System-level integration is accomplished with a system-level chief medical officer who supervises regional CMOs. The system CMO has an administrative counterpart, a CEO and that dyad structure is replicated throughout the system down to the clinic level. But even a solid reporting structure only creates the platform for physician integration.
"It's easy to hire physicians and pay them," Pryor says. "It's hard to manage physicians. Health systems talk a lot about physician integration. One of the things that they don't talk about is how to put in a system of management that those fiercely autonomous physicians will accept."
That management starts with a multispecialty clinic structure that is approximately 40% primary care and 60% specialty care. Scott & White's five regions are built around the central academic tertiary hub hospital that "holds the 13 hospitals together," Pryor says. Regulations bar the corporate practice of medicine in Texas, so Scott & White's physician board is integrated into system management and makes decisions in all key clinical and operational areas as they affect the group practice, Pryor says.
"They make decisions on hospital operations, physician preference items, computer systems, and evidence-based practices. They're into process redesign. They're in all aspects of hospital and clinic integration. So, it's not like we have a separate management structure for the physicians and a separate one for hospitals."
Integration is not just at the top level, Pryor says. "Even at the smallest clinic that we have with four primary care practitioners, there's a physician leader and an administrative leader in that small clinic."