Though still a work in progress, UnityPoint Health's strategic plan calls for physicians to take the lead on managing populations.
This article first appeared in the November 2016 issue of HealthLeaders magazine.
As healthcare organizations take more responsibility for the quality and cost of the care they provide, they face complex problems that challenge existing norms governing how physicians and executives interact. Some people call that "soft stuff." But talk to anyone whose goal is to change a culture and "soft" is the last word they'd use to describe the task. Culture is at least as important as strategy—you can't execute on the latter without a firm foundation in the former.
Culture, and more specifically, physician culture, has a huge impact on how well health systems are meeting their ultimate goal of healing patients. Nowadays, healing is just half the expected outcome. It increasingly must be done cost-effectively, and no group has more of an impact on cost than physicians.
When you attempt to remake their culture, that's where trust comes in, and in many organizations, such trust can be in short supply, says Kevin Vermeer, president and CEO of UnityPoint Health in West Des Moines, Iowa. UnityPoint has been working to align the incentives of physicians and the organization since 2012, when the system began to move toward a value-oriented strategy. Consolidation of several legacy physician groups into a single unit was one important result of the cooperation Vermeer and his leadership team engendered with the organization's more than 900 employed physicians. The work to accomplish that outcome started with an effort to simplify the way the 17-hospital, four-state health system interacts with its physicians.
"We knew we had to move away from episodic, hospital-centric care, and that we needed to be patient-centric and physician-driven," Vermeer says. "But to do that, we needed physicians and providers in general to take the lead in how we manage a community population across the entire continuum."
But how do you get physicians to do that in the face of declining income, increasing regulation, and general frustration with the evolution of clinical practice into what physicians often see as a never-ending treadmill of checkboxes?
Opportunity knocks once
The rise of competition on both the outpatient side and in primary care provides a sense of urgency for many health systems to better cooperate with their physicians. So does the ratcheting down of admissions and readmissions targets for hospitals. Further pressure comes from the implementation of new payment methodologies that determine reimbursement based on much more than whether the organization delivers a service.