Practice Notes

Why fragmentation in the medical group is a system-level priority

How integrated is your organization? Chances are, you’ve answered this question by mentioning how many employed physicians are in your medical group. Historically, health systems employed physicians to protect market share; more recently, they employed physicians to grow lives under management. But while the employed medical group plays a critical role in both of these efforts, employment alone doesn’t earn a health system alignment, or true partnership from physicians. And increasingly, health systems are realizing the opportunity cost of not “partnering” with their medical groups.

Progressive medical groups are seizing the opportunity to take on this larger role, and emerging as the core engine for executing on overall system strategy, like expanding access, pivoting to value-based care models, and satisfying new consumer demands.

This is the new ambition for the medical group. But it also adds pressure on medical group leaders to get their own basics in order: To fully reap the benefits of partnership, the medical group must overcome fragmentation among its practices—in brand and culture, clinical practice, operations, and most importantly, in physician trust in the system.

Get everyone on the same page

Fragmentation in the physician enterprise makes it nearly impossible for a health system to operate a clinically or financially efficient care delivery model, let alone for the medical group to drive a system-wide strategy. But how do you tackle it? One of the key ways to ensure alignment is by building or resetting the cultural foundation and shared set of values.

We recently partnered with an academic health system affiliated with several medical groups and over 300 providers. Each group had its own professional services agreement with the hospital, and naturally there was variation across clinical, operational and economic functions, including compensation. They faced a tremendous opportunity to unite the groups and promote partnership across the system.

The system’s first move was to unite the groups under one legal entity, which would merely create the necessary framework and not in and of itself drive a sense of ‘oneness.’ But with that unified structure in place, leadership from both the medical group and the health system then sat down to lay the cultural foundation. Together, they drafted a multi-directional compact that formalized norms and expectations for all parties—individual physicians, the medical group, and the health system.

Now aligned by the compact, the hundreds of physicians in the organization and the system are able to develop and execute a highly-coordinated care delivery model. It’s such a great example of executive leadership proactively pursuing integration of its broad base of employed physicians, their driving force for growth and value in the community.

A boost for your brand

Developing a common platform to promote consistency in behavior across the medical group is not just beneficial to performance—it’s also part of Branding 101 for the entire system.

These shared expectations enable a system-wide movement toward standardizing clinical practice and operations, which in turn foster a consistent patient experience across all providers. It is the foundation of a brand.

Additionally, we have found that brands offer significantly more value if built upon emerging consumer expectations such as, access, convenience, responsiveness, efficient care deliver models, and transparent competitive pricing.

Building a consumer-centric brand by way of the medical group—essentially an organization’s branches into the community or region—offers growth opportunities over the long term. For instance, if the system is planning to introduce new services or open up new locations, there are much lower barriers to entry for an established and recognized brand to attract the local market.

As more medical groups are brought into the fold as system partners, the most opportunity will come to those that are not just legally and structurally aligned, but also have unity in their care delivery model and a shared understanding of what collective success will take.

Reach out to learn more about how we partner with health systems on integration.

How the University of Maryland unified its medical group

Learn more about how the University of Maryland Medical System successfully integrated their physicians operating under numerous different tax IDs to create a unified medical group.



16 steps to the high-performance medical group

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