Success key No. 2: Governing the physician network
When the Henry Ford Health System—a Detroit-based integrated system with revenue of $4.2 billion and net income of $21.5 million—began its physician alignment with regional physician groups, it considered metrics and governance to improve clinical outcomes. But it was important that the program was essentially "physician directed," according to Charles E. Kelly, DO, president and CEO of the Henry Ford Physician Network, which was formed in 2010.
The Henry Ford Physician Network includes the Henry Ford Medical Group of 1,300 employed physicians, as well as approximately 550 regional physicians in private practice. Overall, Henry Ford includes 2,000 physicians within the system's six hospitals and 32 primary care centers.
Hospital officials are reaching out to physicians, telling them they can maintain their existing business models as private, employed or medical group physicians, but also have access to the Henry Ford services and resources when joining the network, according to Kelly. They work with payers on value-based contracting to improve outcomes under proposed ACO structures, he says. The network also offers physicians a malpractice insurance program, discounted group purchasing rates, as well as electronic health records to support the practices and connectivity to the Henry Ford Health Information Exchange, a secure platform that shares clinical information and results through the system.
By coordinating care, Henry Ford has been able to "break down the silos on the farms," he says, referring almost satirically to the oft-used phrase about separation of work environments. The physician network has improved communication among the Henry Ford Medical Group, the self-funded insurance plan, as well as the continuing care and home health agencies. "None of them were talking to each other satisfactorily," Kelly says. "If you are going to be successful, you've got to get these supportive functions coordinated."
Among the important elements are the committee structures that the Henry Ford group has established to maintain cooperation with physician networks, Kelly says. A 15-member board of trustees, which includes equal representation from independent physician groups and Henry Ford's own medical practices, oversees
Those committees include areas that focus on finance and payer relations, as well as clinical integration and informatics. Each committee also has balanced representation from independent and hospital physicians, including primary care physicians and various specialists.
The groups are "equally populated by employed docs and independent groups and very much engaged in clinical integration and quality," he says. The journey toward coordination is not easy, Kelly acknowledges. When hospital officials initially talked with doctors about joining the network, some physicians had their arms stiffly folded and scoffed at the idea. But through effective persuasion and collaboration, they have won over 500 independent physicians, including one group practice with 52 family internal medicine physicians who signed up two years ago, he says.
The hospital system is focusing on population management tools that "identify areas we need to prioritize and focus on, with medical management and direction of strategy and tactics to address those issues." Those areas include heart failure, constrictive lung disease, diabetes, and end-stage renal disease. "We're looking at a centralized system for delivering medical management and case management and analytics" to make inroads in the care continuum, he says.
Preliminary data shows the Henry Ford Physician Network is "bending the cost curve," Kelly says. Early results show costs decreased as much as 15%, he says, although he did not disclose exact figures. Kelly also cites clinical care improvements that he attributes, in part, to the physician network.