penalties for readmissions, and shrinking margins for Medicare."

Sounds like hospitals and physicians can either succeed together or fail separately. I often hear laments from healthcare leaders about the difficulty of having "one foot on the dock and the other in the canoe"—that is, maintaining fee-for-service reimbursement while preparing for value-based care. At Reliant Medical Group in Worcester, Mass., up to 80% of patients will be under risk-based agreements by the end of this year—and that's a good thing both financially and clinically. "Being in a risk environment allowed us to do many of the things that physicians wished they could do," says CMO Marc-David Munk, MD. Longer appointments, home visits, and closely tracking chronically ill patients are all made easier by risk-based contracts.

At the center of healthcare's transformation is an overhaul of primary care. HealthLeaders Media's monthly Intelligence Report, excerpted on page 30, examines the progress and goals of primary care redesign. Survey respondents say their top goal is improved care coordination and collaboration, exceeding patient volume, care quality, care access, or market share over any other need. There's only one way for that to happen: alignment.


This article appears in the April 2014 issue of HealthLeaders magazine.


Edward Prewitt is the Editorial Director of HealthLeaders Media.
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