Physician engagement and alignment are critical components for healthcare organizations navigating the transition to value-based care. An engaged and aligned physician network is a major determinant for enhanced patient care, lower costs, greater efficiency, and improved quality and patient safety. Successful physician alignment, however, remains a challenge for many hospitals and health systems.
Specifically, healthcare organizations struggle to align a virtual provider network in a way that fits their organization’s goals and strategies. Here are five key considerations when determining how your network will operate cohesively in a value-based environment.
- Integration Strategies
There are multiple physician integration strategies available including direct employment, joint ventures, alignment models — e.g., clinically integrated networks, accountable care organizations, bundled payments and co-management agreements — and other creative strategic arrangements. Usually, your organization’s value-based arrangements as well as market dynamics will help dictate the type of alignment strategy to pursue. The more at risk you are for the premium dollar, the stronger the integration needs to be. Examples include shared savings/losses methodologies among network constituents, employed physician models, and aligning disparate physician groups into a single group.Alternatively, some virtual alignment models need not be as stringent. Clinically integrated networks address the need of providers who want to remain independent yet be part of a larger organization that provides necessary scale.Regardless of the integration model, your organization should use cost and quality data to indicate providers’ ability to succeed in a risk arrangement as well as how to develop incentives and deliver meaningful feedback to the network. On the path to a value-based environment, your integration structure will provide the foundation for a streamlined delivery system.
- Effective Physician Leadership
Physician-to-physician credibility is paramount. Strongly consider appointing physician leaders who will champion the benefits and care goals of value-based contracting. These individuals would typically head committees focused on assessing clinical quality and serve as liaisons between administration and independent practices in the network.
- New Policy and Payment Models
Many physicians are not well-versed in new policy changes and value-based payment mechanisms that may exist in a risk arrangement. They may have heard the buzzwords, but they may not know the specifics behind them. Research the specifics of the policy or arrangement and educate your providers on what they really mean from a “real-world,” pragmatic standpoint. Clearly articulate how they will impact each physician’s clinical processes, their bottom-line financial performance and their operational procedures.For example, outline and educate physicians on regulatory imperatives, such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)1, being sure to say what exactly the practice needs to do to receive the incentive payments.
- Administration and Infrastructure
For practicing physicians, health reform initiatives divert resources and time away from both day-to-day operations and their No. 1 imperative: providing the best care to the patient. Technology implementations that change documentation, along with workflows that are altered to meet value-based contracting needs, can frustrate some physicians. It’s critical to outline how your organization will support physicians in their work and reduce their administrative burden. It’s also important to outline how you will enable them to improve the delivery of care to their patients.
- Incentives and Feedback
Incentives can often serve as the lynchpin to shifting behaviors geared toward fee-for-service and enabling providers to successfully operate in a value-based arrangement. Incentive plans should be sufficient and equitably distributed to encourage providers to improve efficiency and deliver better outcomes.They commonly entail implementing various threshold goals on quality and clinical outcomes, patient satisfaction and financial metrics. Select ones that are based on reliable data, easily tracked and reported, and embody the goals of the value-based arrangement. It is critical that the measures and reasoning behind them is clearly articulated to providers prior to the performance year.At the same time, be prepared to show how physician performance will be tracked, measured and shared with physicians on a continual basis. Dedicate staffing resources to provide physicians with continual feedback on their progress toward goals.
Physician engagement and alignment are pillars for achieving success in a value-based arrangement. What makes business sense on paper can quickly unravel if your physicians are not aligned and attuned to execute against performance expectations and help your organization attain its goals. Wherever you are along the path to value-based care, developing a strong partnership with your physicians is absolutely pivotal in any delivery system redesign.
- Hospital & Health Networks. “MACRA and the Giant Move into Value-based Payment.” December 2016.