Physician Payment and Reimbursement

Early Physician Involvement Vital in Advanced Care Delivery Models

November 6, 2017 11:06 am

Physicians who take on a formal role in helping their organization implement an advanced model should be compensated for their time, members of an expert panel said.

Creating a culture that recognizes the contributions and needs of physicians is essential to the success of advanced care delivery models, according to a panel of physicians who have had significant experience in integrated healthcare organizations.

“When physicians get passionate for a program, it’s amazing the mountains that can be moved,” said Christopher Stanley, MD, a director in Navigant’s healthcare practice and previously the system vice president of population health for Catholic Health Initiatives (CHI). “Conversely, if physicians are not involved, it can be hard to get things changed.”

Stanley was joined by two other Navigant senior advisors—Mark Shields, MD, and Charles Kelly, MD—in a panel discussion entitled “How to Successfully Address Advanced Payment Models and Market Influences Driving Provider Risk” on Oct. 19 in Chicago. The panel was part of Navigant’s biannual Clinical Integration Summit.

Early Physician Involvement

When a healthcare organization plans to implement an advanced care delivery model, such as an integrated system involving physician practices, hospitals, and other providers, early physician involvement is key because of the role that physicians play in many parts of the operation, the panelists noted.

Shields, who was senior medical director for Advocate Physician Partners before joining Navigant, said Advocate understood the value of a physician-centric culture as it built out its integrated system.

“We started with a culture of the right people who understood that we needed physicians working together,” he said. “If you don’t build that culture, other things like incentives or IT implementation will get off track.”

Different physicians may have different sources of motivation, Stanley added. During his time at CHI, where he led the population health efforts for more than 100 hospitals across 17 states, he learned that many physicians are motivated by money, of course, but others are more driven by being asked for input on important decisions.

“Some doctors [are motivated by being] seen as thought leaders,” Stanley said. “I was encouraged to see that. It showed that we can tap into the professionalism of physicians, not just pay them more.”

Physicians are more likely to take part in initiatives when they see that other physicians helped develop them, said Kelly, former president and CEO of Henry Ford Physician Network at Henry Ford Health System in Detroit.

“Physicians respond to physicians,” Kelly said. “When they see messages from their peers, things go far better.”

How to Involve Physicians

Physician involvement can take several forms. Physicians can be asked to weigh in on important issues informally, for example, or they can be invited to participate on committees or boards, the panelists said.

Naturally, not every physician is cut out to be a leader.

“We have to clearly identify physician leaders who will work with and support the physicians with training and governance,” Shields said, adding that leadership training may be necessary to help promising physicians develop into effective leaders. “You should have a governance training program. Just because someone is good in the operating room doesn’t mean he’ll be a good leader.”

Physicians who are asked to serve in leadership positions should be compensated for the time they contribute, Shields said. Offering additional compensation shows that the organization respects and values a physician’s time. In addition, paying them for that service establishes an obligation.

“Committee members should be paid, but there also should be performance expectations on them,” Shields added. “They need to be prepared, or they should be removed from the committee. You can’t be reading the packet of information as you’re walking into the meeting.”

Physicians in leadership positions should be taught to put the interests of the organization ahead of their own interests, panelists also noted. If a committee makes a decision, for example, the physicians on the committee should support that decision—even if they personally voted against it.

Getting physicians involved in leadership and otherwise seeking their counsel may help the physicians feel more like “part of the team” and less like involuntary participants in the integrated network, Shields said. 

Don’t Overlook Specialists

The key role of specialists also needs to be considered when an integrated system is being developed, the panel added.

“We were very focused on primary care physicians in the early years, and later fully engaged with specialists,” Shields said, adding that he now recommends that specialists be engaged sooner. “You want to engage the specialists early.”

Because specialists count on referrals more than primary care physicians do, emphasizing how an integrated system can boost referrals may be part of a strategy to engage specialists. For example, Shields said, a well-run integrated network strives to keep referrals within the system.

Getting specialists involved in the integrated system may also require showing them how such a network can benefit patients, Stanley explained.

“An integrated network helps you see the whole continuum of care, including before and after a procedure,” he said. “We are able to clinically ‘tune up’ patients before surgery and set up expectations that they will go home after surgery. By thinking about before- and after-care, it opens up a world of difference.”

Preparing for Downside Risk

Most managed care programs today feature only upside risk. That will probably change as time goes by, and integrated healthcare organizations should prepare for the shift, panelists said.

“I see the road to risk as a stair-stepping process that should take many years,” Stanley said, explaining that an organization should take those steps carefully to build its ability to move from fee for service to full capitation. “So that when you reach that point, you are ready.”

When Henry Ford Health System began working with risk contracts, Kelly said, the organization started a risk reserve fund. “That way the network could fund losses if they occurred,” he said.

Organizations should read risk agreements closely, Kelly advised. He said his organization lost out on some performance incentives because pharmaceutical costs went up significantly faster than anticipated.

“We should have carved that out, because it was beyond our control,” he said.

When the panel was asked for one final piece of advice, Shields said, “Listen. Listen to the employers; listen to the doctors; listen to the other stakeholders. And ask them, ‘What can be done to help you do better?’” 

Ed Avis is a freelance writer based in Chicago who frequently writes about healthcare management topics.


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