Rising to the Challenges of Managing a Large Physician Enterprise

CommonSpirit Health has a large and diverse physician enterprise, with more than 5,800 employed physicians, about 1,100 ambulatory care sites, and 21 value-based organizations.

Large health systems with far-flung physician practices benefit from creating a shared culture and utilizing effective communication strategies, the new physician enterprise leader of CommonSpirit Health says.

The Chicago-based health system has an expansive physician enterprise across 21 states. The organization has more than 5,800 employed physicians, about 1,100 ambulatory care sites, and 21 value-based organizations.

In December, CommonSpirit Health announced that Thomas McGinn, MD, MPH, had joined the organization as system executive vice president of physician enterprise. McGinn is succeeding Bruce Swartz, who retired in November.

Before joining CommonSpirit Health, McGinn served as the deputy physician-in-chief and senior vice president of physician network operations at New Hyde Park, New York–based Northwell Health. While at Northwell Health, he was also the founding chair and a professor at the Department of Medicine at the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York. Before working at Northwell Health, he was chief of the Division of General Internal Medicine at Mount Sinai Medical Center in New York City.

HealthLeaders recently had a conversation with McGinn about the challenges of managing a large physician enterprise. The following is a lightly edited transcript of that discussion.

HealthLeaders: What is your vision for physician enterprise leadership at CommonSpirit Health?

Thomas McGinn: The fundamental vision is to look at each of our medical groups and communities, then try to come together under one culture and one mission. That mission-driven culture should enhance efficiency and quality.

A first step is standardizing communication across different communities. We put forward our message about who we are, what we are doing, and what are our priorities. You cannot underestimate the importance of well-timed communication that is both supportive and defining.

Then, we have a lot of issues we are looking at across the board on creating standards. For example, quality standards such as blood pressure measurements in Tacoma, versus blood pressure measurements in Houston, versus blood pressure measurements in Fargo. It seems like a basic thing, but how you measure blood pressure and how you collect that data has a standard across our footprints. We have our quality standards that we are setting that people are following. We are benchmarking those standards and have dashboards for them.

We also have operational performance standards that we have created. There are all the basics such as revenue cycle, then we have interesting targets such as virtual health. In virtual health, we went from zero before the pandemic to about 20% of our volume now in virtual care. The standards for virtual care being created across the health system include what percentage of volume should be virtual.

There are also cost standards such as staffing ratios and provider incentives.

HL: What are two of the top goals in your new position?

McGinn: The underlying challenge in each of our communities is the evolution toward an integrated delivery network. Creating an integrated delivery network often comes down to the concept of network integrity. So, we are looking at each of our markets and trying to understand key elements that are missing across the care continuum. One of the biggest challenges in almost every market is the absence of a solid primary care base, which is a common problem among health systems. Most health systems grew out of hospital acquisition, and hospitals tend to have specialists, so there is an inverse proportion of specialty to primary care.

Virtual care is another top goal. We want to maintain the volume of our virtual care and to evolve virtual care into each type of specialty. We need to figure out how to use virtual care in specialties such as pediatrics, surgery, and rehab.

HL: How do you promote value-based care in an integrated delivery network?

McGinn: We need to go into each market and look at it through the lens of how our delivery network is doing rather than how our hospitals are doing. It is an evolutionary process, and each market is in a different stage of evolution in creating an integrated delivery network. You do not have to own everything in every market. You can develop partnerships in areas such as primary care and nursing homes, but partnerships need to be strategic and you need to monitor all of the pieces to make sure they are working.

I use the term ecosystem. Each patient lives in a healthcare ecosystem, and it is usually three or four ZIP codes. You want to know all the pieces in that ecosystem; and you want to pay attention to them, so you know how patients are navigating their healthcare ecosystem. Whether you own all of the pieces of the ecosystem or not, you want to understand how it works.

HL: What are the keys to building and strengthening provider networks?

McGinn: There are a lot of different pieces that go into this puzzle. One major piece is building a culture that people feel they belong to. Another major piece is interconnectivity and having the IT infrastructure so that referrals can happen in a seamless way, which can be a challenge when you have medical groups with different electronic medical records. It can take hard labor to fix IT infrastructure issues.

You need to have people who work to connect clinicians. You need to have people who are physically visiting doctors' offices—even doing social events or virtual events. There are a lot of different tactics that you have to use to bring doctors together to enhance network integrity.

Related: Ecosystem Over Volume: A Guide to Rethinking Market Share