"That platform works best for when we get to changing clinical patterns," says Corso, echoing dozens of healthcare cost experts who claim the real waste in healthcare lies not in the supply chain or in revenue cycle enhancement, but in getting doctors to change the way they practice medicine into a standards-based and team-based alignment.
"The challenge is that you're starting from chaos. And to see your way through that is difficult because some of these relationships already have tension built into them from past misunderstandings," he says.
Despite the myriad forces driving hospitals and health systems and their physicians closer together, physician practices continue to be largely facility-specific, and old relationship patterns that continue post-acquisition can undermine the success of the combination going forward.
"We try to establish where there's a gap between physicians' expectations of employment and the difference between what the system expects to get from that employment," Corso says. "You find gaps not so much in contractual terms but in the implied conditions of employment."
One such gap—the implication that despite their employment status, physicians have been promised autonomy. But autonomy means different things to different people.
"If, as a physician, you expect that, and the system wants to centralize, that's not autonomy," he says. "You had an implied expectation of autonomy that's now being moved. But it's to everyone's advantage for that compact to change, to be interdependent."