Tools & Tips | Value-Based Payment

Health System Perspectives

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Tools & Tips | Value-Based Payment

Health System Perspectives

Most health systems’ key initiatives depend on the involvement of its physician groups (both employed and independent). This tool illustrates the steps in the journey toward population health management and health system sustainability can be made without direct physician involvement.

The need for physician involvement.
Most health systems’ key initiatives depend on the involvement of its physician groups (both employed and independent). As the tool below illustrates, few steps in the journey toward population health management and health system sustainability can be made without direct physician involvement.

Tool: Physician Involvement in Key Health System Priorities

Different needs for different types of health system.
Physician strategies can vary depending on the characteristics of the health system. For example, the issues of an academic medical center involve a balancing of teaching, research and clinical responsibilities. Academic medical centers often have a need to solidify and bring closer their primary care referral base.

Aligned integrated systems, on the other hand, may have already carefully balanced primary care and specialists, but they may have difficulty expanding or accommodating other physician models.

Common differences between different types of health systems include:

Type Of System   Strengths Challenges
Academic Medical Center
  • Innovation opportunities
  • Affiliation opportunities
  • Strong potential for health system/physician integration 
  • Insufficient primary care base
  • High cost structure
  • Unaligned incentives  
Aligned Integrated System
  • Tight physician/system integration
  • Advantages, real and potential, in population health management  
  • Difficulty in expanding physician culture to accommodate new physicians and models  
Multihospital System
  • Scale economies (including potential cost spreading, population health expertise and systems, market coverage)
  • Flexibility in accommodating new physicians and models  
  • Need to manage a wide range of physician models in varying markets
Stand-Alone or Rural System
  • Loyalty of local physicians
    (and patients)
  • Lack of scale
  • Difficulty in building/maintaining specialty practices
  • High hospital support of physician practices
  • High cost of population health infrastructure

As more health systems consolidate, their physician issues will be a hybrid of the cohort examples shown above.  

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