Building the Performance Focused Physician Network

Topics: Clinical Integration, Hospital-Physician Alignment, Physician Issues, Performance Improvement, Accountable Care, Market Trends, Strategy

Clinical integration (CI) should be carefully evaluated to determine if it is appropriate for your organization. After reading this study, members will learn:

• Why CI is emerging as an increasingly popular strategy to align independent physicians around performance improvement
• What legal, institutional, and market conditions favor development of a CI program
• How to select and organize physician participants and leaders to realize a CI program’s quality and efficiency aims
• How to design performance initiatives and incentives that generate significant improvements and attract interest from third-party payers
• How to optimally extend resources and infrastructure to support physicians in attaining those performance goals

Executive Summary

Accountable care heightening imperative for hospital-physician alignment

Always a top-of-mind issue for hospital executives, physician integration has taken on an even greater sense of urgency as organizations prepare for accountable care. With a looming mandate to manage total-cost risk for patients, hospitals must make physicians true partners in delivery system redesign. Yet, for most organizations, current physician relationships are inadequate to create this level of alignment. As a result, many are now looking to clinical integration (CI) as a strategy to align both employed and independent physicians around performance improvement.

CI requires resource-intensive investment to attain potential returns

In a CI program, physicians make a significant commitment to performance infrastructure and initiatives. To support these efforts, independent physicians may, under an exemption from antitrust laws, negotiate jointly for commercial payer contracts. CI allows hospitals and physicians to bridge a potentially rocky transition between payment paradigms, reaping rewards in today’s fee-for-service environment while also building an infrastructure for accountable care. But meeting the high bar that authorities have established for this antitrust “safe harbor” requires a considerable dedication of time and resources from all involved. As a result, the decision to create a CI network is not one to be taken lightly.

Successful CI launch requires considerable management attention

Organizations interested in pursuing CI should first assess whether the strategy is appropriate given institutional, physician, and market conditions. If the answer is yes, executives must give careful consideration to designing a program that can generate real performance gains and meet legal standards for joint physician contracting. Key steps that organizations must take include assembling a selective physician network, designing high-yield performance metrics, extending technological and staffing resources to aid performance improvement, and ensuring adequate interest from commercial buyers to support this intensive investment.

Access the full study for more information

Building the Performance-Focused Physician Network is designed to guide organizations through evaluating and launching a successful CI program, covering 15 key lessons for assessing strategic feasibility and building a program that yields significant performance improvement.

An Emerging Alignment Platform