Becker's Hospital Review

46 Executive Briefing S ince one can remember, health systems have based their operating models around hospital-centric service lines, such as orthopedics, cardiology or cancer. Although this fragmented approach has survived for decades, it rarely leaves care teams confident about who is responsible for a patient's overall journey through the healthcare system. But as the industry has evolved, this standard way of operating must also shift. Operating models — the organizational structure, processes and performance management underlying patient care — based on hospital centric-services and fee-for-performance payment "won't work anymore," said Chris Smedley, vice president of physician enterprise at Premier Inc., a healthcare improvement company networking with more than 3,900 U.S. hospitals and more than 150,000 other provider organizations. Health systems are made up of several departments, spanning acute and ambulatory care, each of which has its own span of control, management team and staff members who fulfill specialized roles. This siloed operating model too often results in fragmented care because the care team is designed in a way where no one feels a sense of responsibility for the entire patient experience. More tangibly, the broken operating model often results in patients left to fend for themselves, navigating the complex care processes, and missed opportunities for health interventions — all of which drag down a hospital's bottom line. Instead, survival in today's healthcare ecosystem requires integrated delivery networks, in which the modern-day hospital operating model supports providers to deliver a continuum of care in a comprehensive and coordinated way and fully aligning all physicians – employed or affiliated – to work toward a system's overall mission of better outcomes while reducing costs. This article discusses critical steps in which health systems can foster a holistic sense of accountability for patients within their organizations as they collaborate with newly-acquired or affiliated healthcare providers and physician groups outside the hospital. The piece also examines the necessary role data plays when measuring progress and informing future value-based operating decisions. Accountability: The bedrock of value-based operating models The writing is on the wall: health systems must make cultural and structural changes in the organization to survive. Currently, Medicare contracts represent about 30 percent of the covered lives in Accountable Care Organizations (ACOs) and that number is expected to grow. As fee-for-service payments are phased out and steadily replaced with value-based reimbursements, hospitals should look to support more effective employed and non-employed physician care coordination in efforts to reduce variation and eliminate inefficiencies while continuing to enhance the patient experience both inside and outside the four walls of the hospital. Hospitals moving toward value-based operating models are working closely with their affiliated physician groups and physician practices to identify opportunities to standardize care and achieve greater clinical efficiencies. These conversations are critical, as there is no one-size-fits-all operating model for a health system today. "When systems start on this journey, they must design a model that is tailored to their organization," Mr. Smedley said. One place to look first? "Focus on breaking down silos and don't let the organization fall short by making unfair compromises," he said. Dyad leadership models and improved physician engagement through committees or leadership roles are two strategies by which health systems can eliminate longstanding divisions between departments, sites of care, administrators and clinicians. 1. Dyad leadership model. A dyad leadership model comprises a hospital administrator and a physician champion. These dynamic pairs, when effective, help health systems navigate the quadruple aim. Pairing an administrator with a physician is an effective way to get physician buy-in with systemwide performance targets. What makes an effective dyad? Finding the right chemistry is critical and the two must operate with a clear understanding of their roles and responsibilities both separately and together. Ultimately, they should function better because of their relationshwip to one another, communicating and coordinating their efforts to reduce operating costs and elevate patient care. Consider a common goal of administrators and physicians: reducing readmissions through improved post-acute care delivery. Approached disparately or on their own, administrators and physicians might direct resources in different ways, only to discover key stakeholders are not on board or that critical elements were overlooked. A dyad holds an administrative and physician leader accountable to make decisions that factor in the broad spectrum of considerations required to navigate the complex healthcare landscape. A dyad can help reduce blind spots that administrative and clinical roles often face as they execute their respective duties. "When a dyad is functioning well, patients can avoid costly readmissions, have better experiences and outcomes during and after their care, and face lower expenses for the same episode of care," Mr. Smedley said. Melding administrative expertise with clinical excellence ensures patient-centric care across multidisciplinary groups — a win-win for boosting a hospital's quality- and financial-based objectives. 2. Align employed and non-employed clinicians through better engagement. A recent Premier survey found nearly 80 percent of healthcare executives agree the alignment of employed and affiliated providers is essential for efficient operations. The 1990s Called – They Want Your Hospital's Operating Model Back Sponsored by:

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