Browne says the difficulty in creating alignment between physicians and hospitals often rests with the lack of timely and accurate clinical data, especially if you are going to create risk-based employment agreements.
"Physicians want to know, like anyone else, how they are measured and how they are doing if they are going to take on any risk. They need to be clear on how they will be measured and tracked, so you have to choose metrics that are reasonably easy to reproduce—and you don't want 15 metrics, you want two to four," he says. "To encourage that alignment, there's got to be a lot of conversations on the front end about how we can agree to hold each other accountable on quality, and you need to put it in the contract."
Also, Browne says the contract needs to be relatively simple and easily understandable, and should include both achievable and stretch goals. "We're openly sharing the metrics we're tracking with our physicians so we can learn from each other, but it's a work in process with population health," says Browne.
Ultimately, when it comes to deciding whether to employ a physician, Browne and Manas agree it shouldn't be rushed, nor should it be done to keep pace with other hospitals in the marketplace.
"When organizations move too quickly and believe the physicians are in agreement with their goals and that there will be an alignment, but then realize after the fact that there wasn't agreement, it will cause problems," says Manas. "There's a lot of pressure within the marketplace to employ, and organizations sometimes make decisions based on the frenzy in the marketplace and not based on their due
To be successful, Browne says, employment has to fit not only the physician, but also the healthcare organization. "Some systems employ the majority of their doctors, and for other systems that model doesn't fit into their strategy; for us it's not the only option," says Browne. "Still, physician employment needs to remain in the toolbox as an option, and if and when the timing is right for an organization, then it can be the right move."
This article appears in the March 2013 issue of HealthLeaders magazine.