4 Resolutions for Physicians in 2016

Based on a year's worth of interviewing and listening to physicians, healthcare executives, and patients, these are the top four things physician leaders should be thinking about—and doing—this year.

Instead of looking back at 2015 to analyze the good, the bad, and the ugly of healthcare, I'm taking a forward view and have put together a list of resolutions for physician leaders to consider making in the coming months.

They're based on a year's worth of interviewing physicians, healthcare executives, and patients for this column and for HealthLeaders magazine. I am not a physician, but I talk to a lot of them, and I listen really, really well.

1. Integrate mental health practitioners into primary care practices.
For decades, the mental health needs of patients have played second fiddle to other healthcare concerns. The Patient Protection and Affordable Care Act expanded mental and behavioral health coverage, but it is still not taken as seriously as it should be. Hospital EDs across the country are crowded with patients who are in crisis, and some hospitals are forming strategic alliances.

In New Jersey, five systems have formed the South Jersey Behavioral Health Innovation Collaborative to find a solution that suits patients, physicians, and hospitals.

But where do patients with mental health needs show up first? Their primary care physician's office is often a patient's first stop. In 2007, authors Patricia Robinson and Jeffrey Reiter estimated that 70% of patient visits to a PCP stemmed from a psychological issue. The Agency for Healthcare Research and Quality, which certifies patient-centered medical homes, recognized the mutual benefit of integrating mental health into PCP offices and now it is a PCMH requirement.

Including a mental health practitioner onsite, whether it is daily or a few times a week doesn't have to be disruptive. But, then, it depends on how you measure disruption in your office, which leads to the next resolution suggestion.

2. Aiming for value? Measure for performance and outcomes.
Physicians who are part of larger systems may be rolling their eyes (because they have metric overload) and that's fine. At least you're measuring! I talk to many organizations—large and small—who have big plans to improve patient experience, communication, physician leadership, etc., but don't have a plan to measure their improvement.

Scripps Health, the San Diego–based nonprofit health system, is taking value seriously, and while the large system has considerable resources, its management structure could be a blueprint for other, smaller organizations, too.

The management of Scripps' clinical service lines is done by two people, an administrator and a physician leader. It's an approach that engages all levels of staff and is reducing variations in physicians' offices, which, in turn, reduces wait times and improves patient satisfaction.

The management teams at Scripps have been able to track supply chain costs, patient satisfaction, and prescription refills by measuring what they're trying to improve. Instead of shrugging off this example because of Scripps's resources, consider what small changes in your practice could be easily tracked, measured, and tied to patient outcomes.

3. Embrace transparency.
 "Transparency is coming! Get Ready!" You've all heard this, right?

Transparency in healthcare has been in previews for about as long as the new Star Wars movie was before it opened in December. But unlike Star Wars fans physicians feel like they are still waiting for the main event.

Some organizations are taking big steps toward transparency in their strategic partnerships and it's paying off. For example, Illinois Gastroenterology Group partnered with BlueCross BlueShield of Illinois to help patients with inflammatory bowel disease receive care more quickly to reduce patients' visits to EDs.

What helped drive the reduction in ED visits was knowing exactly what care patients were receiving and where. An analysis of data from BCBS-IL revealed what IGG didn't and couldn't know without the payer being transparent about its claims data: Most of the reimbursements were for treating complications, not for the management of patients' conditions. Having access to that information led to actions that helped reduce IGG's patients visits to EDs from 17% to 5%.

Not all payers may be keen to hand out claims information, but other, neutral organizations are acting as a third party and processing claims data so that it is understandable for physician organizations.

4. Meet patients where they are: online.
If you are still not writing a blog, tweeting, or using Facebook, that's OK. It might raise the hackles of your marketing department, but patients are online and there are several options popping up for them that eliminate the need to stay loyal to their primary physician.

Telemedicine took off in 2015. Hospitals invested in it and patients are finally getting it. Now, the question is how can physicians capitalize on it? Some are outsourcing the task, such as MultiCare Health System, based in Tacoma, Washington. Its physicians were skeptical of having another doctor care for their patients, but the tele-docs had to agree to use MultiCare's protocols. The system is measuring performance (see resolution no. 2) based on whether patients were ultimately referred to an in-office visit, quality outcomes, and the length of visit.

The "doc-in-the-box" model that physicians thought would be a fad isn't going away because patients value convenience. Telemedicine is unlikely to fade away for the same reason, and patients are used to managing their lives by their smartphones. The newer models of primary care, such as One Medical Group, know this and patient access to its physicians via email is a given.