"We could see bundles coming down the line and we wanted to help influence how it happens rather than be pulled along," he says.
Leadership thought that, if well executed, the program could provide a competitive advantage through expected efficiencies in care, but more immediately, he says, it gave the organization a blueprint to "be inclusionary" for physicians involved in their system, however peripherally.
The doctors were initially very skeptical, says Whittington. Ultimately, he says, they cooperated, but not on the promise of a gainshare check. Instead, their hopes were more modest.
The surgeons didn't ever really expect to receive a gainshare check, but they were convinced that the health system was sincere (even if they thought leadership was wrong), and they hoped they could work together for good operational efficiency and build a busier practice, Whittington says. "They actually got both."
As the health system and the physician groups, through representative boards, sought to set up treatment protocols, supply chain agreements, and care pathways, they also began to focus on the postacute market, which was eye-opening.
"One thing we quickly learned is that there are nearly 70 skilled nursing facilities in San Antonio," he says. "I couldn't believe it. And we were probably using at least 50 of them."
Patient physician preference and geography are factors in those choices, but Whittington says the physicians were very engaged by that point; they understood the marketplace and the need for better rules of engagement.
Baptist used third-party data to analyze outcomes results for the SNFs the physicians on staff used at the time, and then evaluated them on care pathways the health system wanted them to follow, their ability to communicate, whether Baptist could share and receive data from them, and whether there were processes that the organizations could use jointly to reduce readmissions.
"We found that half of the 30-day readmissions were very preventable just with better communication between the postacute provider and the physician," says Whittington.
Baptist has no contractual relationships or volume guarantees with those organizations, but it did use its evaluation tools to create a preferred provider network.
Philip Betbeze is the senior leadership editor at HealthLeaders.