The Exec: How Providence Is Aiming for Success in Ambulatory Clinics

Effective ambulatory clinics have strong leaders and employ tools that bolster insights and decision-making, this chief physician executive says.

The first key to success in operating ambulatory clinics is selecting the right leaders, according to the new chief physician executive of Providence.

As of February, Susan Huang, MD, now serves as the chief physician executive at Providence and chief executive of Providence Clinical Network, which features 1,100 ambulatory clinics. Prior to taking on her new role, Huang served as CMO of the health system's South Division and CEO of the payer-provider Providence Health Network in California.

"In ambulatory clinics, you need to have the right leaders in place, so it is important to recruit the right type of talent," Huang says.

Providence has several programs to develop ambulatory clinic leaders internally, according to Huang.

"What we have found is that when we are able to grow our own leaders, they understand the Providence way, culture, and mission," Huang says. "That helps a lot with continuity."

The health system wants leaders of ambulatory clinics to have exposure to the broad environment of healthcare, Huang explains.

"We try to educate people on what is happening in the global context of healthcare, which is changing a lot," Huang says. "How healthcare was delivered in the past is not how healthcare is delivered now."

Changes in the delivery of healthcare over the years include an increase in administrative burden and a shift away from a paternalistic approach to the practice of medicine. For example, patients are more involved in their care now than in the past.

"The healthcare of the past was top-down. We knew what was best, and the patient was expected to follow," Huang says.

According to Huang, the advent of the electronic medical record was positive because health systems can now collect data in one place and extract information more readily.

"But at the same time, the EMR has created burdens in documentation, not just for physicians, but also for other staff," Huang says. "While we want to realize the potential of the electronic medical record, we also want to decrease the administrative burden that comes along with the EMR."

Successful ambulatory clinics also must have the right tools that lead to better insights and decision-making, Huang explains.

"You need tools that are timely," Huang says. "We have been aided by advancements in artificial intelligence's predictive abilities, including the ability to analyze large amounts of data, so that we can better understand our operations, populations, and the clinical care that we are delivering."

Susan Huang, MD, is chief physician executive at Providence and chief executive of Providence Clinical Network. Photo courtesy of Providence. 

Succeeding in value-based care

Providence has posted positive results in value-based care.

"Looking at the program year for the Medicare Shared Savings Program in 2023, we generated more than $100 million in shared savings," Huang says.

Several factors dictate whether a health system can be successful in value-based care, according to Huang.

"There must be an alignment between the economic model and the clinical care and operational models," Huang says. "You need the right data and insights—you need to be able to make predictions and understand your populations."

Health systems must be aware of misaligned economic models in value-based care, Huang explains.

"With the flow of funds, they need to be aligned with the clinical activities we are expected to do. This includes incentive metrics for physicians," Huang says.

Clinicians play a significant role in delivering value-based care, according to Huang.

"They need to be attuned to evidence-based care, care pathways, best practices, and making sure there is a reduction in unwarranted variation in clinical practices," Huang says.

Providence helps clinicians to limit variation in clinical care. For example, the health system has embraced a decision-support tool called Clinpath in oncology.

"It is a tool that helps direct the chemotherapy regimens that a patient should be on based on factors including the type of tumor and pathology," Huang says. "We can establish the recommended chemotherapy and assess our compliance with evidence-based regimens." 

Everyone in a health system must be involved in value-based care to achieve success, Huang explains.

"It is not just the physicians," Huang says. "It is not just the care managers. It is not just the hospitals or the clinics. Everyone must know they have a role to play in value-based care."

Flexibility and innovation are also essential in value-based care, according to Huang.

"You must be flexible, and you must innovate," Huang says. "You must think about new ways to engage your patients. This can involve technology such as remote patient monitoring to take care of a cohort of your patients."

Success in physician leadership

Providence provides opportunities for physicians to take on leadership roles.

"One of the keys to success in physician leadership roles is creating opportunities for physicians and advanced practice practitioners to understand what they could do in a leadership role," Huang says. "We also want to create a pipeline and a pathway for people to grow in their jobs."                                   

At the health system, physicians can participate in committees and governance structures to experience leadership in different ways, according to Huang.

"Not everyone wants to take on leadership roles in the same way," Huang says. "Sometimes, it is taking a small bite of the apple, getting a little bit of exposure, and learning more about leadership."