Health care delivery models—and relationships between hospitals and physicians—are changing rapidly, but until more systems implement new models, the traditional structure isn’t going away, according to discussions from an industry conference highlighted in an April 18 Health Affairs blog post.
The conference, held in October and convened by the AMA, the American Hospital Association (AHA) and Health Affairs, brought together health policy experts and representatives from 10 innovative integrated care delivery systems. The discussions highlighted successful, but varied, innovative approaches to creating an environment in which practicing physicians and hospital administrators and staff work cooperatively for the benefit of patients.
Integrated Care Delivery Systems
Some physicians are uncomfortable with the idea of integration with hospitals, fearing that they may lose professional independence, and prefer to organize themselves as entirely separate from hospitals, according to the blog post. On the flip side, some hospitals have concerns about integration, too—for example, a hospital’s more hierarchical structure may make it difficult for leaders to see physicians as equal partners, the blog post notes.
Despite these concerns, many physicians and hospitals now have opportunities to redesign care “to be more coordinated, efficient, patient-driven and effective in achieving outcomes society both needs and deserves,” write blog post authors Francis J. Crosson, MD, AMA group vice president of Physician Satisfaction: Care Delivery and Payment, and John R. Combes, MD, senior vice president at the AHA and president of the Center for Healthcare Governance.
Common Elements for Success
Discussions at the October conference revealed that no single structure or business model of care integration can guarantee success or failure, but there are a number of common elements among successfully integrated systems that can be replicated.
For example, all parties in the organization, from the hospital governing board to physicians, should have a clear understanding of the organization’s mission and a sense of mutual respect, despite different training, experiences and priorities. A sense of responsibility for the long-term success and reputation of the organization is crucial to success as well, Dr. Crosson and Dr. Combes write, as is a commitment to performance measurement transparency and improvement.
“Physician leadership and committed involvement are key to building and maintaining such a successful culture,” the post states.
Flourishing integrated organizations need to foster an empowered physician community that can take on greater organizational responsibility, and which, in turn, supports physician professional integrity..
At the same time, hospital executives must develop a deeper understanding and respect for the clinical world, keeping in mind physicians’ autonomy and expertise.
Topics to Address
The conference resulted in a number of policy implications, including the need for more rapid development of physician organizations capable of self-governance and collective management. In addition, there is a need for more integrated leadership in the key management decisions of the institution. It also brought to light the inadequate supply of physicians with leadership and management training, an area that medical schools and residency programs could oversee for future physicians.
Above all, discussions at the conference exposed the need for cultural change. Further, successful organizations need to document their methods for favorable cultural change so other groups can implement their own changes.
“The traditional triune model of hospital governing body, hospital senior management and staff, and organized medical staff will not go away any time soon,” Dr. Crosson and Dr. Combes write. “Nor should it, until it can be placed by new structures reflecting the determinants of success … in the meantime, it will be important to understand how emerging integrated leadership models and existing traditional roles and models, especially those of the organized medical staff, can coexist without unnecessary duplication of effort or conflict.”
The conference did not examine the roles of health insurers, payers or patients in these new care delivery models, but the AMA is continuing to answer questions surrounding these groups as part of its Physician Satisfaction and Practice Sustainability initiative.
In this work, the AMA is researching and developing best practices for care delivery and payment that improve outcomes and health, increase productivity, and save lives and money. The AMA also is creating tools that will allow physicians in any practice setting or size to streamline their practice operations and adopt the best models for their practices.
