Physician Executives Play the Point in Value Transformation

By cultivating creative leadership and real-time collaboration, physician executives develop trust and the ability to make the decisions that lead to improved patient outcomes.

In basketball, arguably the key position on the court is the point guard. He or she makes the decisions on how to attack the defense, how to position teammates on the floor, and how best to distribute the ball so that more often than not, the team puts the ball in the basket.

In a similar way, physician executives are key to the transformation from fee-for-service reimbursement to value-based care, in which success or failure is defined by improved patient outcomes.

While the hospital or health system CEO's role may be as the coach, the physician executive makes the key decisions that matter on the floor. For that to work successfully, other physicians have to trust him.

"Culture is one of the most important factors in determining both the pace and the degree of success in making that transition," says Russell Holman, MD, chief medical officer at LifePoint Health in Brentwood, Tennessee, with 72 hospitals in 22 states.

"Internally we talk about going slow in order to go fast, meaning that we need to spend a lot of time reinforcing and tying culture to strategy."

For many physician executives, a focus on culture is refreshing, because no matter how well physician executives do the job on the business side, ultimately, they got into healthcare to help patients. Many see their business training and their role as leaders of other physicians as an extension of that goal, only they're able to do it on a much more massive scale.

In some geographies the transition to value-based care is happening more slowly than others, due largely to factors outside physicians' control: payer mix, commercial adoption of value-based reimbursement methodologies, and, to a lesser extent, consumer pressure.

But many physician executives are convinced it's the right way to practice medicine, and that focusing on value and holistic care of the patient will continue to gain traction over time.

Therefore, it's possible to make strategic decisions on care protocols that will help the hospital or health system succeed regardless of whether the environment is value- or risk-based or remains predominantly fee-for-service, Holman says.

Translating that shift in strategy to physicians takes nuance, says John Phipps, MD, executive vice president at Winston-Salem, North Carolina-based Novant Health, which has 15 hospitals. But the message of providing value strikes home more often than not.

"The concept of delivering value isn't new to us, but the conversation around value resonates more with physicians than any other way we've talked about care delivery in the past," says Phipps, who is also president of the more than 2,400-provider Novant Health Medical Group. "The idea that you have to do more, see more—a fee-for-service treadmill churn—nobody ever liked that. So our physicians are embracing the idea of value."

Critical to making the transition to value work is that physicians feel as though they have a voice in the changes that are made not only in care protocols, but in linking different sites and acuities of care so they are more patient-centered.

"If you can give physicians a voice while obtaining a consensus on what value is, then everyone is more engaged; everyone is more willing to collaborate and then drive change in the same way," says Theresa Herman, MD, chief quality officer at Saint Thomas Health, a seven-hospital unit of Ascension in Nashville.

What's attractive to physicians about the evolution of the value-based care model is that it's consistent with the ideal long-term clinical model of managing patient situations over time that physicians went into healthcare seeking, but often have failed to find until relatively recently, says John Hensing, MD, executive vice president and chief medical officer at Phoenix-based Banner Health, a 28-hospital health system.

"There's a reemphasis on the delivery of services to improve clinical care in chronic disease management as opposed to heavy emphasis on episodic or surgical intervention," he says. "That serves as an excellent framework to move toward health management, population health assessment, and management in a risk-based environment."

View the complete HealthLeaders Media Roundtable report: "The Physician Executive's Role in Value-Based Transformation."