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CAPP Leaders Discuss How They Develop Physician Leaders at Washington, DC, Colloquium

The Council of Accountable Physician Practices partnered with CAPG — a trade association that promotes accountable care — to host a panel at the CAPG Colloquium held in Washington DC, on September 29, 2016.

The panel, “Physician Leadership in the Movement Toward Accountable Care,” featured four CAPP medical group leaders who discussed best practices for recruiting, training and developing physician leaders.

The panelists represented a diverse range of medical groups in size, geography and model. The panelists were Dr. Marc Klau, Southern California Permanente Medical Group; Dr. Philip Oravetz, Ochsner Health System; Dr. Lee Sacks, Advocate Physician Partners; and Dr. Nick Wolter, The Billings Clinic. Dr. Robert Pearl, Chairman of CAPP and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group, served as the panel moderator.

“It will not be possible to move the country toward accountable, value-based care without strong physician leadership at all levels of the organization,” said Dr. Pearl. “Healthcare systems should view physician leadership as a capital investment for the future with huge ROI. The CAPP medical groups are committed to sharing their considerable experience to help all provider organizations face the challenges ahead.”

Development starts at recruitment
Over the course of the discussion, the panel touched on key aspects of their physician leadership development approaches. All agreed that leadership development starts at the moment of recruitment into the organization. “Every physician is a leader. We start with that assumption,” said Dr. Klau. “Take every physician on as a leader and then expand their capability, because you never know when you will need them.“

Dr. XX speaking at the CAPG colloquium.
CAPG CEO Don Crane introduces the CAPP leaders and the importance of physician leadership to move the needle on accountable care.


Each of the medical groups has their own leadership training programs that have evolved over the years. Ochsner Health System, for example, has several tiers of leadership training that are designed to match physicians with their age and career experience. “We believe every physician is a leader by definition, but some exhibit their ability to lead more than others, or earlier in their career,” said Dr. Oravetz. “Our program exposes these folks to what a management career might look like.”

Regardless of the specifics of the training and development programs, the panelists overwhelmingly agreed that two critical traits for physician leaders are emotional intelligence and proven clinical excellence. “The best leaders are going to be visionary but anchored in reality,” said Dr. Klau.

“Self awareness is important to put on the table. What’s your humility? How do you develop people to create trust that’s necessary for good teamwork?” said Dr. Wolter.

Physician leadership as a strategy
Dr. Wolter stressed that physician leadership development should be considered outside of health care system payment as a strategy to improve care quality and patient outcomes. “No matter how the payment system evolves, if you leverage team care and leadership, that’s going to lead to better outcomes.”

Dr. Sacks agreed, saying that his group places leadership development at a premium. “It’s about improving care. The finances will follow,” he said. “Focus on what really resonates, which is improving outcomes.”

Following the discussion, the CAPG audience posed questions to the panel about the how-to’s of physician leadership development. The panelists agreed that physicians who aspire to lead their health system should start small. They mentioned that emerging physician leaders could join clinical improvement committees or attend the first stage of a leadership program as ways to determine if the track is right for them.

The panel was comprised of four of the 11 medical groups that contributed their case studies to CAPP’s five-part journal series about physician leadership development, which was published in the journal Healthcare: Delivery Science Innovation. The articles can be read in full here.

Medical group leaders gathered to discuss physician leadership at the recent CAPG Colloquium.
CAPP medical group leaders gathered to discuss physician leadership at the recent CAPG Colloquium.


Photos courtesy of Thomas Van Veen of Documentary Associates

Achieving Physician Leadership in Changing Times: A Call to Action

By Laura Fegraus, Executive Director, Council of Accountable Physician Practices

In the dynamic and often complicated movement towards “accountable care,” the need for dedicated and skilled physician leaders has never been greater. Physician executives at CAPP’s progressive multi-specialty medical groups recently pooled their collective insights, experience and advice on building physician leaders in a five-article series on this topic, published as a special edition in Healthcare: The Journal of Delivery Science and Innovation. The open-access articles are now available for sharing through this link.

Recognizing the shortage of “how to” guidance on physician-leadership development, this series addresses the specifics of building physician-leadership capacity within a medical group or health system. Through detailed case studies of their organizations’ efforts, the series’ authors present creative and proven ideas to recruit, train, and develop physician leaders within medical groups and health systems.

The introduction to this series, “Physician Leadership in Changing Times,” is a compelling call to action from physician leaders, Jack Cochran, M.D., formerly of The Permanente Federation; Gary S. Kaplan, M.D., Virginia Mason Medical Center; and Robert E. Nesse, M.D., Mayo Clinic Health System.

The authors discuss the history of the accountability movement from its inception with the 2001 release of the Institute of Medicine’s report on Crossing the Quality Chasm. Since then, there has been growing recognition that high-quality, high-value health care cannot be achieved through the uncoordinated actions of individual physicians and other healthcare providers serving the interests of individual patients, one at a time.* Instead, physicians must lead all stakeholders in the healthcare system to work together toward a broader vision of improved patient care experiences, better population health, and lower costs, otherwise known as the “Triple Aim.”**

The remaining four articles in the series detail the “how-to’s” of recruiting, retaining, and supporting robust physician leadership inside of our CAPP groups — including reflections on how to maintain organizational focus on this important cultural component during times of transition. Readers of this series will hear from organizations like Billings Clinic, Southern California Permanente Medical Group, Advocate, Henry Ford Health System, Ochsner Health, Intermountain, and HealthCare Partners that have successfully maintained and fostered their commitment to physician leadership, regardless of organizational setting or environmental context.

The multi-specialty medical groups that belong to the Council of Accountable Physician Practices are committed to nurturing the next generation of physician leaders, and are dedicated to sharing their best practices and learnings with other healthcare stakeholders. Effective and patient-centered delivery system change will be optimized by physicians leading and shaping the healthcare delivery organizations of the future.

To read the entire series introduction, please click here.

* Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
** Berwick D, Nolan T, Whittington J. The triple aim: care, health, and cost. Health Aff.2008;27(3):759–769.

Physician Leadership in Changing Times

In health care, as in life, change is the only constant. Today, the tides of change are pushing the health care system toward ever greater shared accountability among physicians, hospitals, and payers. Whether that change will ultimately benefit patients – or simply become an exercise in rearranging the deck chairs on the Titanic – will depend, in large part, on the skill of those who are leading the movement. As physician leaders of three of the nation׳s largest integrated health care delivery systems – Kaiser Permanente, Virginia Mason Medical Center, and the Mayo Clinic Health System, respectively – we believe physicians must be central to this effort, in solid partnership with skilled administrators.

Among all providers, physicians have a disproportionate impact on the health care system and therefore have a disproportionate responsibility and opportunity to lead change. Patients experience their own health and the health care system in many ways: physically, socially, psychologically, and financially. As the first and primary point of contact with the health care system for most people, physicians must therefore act as caregivers, teachers, trusted information sources, and fiduciaries for their patients. They cannot and should not opt in and out of accountability toward their patients in any of these roles. In post-reform health care delivery systems, physicians are ideally positioned, and in fact compelled, to take responsibility for helping shape the health care system – not just their own practice – to better serve patients׳ physical, social, psychological, and financial needs. Many physicians in small, private practice are already experienced as civic and small-business leaders in their communities. However, the skills needed to run a small business and manage its resources are very different from those needed to lead delivery system change. This expanded paradigm of physician leadership cannot be accomplished working in isolation from the integrated systems of care, nor with indifference to the resources necessary to achieve good outcomes for entire populations.

We have a uniquely bright view of physicians׳ ability and willingness to take on this expanded leadership role. We also believe physicians can be led as trusted and respected members of a team that is greater than the sum of its parts. We call on physicians as a profession to view leadership – and the development of leaders – as key aspects of their role as advocate for their patients. In doing so, we draw on our 68 years of collective experience leading physicians into stable, respectful relationships with other delivery system stakeholders to support some of the most successful, patient-centered care systems in the nation.

Click here to read more about  “Why now, and why physicians?,” “What is a physician leader?,” and “Policy levers” in the full article by Drs. Jack Cochran, Gary S. Kaplan, and Robert E. Nesse in Healthcare: The Journal of Delivery Science and Innovation.

What Kind of Ancestor Will You Be?

By Jack Cochran, MD, FACS, Executive Director, The Permanente Federation

Is excellent good enough?

As physicians, we are trained to diagnose and treat disease. We dedicate ourselves to searching for cures and perfecting procedures that will restore the health of our patients. Over the last 50 years, we’ve made some remarkable progress. We’ve reduced the death rate from heart disease by 32.5% with a better understanding of primary and secondary prevention and advances in treatment. We’ve made similar progress in cancer care with better treatment options through radiation, surgery, chemotherapy, and genomics. We’ve changed an HIV diagnosis from a hopeless death sentence with limited treatment options to a manageable, chronic condition.

These truly excellent accomplishments in medicine have been life-changing for millions of people. But is excellent good enough?

While we have made great strides in clinical care, the American dream is faltering. Americans are more obese, more medicated and more in debt than at any other time in the history of our nation. One-third of our nation’s total health-care spending, about $750 billion per year, is wasted on unnecessary treatments, redundant tests, and uncoordinated care [1]. Health Care Reform will have limited impact on this waste. While the rate of increase of health care spending has slowed in recent years, the United States still spends 2.5 times more than most developed nations on health care [2]. U.S. health care spending is on track to reach $4.8 trillion in 2021, almost 20% of our gross domestic product [3].

This trend, compounded by one of the longest and most serious economic downturns we have ever faced has created a crisis for families, businesses, and communities that is tearing the fabric of the American dream. Health care is right in the middle of this crisis. The total cost of health care for an average family now exceeds $20,000 a year. When I began practicing as a surgeon, health care was at 10 percent of the GDP. Now it is at 18 percent of the GDP. These are investments health care have taken away from education, the environment, and infrastructure.

This has happened on my watch. I do not want an 18 percent drain to be the legacy of my generation. This insidious drain on families’ hopes and futures has to stop, and the trajectory in health care needs to change. Rather than causing despair and disappointment, it should be a positive enabler for a better life – physically, personally, socially, financially and psychologically. As an industry, we need the will and the resolve to create an inflection point and declare that excellent is not good enough.

Creating an inflection point to transform health care

It wasn’t too long ago when health care was centered around the doctor’s office or hospital. Physicians practiced with minimal support staff and subscribed to one journal. The problems physicians faced could be solved using the knowledge and skills they acquired in medical school. Patients went to the doctor’s office for all the information on their condition and for treatment. That was the industrial age of medicine.

Today, health care is much more complex. Physicians are accountable for a population of patients, whether the patients come in to the office or not. There are now more medical journals than physicians could possibly read or digest on their own. What physicians learned in medical school is no longer sufficient. Often, patients have extensive information about their diseases from Google searches and online patient communities like PatientsLikeMe. In these instances, physicians still play an important role as a trusted source – helping patients interpret the information they find and providing more context, evidence, and nuance so that patients and physicians can make informed decisions together. However, make no mistake, the locus of information and “power” has moved from the doctor’s office to the patient.

We’re forging the information age of medicine. In order to be effective, we must optimize the use of information, technology, tools and teams. We need to turn masses of patient data, science, and clinical evidence into clinical knowledge. This information must be available to patients, physicians, and care teams. And they must have access to technology and tools to make the right thing easier to do. Physicians and care teams should have clinical decision and panel support tools that not only put the latest evidence at their fingertips, but also enable them to provide personalized care to each patient.

Transforming health care into a learning industry

We need to make health care a “Learning Industry.” The inflection point won’t come from one bright leader or one superb organization. We have a wide range of inter-connected issues in health care. We can spend time blaming different parts of the industry for these challenges, or we can realize that we can influence and accomplish much by working together. We need talented people who have deep expertise in specialized areas and at the same time an understanding of the broader impact of their actions. We need to draw from all parts of the industry; harnessing our collective knowledge from the practice of medicine, the pharmaceutical industry, and medical research; as well as from a variety of disciplines, such as policy, economics, and engineering. We can only achieve this inflection point by being interconnected, by working collaboratively, by learning together. We can’t treat our way out of this crisis, we must learn our way out of it.

Health care needs to become a community that embraces measurement, comparison, acknowledgement, learning, and improvement. As physicians, we believe, and have every intention, that we are providing the highest quality care to our patients. But it is only when we measure and compare our performance that we can see if we are truly providing the best possible care or if there are gaps in our preventive care and treatments. Once we have the appropriate data, clinical guidelines, and resources, we can engage patients and close those care gaps. And then we won’t just believe we’re providing the best care; we’ll have proof. We must have the openness and spirit of collaboration to achieve this. We must also be willing to share our failures as broadly as our successes. As physicians, we often hear about the latest breakthrough treatments or procedures, but we are much less likely to hear when those procedures produce complications in the long-term.

Our greatest responsibility is to be good ancestors

As I look back on my career, I consider the legacy I will leave behind for my 6-year-old grandson and the generations that follow. Today, we talk about accepting “accountability” in health care for a patient population, across the continuum of care. Dr. Jonas Salk, inventor of the polio vaccine and one of the most important innovators in medicine, took a longer-term view of what accountability meant. Dr. Salk asserted that “Our greatest responsibility is to be good ancestors.”

By building a learning coalition, we can learn from challenges and successes across the health care industry. The innovations that can transform our industry are out there. They’re just not everywhere yet. We need to become rapid learners through connectivity, openness, discipline, collaboration, and a sense of curiosity. Organizations like the Institute for Healthcare Improvement, Alliance for Community Health Plans, American Medical Group Association, and Department of Defense are fostering connections among health care organizations as well as other health care stakeholders, and their efforts are gaining momentum.

The American dream is faltering. We need to restore hope and give some of the 18 percent back to the American people.  Ultimately, within each of us must be the resolve. Resolve is not about hard work and dedication. Those are table stakes. It’s a relentless focus on the reality and the mission. The future is going to be tough, but it’s in our hands. We have the ability and talent to create that inflection point that transforms health care and restores the American dream for future generations. Our patients, families, and communities are depending on us.

What kind of ancestor will you be?

This commentary was originally posted on The Health Care Blog.

Physicians Leading Accountable Care

By Eugene Lindsey, MD, president and CEO, Atrius Health and Harvard Vanguard Medical Associates

The Accountable Care Organization (ACO) is where I find optimism in healthcare today. Far from being the flavor-of-the-week, there are successful ACOs across the countries providing sustainable, high quality patient centered care.

While there’s no one-size-fits-all blueprint for an ACO (nor should there be), the goals are the same: transforming health care to deliver the highest quality care possible. I am convinced that for this transformation to be successful, it must fundamentally be physician-led. Physicians working with patient care teams—e.g., nurse practitioners, behaviorists, nutritionists, population managers, administrative staff, and others—know best the current system and its inherent waste and are therefore suited best to led the operational and cultural change that bends the cost curve while improving patient health.

First and foremost, we recognized that for real cultural transformation to happen, it could not be only a management initiative; physicians have to embrace and lead the change from the ground up.

That’s why we are working to adopt the Toyota Lean operating platform that is built on respect for the people who are doing the work. With this as a cornerstone, we have begun to reorganize our practices around value creation for our patients by focusing on decentralized leadership and localized innovation that eliminates wastes. In addition to the benefits of higher care quality and efficiency, the Lean process of continual improvement has helped clinicians free up time to use for increased access for patients, including by phone and through the patient portal.

We have also established the Leadership Academy for chiefs and clinical leaders–a 10-month, MBA-style program focusing on leadership, management, financial stewardship and clinical operations–to accelerate the professional development and managerial skills essential to a successful, decentralized organization. So far more than 300 clinical leaders and administrators have participated in the program.

The results are real. Atrius Health reduced the cost of care delivery for 2010 as measured
against prior trends by approximately $62 million through improving quality performance across all measures. It’s a testament to what’s possible when physicians have the support and resources to direct patient care accordingm their clinical judgment and established best practices.

We have known for years that the key to high-quality care is empowering the physician, but we weren’t the first. In 1933, a presidential committee charged with finding a way to address the rapidly increasing growth of health care expenditures (then 4 percent of GDP) concluded: “Medical service should be more largely furnished by groups of physicians and related practitioners, so organized as to maintain high standards of care, and to retain the personal relationship between patients and physicians.”

Nearly 80 years later, to paraphrase T. S. Eliot, we find ourselves where we started and know that place for the first time. Now, finally, is the time for physicians to take the lead with ACOs.