Accountable Clinical Management - Driving Sucess through Shared Leadership

Integration, alignment and, more importantly, engagement of physicians is a strategy critical imperative for health systems seeking to create high-performing, future-ready, accountable care organizations. Over the past decade or so, many models have been tried – some successfully, others not so much. In the search for the holy grail of physician integration, most hospitals have concluded that a pluralistic approach, pursued in the context of an over-arching framework for clinical care and performance transformation, will be required to address the rapidly evolving world under healthcare reform.

Clinical co-management is an integration structure that has seen renewed interest from both hospitals and physician organizations. Under the co-management arrangement, hospitals contract with an organized group of physicians to provide day to-day management services for the inpatient and outpatient components of a specialty service line such as cardiac, oncology or orthopedics. The first generation of co-management was an outgrowth of gainsharing where physicians benefitted from cost savings arrangements. Most of these early models, however, faded quickly once savings reached a point of diminishing returns. And many failed when financial rewards didn’t materialize because cost improvements weren’t achieved.

The new generation of clinical co-management, however, provides a foundation for creation of "accountable" clinical care models at the service line level.  It offers substantially more value in that the agreement between the hospital and physician organization provides for and rewards physician engagement and leadership in a broad spectrum of activities that improve patient care and outcomes, generate cost efficiencies and make the clinical service more competitive in the market. The model also differs from conventional hospital-physician joint ventures in that the hospital maintains ownership of the clinical service line and resulting revenue stream, while physicians gain much greater participation in and compensation for strategic planning, budgeting, clinical program development, quality oversight and improved patient experience.

With this approach, physicians have more clinical and operational influence than they have had traditionally. The hospital gains from quality, safety, cost efficiency and patient satisfaction improvements, especially where pay for performance and physician quality reporting initiatives are prevalent, since these directly tie financial reimbursement to outcomes. And the strategy-critical structures, processes and relationships are forged to create and build success in the new 'value-based' healthcare economy.

The real winners, however, will be the patients that benefit from aligned hospital-physician incentives that have a positive impact on patient care.