Becker's Hospital Review

49 Executive Briefing 7 Steps to Achieve Physician-Hospital Alignment, Collaboration and Trust H ealthcare's second curve is coming fast. Hospital and health system leaders know they won't survive it with- out improving alignment, collaboration and trust with physicians. The first curve was all about pay for volume. Physicians had to crank RVUs and hospitals needed heads in beds. For the most part, a hospital's success on the first curve could be a byproduct of physician success, even if their incentives weren't fully aligned. The same won't hold for the second curve. It will be about pay for performance, outcomes, population health manage- ment, the Triple Aim and other forms of pay for value. This means physicians and hospitals must work together to trans- form their business model from providing services to achieving health. "Hospitals, physicians and healthcare systems are trying to figure out when to jump to the second curve. If they jump too soon, they leave money on the table. If they jump too late, someone else will be ahead of them on the learning curve," says Rick Sheff, MD, principal and CMO of The Greeley Compa- ny, a healthcare consulting firm based in Danvers, Mass. "The imperatives to succeed on the second curve are to improve quality and reduce costs at a pace and magnitude no- body knows how to do today. But somebody's going to figure this out. And if that somebody isn't you, they'll be eating your lunch," Dr. Sheff adds. Getting onto the second curve requires experimenting with different models of reimbursement. Hospitals and health systems are entering alternative payment models, including bundled payments, shared savings agreements, pay-for-perfor- mance contracts, accountable care organizations and pa- tient-centered medical homes. As of February 2015, 42 percent of hospitals reported that 10 percent or more of their revenue stemmed from val- ue-based contracts, according to a survey from Kaufman, Hall & Associates. Another 22 percent expect 50 percent or more of their revenue from value-based contracts by 2017. According to Dr. Sheff, "For every one of these new ar- rangements, part of the solution has to be the doctors — get- ting physicians to change how they practice medicine and are rewarded. Now comes the hard part." Here Dr. Sheff outlines seven steps to improving physi- cian-hospital alignment, collaboration and trust so both sides can make the jump together successfully. 1. Acknowledge the past. "This step is critical where trust is low," says Dr. Sheff. "It's usually low because of events in the past that have left a scar. You need a time-sensitive and efficient way to address the past, and leave it in the past." When trust is low, hospitals and phy- sicians must listen to each other and acknowledge the impact their previous actions have had on the other. If trust isn't low, organizations don't need to spend much time on this first step, he says. But if it is low, naming and acknowledging the most impactful events from the past are critical to success. This holds true even when the current players weren't involved in the past events. "If we don't do that work, the past keeps coming back to poison the present." 2. Reframe the challenge to align physician, hospital and patient interests. "If each party focuses on its own success and neglects the success of the whole, then both the whole and the parts suffer," says Dr. Sheff. It's neither sustainable for the physicians nor the hospital to focus solely on their own interests. Reframing current challenges can be helpful for physicians and hospitals. "One of the most helpful reframes is, 'How are we going to achieve physician success, hospital success and good patient care at the same time?'" says Dr. Sheff. This reframing can help physicians and hospitals realize they are on the same side of the negotiating table and their success is not mutually exclu- sive. 3. Consider the process an interest-based negotiation. The proven track record of interest-based negotiation has shown that parties are much more likely to come to a mutu- ally satisfactory outcome when their respective interests are met than when one "position" wins over the other. This means reframing your physician-hospital alignment efforts by focusing on interests to be satisfied rather than positions to be won. Once physicians and hospitals are seated on the same side of the table, both parties should share a list of their respective interests. Meeting the interests of both parties then becomes a shared challenge rather than a competition of one side against the other. 4. Create a new vision for physician-hospital collaboration and alignment Once all parties are unstuck from only maximizing their personal interests, the group must decide what a successful fu- ture looks like. That vision must be specific and simple enough to articulate a goal or set of goals so the organization can mea- sure progress. This vision should be a "touchstone for every major decision," according to Dr. Sheff. This should be distinct Sponsored by:

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