The Top 5 Things Medical Groups Can Do to Prepare for System Reform

By Robert Nesse, MD, chief executive officer, Mayo Clinic Health System

In my previous writing for this Accountable Care column, I stated that to embrace our current healthcare challenges and move toward solutions, we must address these three questions:

  • What can we do to solve the problems of health care in America?
  • What are fundamental attributes that medical groups must have to succeed in the future?
  • Why should we do it now?

You can read the answer to that first question here. In this column, let me discuss question number 2: what are fundamental attributes that medical groups must have to succeed in the future?

While there are many requirements, I suggest that medical groups concentrate on these five areas to start:

    • A network of providers
    • Aligned purpose among those providers
    • Coordinated care systems
    • Aligned financial model
    • Practice analytics

In the old model, we could pick and choose what we wanted to focus on in our business. All too often this was done by taking a close look at payment for specific services, and then tailoring the business toward the most profitable ones. In our new world, the usual profit centers will become cost centers counted against payment for outcomes and the total cost of an episode of care. Your organization will need to develop a network that provides continuity for populations of patients. Then that network needs to be aligned-culturally and financially — around the shared purpose of providing quality outcomes and cost efficiencies for populations of patients (also known as the Triple Aim). The majority of providers in this country work in groups of less than 10 physicians. Those small groups will face significant challenges as they try to successfully achieve these goals, so it is anticipated that smaller groups will continue to merge with or align with larger groups to achieve the desired results.

Once you have your network, you need to coordinate the care. Care coordination reduces waste and rework — a benefit in itself. However, just as importantly, good care coordination embeds patients in a system that meets their needs. They do not have to act as independent agents churning through resources as they bounce from provider to provider getting each of their body parts evaluated.

Unfortunately, all of this will just be a hobby if we don’t align the financial model with our best practices and our network. We must advocate for our accountable care model and drive the system to support it. A good number of people are making a lot of money from our current dysfunctional system. Wherever possible, we should engage with payers and others to change rather than continue a one-sided vendor relationship with mysterious justifications for cost and payment increases and murky data.

This brings me to the last requirement and perhaps the most important: practice analytics. If you don’t know what your physicians and group are doing and are not able to track your performance, your future will never be in your control. You will be victimized by new payer contracts and pilloried by public displays of your performance data. There are new technological systems out there that will support your transformation, but embracing practice analytics must be an urgent priority for your group. In our new world, clinical knowledge and data sharing not only supports our patients’ medical interests and needs, it supports our future viability as healthcare providers.

Working on developing these five attributes is, in my view, the best approach that physician groups can take now to prepare for the future.  Each of these will take time, but each is attainable and will contribute greatly to the success of the accountable care model.

In the next “What the Experts Say” column, Dr. Nesse will address the third question: Why should the healthcare industry tackle delivery system reform now?

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