Physician Engagement Whats Your Role Jeff Brickman Brian Nester Andrea Simon Kriss Barlow, Facilitator
Agenda• Defining physician engagement• Framework: trends in our world and the market• Methods and models• The physician’s view• Tactical implementation – Needs for a successful organization – Cultivating relationships – Marketing’s role – Evolving relationship strategy
Healthcare Revolves Around Physicians Opening line… “The words “alignment” and “coordination” have been tossed about as the government and the healthcare industry wrestle to provide more value for every healthcare dollar spent. Under those words, every strategy to fix the problem revolves around one thing: physicians.”HealthLeaders Media Breakthroughs. Aligning Hospitals and Physicians toward Value.Dec. 2009. In collaboration with PricewaterhouseCoopers.
Leader Defined Physician Engagement• Healthcare Revolves around Physicians• Health System moving from System focused on volume to system based on value• To be successful every strategy to adapt to this new reality revolves around one thing: • Physicians
Leader Defined Physician Engagement• Physician leadership engagement needed to: • Redesign existing processes of care to improve efficiency • Integrate physician thought leadership in market based strategies to address needs • Address supply chain initiatives • Align financial and strategic incentives to address population needs
The Physician Conundrum■ I’m 55 years old…I lost it all • “SEP?, 401?...I have my real estate”■ I’m 40 years old…how do I get out of this • Is it too late to change careers■ I’m 32 years old…what have I done • My student loan payment will outlast my jeans
Clinical Integration - after decades of FFS, let’s getDoctors & Hospitals to work together Yeah, Right !
Understand the physician network in your market■ Who are the influencers? • Formal (Med Staff President) and Informal (Respected Clinician)■ Confederations or onesy-twosy? • Size matters■ Is there an IPA? • Functional? Aggregator? Contracting Experience?■ Is there a PHO? • Viable? What’s the history? Raise from the dead?
“Marketing Defined” Physician EngagementBut Engage Which Doctors?
Engagement at a MarketLevelexpects better alignment, shared payment and transparency. WhatThe marketcan we learn from the data?• 75-85% of the decisions that drive quality and cost are determined by physicians• Malpractice and manpower shortages concern doctors• Margins from private payers have barely covered the negative, payment to cost ratios from Medicare and Medicaid• Alternative income sources are scrutinized and disallowed
And for Hospitals…• 25% of community hospitals have had negative operating margins• Mounting regulatory requirements• Technology upgrades• Utilization is steady but rates for days have declined• Cherry picking by free standing facilities
Why does it matter? Changing business environment Demographic shifts Patient Changes in expectations Financial Challenges for healthcare institutions Financial Challenges for physicians and ambulatory centers Plain Old Change!!
By 2011, Gallup research… Shows how it matters. Reported a drop of 5 percent in the number of physicians who are fully engaged. An increase of about 10 percent in the actively disengaged. Worries about the impact of value- based purchasing, and changing reimbursement and incentives.
Engagement matters Gallup reported at one health system, outpatient volume increased +17.5 for engaged physicians in the top quartile for improved engagement. Disengaged physicians in the bottom quartile, their outpatient volume declined -11.7%.
Morehead research Morehead has found some association between high-performing hospitals and physician engagement. “Typically, when we see physician engagement move, we see other important metrics move,” Morton said. “Physician engagement is the lynchpin of many strategies in the organization, and without it, [those strategies] will not happen.” Morehead reported a shift in balance, with physicians treated less as customers and more like partners in patient care.
Will I know it when I “feel” it? How do you know an “engaged” physician from a “fully” engaged physician? Is it shifting or constant? Is it situational? Do they have linguistic or body language that tells you? Will you know what to look for? How to feel it?
How are you engaging with your physicians? Share with us some of the ways you might be building an engagement strategy today? What kinds of experiences? Communications strategies? “Feeling” opportunities? By whom?
This is work!WHY IS “ENGAGEMENT”SO CHALLENGING?
All about our Brain and our Culture Brain Hates Culture Binds Change You Together 23
When you are getting “engaged” It is like a new role you must play Think about what you will: Do more of? Do less of? Start? Stop? Never Change?
Models and Methods Physician arrangements Choosing the modelUnderstanding cause and effect
Business Imperatives Yesterday & Tomorrow■ Yesterday (FFS) – Aligned Physicians (heart-strings) • Referrals to hospital & ancillary services • Referrals to aligned specialists■ Tomorrow (Value-based reimbursement) – Aligned Physician Network (business rationale) • Principally primary care • Shared savings
High Splitters 1,200 docs • Brian, add your slides here to address the he physician arrangements and business strategies100% Alignedat alignment Private Practice aimed • Management Services Business models and degree of800 docs alignment risk Agreement physician and the hospital for the CCIA Lease EmploymentLow High Low
PHYSICIAN ENGAGEMENT – CHANGE IN CULTUREHospital – Centered → Physician - centric• Redefined Senior Team’s Focus to Physician Based Initiatives• Redefined mid-level interactions• Restructured physician liaison focus• Changed leadership structure to focus on physician intel and alignment priorities
Structured for Organizational Success• Leadership Goals established • Growth Council • Growth Reports • Service lines established • Physician leaders created • Physician sales retrained and expanded
Tracking Physician Engagement E ATIV NTITQUA Target List: Physician loyalty trending • Volume • Revenue • Payor Mix • Surgery vs. Medicine (or desired case types) • Elective vs. ED • Quality Order Set compliance; Morbidity/Mortality; Infection Rate; ED Call coverage • Efficiencies/”Workshop” Improvements CMI; Cost per Case; Supply Compliance; On-time Starts • Hospitalist &/or Specialist referrals • Ancillary utilization • Program participation/Leadership roles • Competitor share (splitting)
Let’ s take a look: Case StudyHow Doctors Engage & Howto Engage Doctors
Situation Hurley Medical Center in Flint, MI Opportunity to build a physician services approach to engage physicians from a region in the growth of a hospital. Two competitors in the local area: Genesys and McLaren And, not far away, many major medical centers intent on drawing patients from the region.
First We went Exploring Listened to their Stories Ethnographic approach Narratives tell you what surveys cannot And building it from the doctor backward, not the hospital outward.
What did we hear? Stories about how the other hospitals treated them. How the other PHO made it a financial “sin” to refer elsewhere. How they were closely tied to the other hospital and thought it was unnecessary to go elsewhere. Had self-selected to belong to the other institutions.
On the other hand… For Hurley, we had to listen better! This hospitals treated the doctors differently, in the voice of the doctors. Hurley had to work on service issues and concerns with the future investments of the hospital. IT Medical Records / Patient Charts Transcription Services Nursing Equipment/Technology
What were we going to do? Engage! Bring the doctors into the hospital differently. What could we do to help them? Not us!
Emotions matter Shared values, beliefs and behaviors create active culture—which makes us humans. We buy with emotions and justify with logic. This was a great deal about how the doctors “Felt.” The problems seemed functional. The reality was very emotional.
Functional changes CEO visits New technology and a new Emergency Department New Electronic Medical Records, Heavy Physician involvement. Physician Leadership engaged Engagement in the Strategic Process
Emotional Changes Launched a new physician services program to change the way it felt to be part of the hospital. Shifting from service recovery approach to a support and practice development approach. Key: “what do you, doctor, need and how do we help you?” What will enhance your reputation? TISP: Trusted, Important, Special and Pleased
Marketing What can you do to help them grow their practices and in turn, your services? What can you hold in their offices or for their patients? How can you attract more patients with and for them? How do they help tell your story and how does it help them tell theirs? All within regulatory environment? Then we Measured.
All about “Beliefs” What you “Believe is What you Will See!” 46
What Does it Mean for Me? Obligation Implementation What works, what doesn’t
Successful Engaged Organization of the Future• Move to greater integration of physician leadership in governance • Physician Enterprise • Employed Physicians • Independent Physicians • Align Financial & Strategic Interests • Focused on Meeting needs of Population, Local Businesses & Payors
Successful Engaged Organization of the Future• Collaboration & Integrated Decision Making• Elevate Physician Leadership in organizational Role to • Improve Quality & Safety • Improve Efficiency • Redesign Patient Processes of care across continuum
Change In Leadership Expectations• Leadership Development of Physicians• Greater Integration of Physicians in Designing & Managing “Second Curve” of Health Care• Sharing of Leadership• Change in Focus on Value • Cost • Quality • Convenience • Service
Tactical Organizational Commitments■ Dedicated resources – MOST Liaisons IMPORTANT: – Clout (VP) Know the vision for your – Physician leadership organization and what it needs to – Market intelligence accomplish with its physician – Business analysts base. – Relationship with finance
Revenue Outlook Operating Margins will suffer Risk Based RevenueTODAY TOMORROW
Volume-to-Value■ “Pay-per-Click / Hamster wheel Transactionism moves to Population Health and Payment for Outcomes” Decades of (perverse) FFS incentives leave hospitals and physicians ill-prepared for a necessary economic/reimbursement paradigm shift Quality (Q) Value (V) = Cost (C)
Accountability – theremust be a goodpolitical solution NOT !
Balancing Relationships Engaging physicians as “vital partners” These are changing times. Can we partner our way forward?
Physician Services and Marketing“4 I’s”1.Insight: Come from listening to our physicians andtheir customers?2.Innovation: Add value in innovative ways.3.Integrating: Let’s not sell the factory. Let’s integratewith our physicians and our customers so together wedo better.4.Implementation: Execution wins!
Tactically that means… Different ways to listen and act together. Leadership involvement and broader empowerment. Outreach Program/Coordinators transformed from liaisons and problem solvers to relationship builders. What do the physicians need, not what can we sell them?
Tactical Plans cont’d. How do we help them by sharing and educating on changes. Communications are changing, have we changed ours—while sustaining those for older physicians and using new ones for younger ones. Text versus fax? How does social media and mobile applications tie us together. Data. Who has it? How do we use it? How do we think about it?
Model might look like this… Physician Services Outreach Programs Physician Needs andHospital Needs and PrioritiesPriorities •More Patients•More Patients •More Revenue•More Revenue Patient •More Collaboration•More cross-selling Relationships •More Hospital and Referralsof services•More Quality Satisfaction •More Resources•More Referrals Increase •More Back Office•More Services Support•More Technology •More Technology More Revenue for Both Doctors and Hospitals
Growing What You NeedHave a plan: Recruitment and Retention•You can’t wait and don’t always want those that come to you.•Onboarding is your chance to learn their expectations ofengagement•Don’t wait until they arrive. Plan and define the handoff. It iseasier to keep business than to grow new. Tend to your mostloyal. – Remember they love you enough to whine – Respect their level of connection
Physician Relations• Think outside the hospital• Seek new information• Internal obligation to define the physician business strategy – Market softening – Validation – Pure intelligence – Optimal experience – Earned growth in clinical area
What Credentials Do Doctors Find MostImportant in a Physician Relations Rep?
The Right Level of Impact• What do doctors want? – How do you earn value? – How do you reinforce this?• What do leaders want?• What do you want?
How Helpful Do Doctors Find the Topics thePhysician Liaison Discusses With Them?
Vision • Can’t live in limbo • Create the vision for today and follow with a plan, but be nimble • Talk about their vision
Engaged and at Your Peak• What does “engaged performance ”look like?• What did you do within the last week that demonstrated your work to better engage your medical staff? – Qualitative – Quantitative• What can you do to achieve this level with more consistency?
Your Observations and Questions • Surprises? • Obligations • Topics still open • Comments
“Peak performers develop powerful mental images of the behaviorthat will lead to the desired results. They see in their mind’s eye the result they want, and the actions leading to it.” - Charles A. Garfield
Thanks!Jeff, Brian, Andi and Kriss Kriss Barlow RN, MBA Principal 651 Old Hwy 35 South Hudson, WI 54016 (715) 381-1171 firstname.lastname@example.org