Before we review what it takes to operate a high-performing health system, let’s start with some fast facts: 60% of U.S. physicians are now employed by hospitals or hospital-based health systems. That equates to approximately:
Exactly who is leading and managing this once fiercely independent collection of practices and physicians? Are their incentives now aligned with those of the hospital or health system with whom they’re employed? Is there a governance structure in place to keep the mission and vision of the hospital or health system in focus? And does this structure address the medical group constituency?
Great questions. While health care currently trails nearly every other industry in innovation (currently in line with where the retail and newspaper industries were around 1998) the seeds of change have been sewn. And the rate of change is accelerating. We are just beginning to see a wave of innovation the likes of which our industry has never seen: ten years ago, there were no stand-alone Ambulatory Surgical or Emergency Centers; five years ago, there were no retail clinic chains; two years ago, there were no professionally managed urgent care chains. All that has changed, and even “hospital at home” programs are demonstrating improved patient satisfaction and better outcomes, for dramatically lower costs.
Why now? This shift is being fueled, in part, by new reimbursement opportunities that support evolving models of care delivery, such as population health management, coordinated care, Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs).
Each of these models relies upon caring for patients in the most cost-effective, clinically appropriate setting. And to succeed, each requires highly coordinated provider networks—networks of high-
performance medical groups, really—that effectively manage patient populations across the entire continuum of care.
So how does a health system transform a collection of independent practices into a high-performance medical group, one that governs a rapidly expanding continuum of care across owned and affiliated providers? The solution requires three core capabilities:
- An information service that unifies data from across disparate electronic health record (EHR) and claims systems, providing a single source of relevant information. It is unlikely that all of your close affiliates, never mind casual affiliates, will all operate on the same platforms. A closed system simply cannot support the models of the future.
- An analytics service to develop clinical and operational insight. Visibility is simply not enough. You will need access to real-time metrics and dashboards that help you understand revenue drivers—like order patterns and gaps in care—and help you control decision-making at the point of care.
- Workflows that guide action to the right caregiver at the right time. It’s not enough to understand what’s going on. You need the ability to take action on your data intelligence.
From a technological standpoint, cloud computing is uniquely positioned to deliver these three pillars to hospitals and health systems. Here are a few examples of the advantages the cloud provides in comparison to traditional “closed” software offerings:
- Comprehensive, intuitive access to and sharing of information—regardless of platform—across the entire continuum of care;
- Complete, real-time visibility across the entire network;
- The ability to adapt to change quickly, and implement revisions in the reimbursement, clinical, regulatory and technology environments;
- Rapid deployability, at scale, to accommodate new partners and growing networks;
- Financial efficiency, with little to no start-up capital required (no software to install or servers to maintain);
- Capability to provide the right information to the right person at the right moment of care.
With approximately 475,000 physicians already practicing within the network of a hospital or health system, and the trend toward outcome-focused reimbursement on the rise, these guidelines may evolve into more than just “best practice”—they could be a means to surviving the competition.