Building a player/coach environment at Privia

  | June 1, 2016

How do you build a provider organization from the ground up, expressly designed to succeed in the value-based era?

For Privia Medical Group, which has grown to nearly 1,400 physicians in the past two years, it’s about building a culture of empowerment.

Privia Health Headshots
Scott Disch, National Practice Leader, Privia Health

“The most defining element around Privia is our leadership really has a player/coach environment,” says Scott Disch, MPH, Privia’s National Practice Leader. “We roll our sleeves up and we get in the weeds with our front line team. We do the work alongside them to empower them that it’s okay to take risks, it’s okay to fail because we’re going to be able to pull each other up.”

Disch points to a motto that he embraces personally: “Our leadership will be the best at getting better.”

athenaInsight sat down with Disch to discuss Privia's leadership approach for driving high performance across its physician network.

You’ve described Privia as being “purpose-built” to succeed in a value-based world. Does that vision require a different leadership approach?

I believe as a leader that the fee-for-service world requires a different management style than under value-based reimbursement. In the fee-for-service world, you can drive volume, you can drive widgets, your focus is on improving operations so you can just see more patients. With value-based contracts, as a leader you’re thinking about transforming teams to focus back on patient panels. It’s not about “How many patients can physicians get through today?” It’s opening up their schedules so that the highest-risk patients are seen first. It’s understanding and finding ways of putting your arms around the entire population to improve public health. It’s new, and I’m excited about this because it’s about time we start focusing back on our community of patients.

Is it hard to engage physicians and align them to Privia's overall vision and goals?

Physicians struggle with “How do I lead a group of people towards business success?” They are not trained how to do that in medical school. Developing high performing medical groups is largely about behavioral change for the physicians and their staff and thus working on a patient-focused team.
When we think about getting physicians to align with the goals of the medical group, we focus on building physician leaders who learn how to manage “on the practice” rather than “in the practice.” This is a crucial distinction, because if you try and control the environment within your practice you will spend 18 hours a day working in a silo for your patients.
If you learn to manage and control on your practice you’re really maximizing everyone’s license through care coordination, team huddles, meeting social and behavioral needs of your patients. Thus, this patient-centric team approach allows the practice to hit the quadruple aim. The quadruple aim is aligned with the physician enjoying what he or she does best, and that’s the joy of medical practice.

It sounds like you spend quite a bit of time emphasizing high performance teams?

Yes, successful, high performing groups need to develop teams and team-based care models. Often you could use a Sinsky model of care, you could use a cyclical model of care where you have teams of nurse practitioners, RN, LPNs, as well as the physician, leading with medical assistants, front desk staff to really develop a patient centered medical home. The result is that the patient now has 10 individuals caring for them, rather than one individual trying to manage every aspect of those patients’ care.
When a provider works on a panel of 2,000 patients, they need the support of a team. And when that care team is informed about the needs of the practice panel, supported with resources, capital and technology, they start to really succeed together. This is where Privia’s Care Team comes in with a plethora of wrap around population health services for physicians, such as pharmacy medication management, nurse triage, case management, social work, and automated preventative activities just to mention a few. The physician and Privia’s Care Team link arms to manage the Care Center’s patient population together, close important care gaps, and allow for navigation along the care continuum to be seamless and meaningful.

How do you define Privia's culture?

I would say that Privia’s culture is very fast paced, performance metrics driven, and laser focused on our mission of changing health care for the better. Our goal is to really put physicians back in the driver’s seat of this health care system and let them do what they do best: providing patients with the quality care they deserve. Our group of physicians and staff that works in and outside of our care centers is fueled by this mission. That perseverance and motivation is a key component of our culture.

Can you talk about selecting physicians for fit with your culture?

When Privia looks at selecting physicians to join the network, it really is around alignment to mission and vision. The physicians we partner with desire to embrace the idea of practice transformation. In order to be a successful physician in a high performing physician enterprise, a lot of changes are needed: not only a new EMR or a new funds flow, but a new way of practicing medicine. They have to be willing to think about their panel differently. They have to want to be part of driving behavior change. Even though Privia simplifies physician workflows and allows them to practice great medicine efficiently, we need to be confident that the physicians will align with our mission for taking cost out of the system, and increasing the quality of care and improving patient experience.

Can you expand on how Privia uses data to improve performance?

As a company, we are driven by data. We are performance driven and we use data in an un-blinded format. For example, at our POD (Physician Organized Delivery System) meetings, we share un-blinded data around which physicians are doing really well —for example, who’s vaccinating with Pneumovax and which ones aren’t, and it leads to a great discussion. Using peer pressure, using opportunities to help educate the network, allows us to grow together.
Physicians want to be best in the class. They want to understand where they’re struggling and where they can improve. And so using data in a positive way allows them to see true performance, what is working and where we need to improve together.
When you think about it, physicians can be accountable in either a small organization or a large organization. Part of it is about giving the data to the physicians and the other part of it is about getting out of their way. We don’t want our physicians to feel overwhelmed and micromanaged, and thus we provide clear action steps and recommendations for them to incorporate into their practice to improve outcomes.

What about engaging other frontline staff members, non-physicians?

Physician performance and that of the PAs, the nurse practitioners, is really important. But even more important is the performance of the staff. Within Privia, we have a staff bonus to help incentivize the MAs, the front staff, the office managers. It motivates them to engage in what this journey really means: How do we make changes at the practice level that is best for our patient?
If you really partner with your medical assistant, and teach that individual, you allow them to do so much more for that patient. They’re able to maximize the physician’s license, letting doctors spend more time on medical decision making and less time on documentation.

What does Privia leadership do to keep focused on hitting its goals?

The difficult thing for most leaders is saying no, so what we use is a key objectives process. Quarterly, we focus every employee on six to seven priority items, as well as team objectives, that all directly support our greater mission and key goals. It keeps us from getting distracted by those shiny objects, and it allows us to achieve success against specific individual and team goals.

How would you hope that the people who work for you describe you as a leader?

As a leader, I hope that those that I work with describe me as approachable and as an educator. I hope that I’m regarded at the company as the resident expert who others can feel comfortable coming to with questions, problems, and if I know the solution I will walk them through it, work through it with them so they understand there is somebody here who is a resource and ally to achieve success.

Is there a company that inspires you as you plan for the future?

Pixar is an interesting model. They embrace teams. They enjoy hearing from the grassroots employees and infusing that into what they do every day. Your front line employees have great ideas, and if you embrace those ideas, the stickiness becomes infectious. Then they really enjoy working for your organization, rather than feeling like they’re just punching a clock.

Building a player/coach environment at Privia