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March 29, 2022

How physician partnership is changing

Daily Briefing

    The physician landscape is constantly changing, and now there are more partners than ever before. Radio Advisory's Rachel Woods sat down with Advisory Board's Eliza Dailey to talk about the changing physician landscape, what physicians want from their partnerships, and how to make a partnership successful.

    Read an excerpt from the interview below and download the episode for the full conversation.

    Rachel Woods: We know that we need more of a two-way relationship when it comes to any partner, hospital or otherwise, working with an independent physician group. Do we know what physicians actually want from their potential partners?

    Eliza Dailey: We do. I can share a couple of things here. I would say the biggest opportunity that we heard from independent groups in our research is to partner around value-based care. We've been tracking for a while that independent physicians tend to be more serious about risk-based payment and a lot of them are continuing to double down.

    This is an area where they're actually proactively looking for potential partners. If you can provide a solution here, offer them data, offer them the infrastructure they need to succeed in these contracts, those are the types of things that they're looking for.

    For example, the number one thing we heard in our interviews that independent physicians want is access to real-time clinical data. They specifically want it for patients who are attributed to them and their value-based contracts so they can see patient progress, when they're admitted to a hospital, they can see what their utilization looks like when they're getting care outside of their practice, all of those things that might all ultimately impact their bottom line performance in risk-based arrangements.

    Woods: Because it impacts their ability to control cost, uphold quality under a value-based payment agreement.

    Dailey: Exactly. It's a whole lot easier if you're on the same EHR. Most organizations are not. So we're seeing a lot of workarounds here, either standing up ADT feeds or setting up encounter notifications. I think it's an important opportunity for business partners and tech vendors to be able to provide a solution to bridge that gap.

    Woods: So they want help with their business model, they want help with value-based care. What else are they looking for?

    Dailey: The other big thing that physicians are looking for is autonomy and to retain their decision-making. The physicians who have remained independent today are independent by choice. When we talk to them a lot of them actually call themselves fiercely independent.

    So we've seen partnership models that allow for more flexibility in autonomy, surge and popularity. In the past, I think a lot of partners have viewed the models that allow for more control to be the more successful ones, but we're actually seeing now that because the landscape has changed, the inverse is true.

    For example, we're seeing MSOs become more popular; management services organizations. Those are kind of membership type models that physician practices themselves have run for years. We're actually seeing hospitals begin adopting some of those looser membership type models too.

    Woods: By the way, this is exactly why we decided to create a new framework for how to look at independent physicians, physician partners in the market. And that's why when we had that episode with Sarah and Prianca we spent so much time talking about the role and the kind of scale of autonomy and what different partners could provide.

    Dailey: Yeah, exactly. I think importantly, this is an area where hospitals have been further behind. And so we see them actually looking to other types of partners and suitors in the market and drafting off some of the models that they've been rolling out to date.

    Woods: This is exactly where I wanted to go next. If we know what the physicians want, they want help with their business model, they want more autonomy, how can potential partners actually differentiate themselves, especially given the fact that the market is just more and more crowded?

    Dailey: First, I would say that partners need to make sure that they're going out to the market with a pitch that actually reflects the needs and wants of physicians today. So value-based care support, autonomy, the things we just talked about. But really just as important as what you're offering is how you work with physicians. What does it actually feel like to be a physician who partners with your organization?

    We've seen physicians become really adamant that they want to be involved in decision-making, they want to feel like they have a voice, that they are valued as a strategic partner. In some ways that's equally as important to the actual tangible offerings you're providing to physicians in your partnership.

    Woods: By the way, I want to underline something that you said that our audience might have missed, which is that some partners do this better than others. A consistent feature we've seen across shifting power dynamics over the last several months, several years is that hospitals tend to be at the bottom of the list, which is so interesting to me, given where we started with alignment being this concept that historically favored hospitals, and today, I'm not sure that it does or that it should.

    Dailey: That's exactly right.

    Woods: Let me continue to kind of channel these potential partners, whether or not we think they are a good partner or not. It must be difficult from their perspective because they're working with several physician groups and several kinds of physician groups. So should they have a single partnership strategy or are they sort of forced to have many?

    Dailey: That's an inherent tension that we heard throughout this research—how to strike the right balance between working with independent physicians at scale, while still providing them kind of the tailored support that they want and that they feel is important.

    The answer is yes and no. You want to have some strategy that outlines a consistent approach to partnership across multiple entities that your organization is really holding hands on. But at the same time, you really need to be rolling out partnerships at a local level.

    Dailey: What we found is that market dynamics, like the number of competitors or the size of the organization or the other players that are in the market, really dictate what these partnerships look like in practice. So especially for those organizations that work across several markets, you will have an overarching strategy, but what partnership actually looks like in practice and the individual ways that you're working with individual physician groups, will look different.

    Woods: So beyond having too narrow of an approach to partnership, what are some other big reasons why we see these things break down? What can we help our listeners avoid as they work with physicians?

    Dailey: A couple of things here. I would say the first is overly relying on the contractual models to really underpin these partnership arrangements. We find that organizations tend to run at the models or the specific contracts without actually thinking through what the shared purpose is that they're trying to achieve, what their overarching strategy is. And like I mentioned before, you need both. I would encourage organizations to really invest in the upfront considerations around you and your partner's goals. What are you trying to achieve? How will you measure success? Things like that.

    The other thing, and this was actually one of the most interesting things we found in the research is that those partnerships that hinge on interpersonal relationships are actually more vulnerable. How many times have you talked to an executive and they say, "Yeah, I'm buddies with the CEO down the road and we have this great relationship."

    I think that's great, but it actually makes the partnership pretty vulnerable because we find that when those executives turnover, not uncommon in healthcare, you actually have to start the partnership from scratch. So rather than focusing on those individual interpersonal executive relationships, how can you build trust as an organization and really embed that across all levels.

    Woods: If that's what we want our listeners to avoid, what are the hallmarks of successful partnership?

    Dailey: Successful partnerships place more importance on having a shared purpose and shared understanding of what both sides are trying to achieve rather than the specific contractual model. I'd encourage executives to really invest in that upfront discussion with both sides present at the table to really understand what your goals are for the arrangement, really building that trust upfront and acknowledging how this partnership will be different than maybe those of the past.

    Woods: Even so, I think that we're still a little abstract right now, to be honest. I think folks might be nodding their heads and saying, yes, I agree with purpose first, contract second, help me make this real. How will an organization know if their partnership is actually successful?

    Dailey: Just like any strategic initiative, it's important to have metrics of success. Particularly with partnership, I encourage organizations to actually agree on those upfront, pre-define them before you actually enter the arrangement so both sides know what they're trying to achieve and what success looks like.

    Specifically with partnership, these should be tailored to the specific arrangement. So we're not thinking metrics that could really be used to measure success for anything, but how can we look at the difference in what would've happened if we worked alone versus what the outcome is now that we've worked together.

    For example, if you look at a clinical partnership, oftentimes we'll see organizations measure cost savings for care delivered via the clinical partnership versus delivered separately. So really trying to parse out what is the value add from us working together.

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