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4 Leadership Priorities for the New Year

 |  By Philip Betbeze  
   January 07, 2011

It's the beginning of a new year, and if you're like me, you're glad to put the past one well behind you. Personally, my family and I had a move, a flood, and a bunch of other crazy stuff happen to us this year, so we're turning the page. I'm sure you're doing that as well.

Now that you've had a few months to digest some of the big changes coming to the industry, you've probably got at least an idea of the key strategies on which your organization's success will depend this year and in the long-term future. But just in case you hadn't considered some of the following broad themes, here are a few ideas at some resolutions you might want to make for the new year.

1. Bring risk back into your financial equations
At least since the days of capitation in the middle of the last decade, many healthcare providers (and I use that term to include any entity that provides a healthcare service) haven't had to worry about risk. There are exceptions, of course, but by and large, you've negotiated prices for certain services with major commercial payers and you got what you got from Medicare and Medicaid. But for the most part, you haven't been responsible for quality or outcomes.

As healthcare reform legislation matures, that's changing rapidly not only for government payers, but also for commercial payers, who are placing ever more conditions on payment for services, depending on how well the patient does following the service. It's the reason for the word "accountable" in the latest buzz term that's scaring everyone to death—the accountable care organization. Speaking of which…

2. Learn from the best (and from their mistakes)
Keep a close eye on the accountable care pilot programs and demonstration projects going on at health systems across the country.

Even if you're not participating, these systems can offer broad opportunities for learning what works and what doesn't in the new reimbursement environment. If your organization is not involved in one of those programs, it might not be a bad idea to run through your Rolodex (or Outlook contact list or Blackberry, if you prefer) for professional contacts at those institutions who may be involved with creating the structures of the future.

Place a quick call to renew ties and talk a little bit about the strategies they're testing. Where are they having success, and where are the challenges? Best of all, you don't have to invest the dollars right now until best practices start to shake out. But again, don't wait too long. While others are experimenting, your organization can also do some experimentation on ways to redesign care and realign economic incentives.

3. Investigate how consolidation might help you
This doesn't have to be a full financial merger. But given the fact that reimbursement will be increasingly tied to efficiency and quality, a merger might not be the worst thing to investigate in the new year. Scale will matter, even if it seems it doesn't right now. In one recent conversation I had with a CEO, he mentioned that in the very near future, all healthcare providers, whether they be clinics, hospitals or health systems, will be either buyers or sellers. In many cases recently, that future is now.

Which will you be? If neither, perhaps you are ignoring reality. Perhaps you're a wallflower as the dance begins, looking for the perfect partner. Just be sure that you're not left on that wall waiting for the hottest prospect in the room while perfectly good matches go ignored.

4. Look at rearranging your leadership structure
We've seen lots of organizations—especially multi-hospital health systems—looking at reorganizing their leadership structures in a way that will focus on moving patients more efficiently through the system. For example, many are doing away with titles at individual hospitals within the system, such as the CEO, CFO, COO. Instead, they are appointing senior vice presidents (in some cases, these might be the very same people who were removed from individual hospital leadership functions) of business units, such as imaging, cancer care, physician practices, etc. Hospitals operate differently than physician practices, which many health systems and hospitals now own.

Why should someone with expertise running a hospital be in charge of running the physician practice? While there's still a CEO, CFO, and COO for the whole system, of course, it's a way to capture that sense of "systemness" that is elusive, but that leaders are always talking about. The hospital, after all, is no longer the center of the healthcare experience. Yes, it's a way of breaking down silos but it's also a smarter way to establish that better helps accomplish the goals of the kingdom rather than the fiefdom.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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