The Exec: Keys to Success in Integrating Care at Health Systems

For CMOs and other senior leaders, the principles for integrating care at health systems include understanding the needs and priorities of entities such as hospitals, this new health system CMO says.

Integrating care is a top priority for Reid Adams, MD, the inaugural CMO at UVA Health.

From a health system perspective, providing integrated health services includes managing and delivering services to provide patients with a continuum of health promotion, disease prevention, diagnosis, disease management, and rehabilitation across different sites of care, according to an article published by the International Journal of Integrated Care. For CMOs, the benefits of integrating care include boosting care quality, improving patient outcomes, and increasing access to care.

Adams became UVA Health's CMO on March 1. Prior to taking on the new role, Adams served as CMO of UVA Health University Medical Center, which is an academic institution based in Charlottesville, Virginia.

There are five principles to guide integration of care at health systems, according to Adams.

• CMOs and other senior leaders must engage in deep listening to understand the needs and priorities of entities such as hospitals.
   
• There need to be collaborative conversations to ensure there is alignment between the health system's strategic priorities and local facilities.
   
• There should be consistency in how CMOs and other senior leaders implement best practices across a health system while allowing operational flexibility at the local level.
   
• Data analytics must be used to drive care and develop processes, which can help a CMO identify clinical care variation and gaps in care.
   
• Teamwork is essential to develop and implement care integration initiatives.

Adams says strategy alignment is going to be essential in efforts to improve care integration at UVA Health.

"One of the things we want to do is drive care in local communities while also providing tertiary care at our academic medical center," Adams says. "Many people come to the academic medical center for specialized care, but we want to provide as much care as possible at our community hospitals, so patients do not have to travel long distances for services."

Addressing Workforce Shortages

With workforce shortages such as shortfalls of physicians and nurses impacting health systems across the country, a CMO must be focused on workforce planning.

UVA Health has important advantages in the recruitment and retention of healthcare workers, according to Adams.

"It all starts with aspiration, inspiration, vision, and mission," Adams says. "If these elements are compelling, it makes it much easier to recruit and retain staff members. When we interview candidates, it is pretty uniform that the vision and mission of UVA Health resonate with people."

UVA Health's academic mission is an attractive selling point for recruits.

"As an academic organization, UVA Health has huge advantages in recruitment because people want to interact with learners and educate the next generation of healthcare workers," Adams says. "An academic health system is also attractive to people who are interested in discovery that leads to improvements for patients and care."

When it comes to recruiting staff members, the best salespeople are frontline workers, including physicians, nurses, and therapists, Adams explains.

"They can talk about your culture and workplace environment as well as what excites them about being part of your organization," Adams says.

Recruitment efforts should include engaging people who may not have thought about healthcare as a profession, according to Adams.

"This effort includes building workforce pipelines from secondary schools in local communities and supporting people with educational and training opportunities," Adams says. "It also includes establishing professional growth pathways, so people who come into your organization in entry-level roles can grow and find opportunities for new roles."

A CMO must be involved in physician recruitment and retention. UVA Health has an advantage in physician recruitment because the health system can offer different aspects of professional development and growth, including education, research, and diversity in clinical care.

"Our physicians can practice general or highly specialized care, which allows them to build on their vision for whatever kind of care they are interested in," Adams says.

To boost physician retention, a CMO must focus on the workplace environment, Adams says.

"You need to create an environment where physicians feel they can flourish as well as fully utilize their knowledge and skills," Adams says. "A collaborative and collegial environment also is important for physician retention."

A CMO's efforts to boost physician retention also requires the recognition that healthcare is a challenging field and easing burdens on physicians is crucial, Adams explains.

"You need to make care as efficient and seamless as possible to promote physician retention," Adams says. "This makes it easier for physicians to do what they want to do, particularly care for patients."

Physician Competency

Physician competency is a top concern for CMOs.

The first step to having competent physicians is ensuring that you identify and attract high-quality individuals, according to Adams, who previously served as vice chair of the Physician Competency and Health Workgroup at the American College of Surgeons.

"You need to collect data and do your homework to understand key factors about recruits, including their career trajectory, their training, and their experience," Adams says. "The data points include quality and clinical outcomes."

Physician competency assessment should begin soon after a physician is hired, Adams explains.

"The best practices for assessing physician competency include evaluation upon entry into an organization by other clinicians to ensure that physicians have the skills to be safe and effective practitioners," Adams says.

CMOs should have processes in place when a physician's competency is called into question, according to Adams.

"If a physician's competency is found to be lacking, you can have mentoring programs to help a physician develop the skills that they may not have, so they can practice successfully," Adams says.

When healthcare organizations hire physicians out of medical school, they should support them to develop a high degree of competency, Adams explains.

"If you hire new graduates, most new physicians do not come fully formed for your organization, so you must have intentional mentoring and coaching programs for new physicians," Adams says. "At an academic institution, these mentors and coaches should be drawn from your senior faculty."