7. Factors Driving Integration
• Market Share Control
• Declining Reimbursement for All
• Increasing Administrative Complexity
• Increasing Risk for All
• Increasing Costs for All
• Provider Consolidation
• Physician Aversion to Risk
• Physician Lifestyle Objectives
• Physician Disinterest in Entrepreneurship
• Access to Capital
Source: Halley Consulting Group
8. Common Integration Challenges
• Win/Lose Scenario
• Form Before Function
• Hospital-Centric Vision
• Absent or Conflicting Objectives
• Personal Agendas/Self Interest
• Disagreement Over Tactics
• Accountability for Performance
• Historical Animosity
Source: Halley Consulting Group
9. Hospital-Physician Integration Strategies
• Hospitalists and Professional Service Agreements
• Compensating Physicians for Time Spent in
Improvement Activities
• Sharing Performance Data with Physicians
• Gain Sharing
• Management Services Organizations
• Joint Ventures
• Integrated Ambulatory EHR
Source: HFMA
10. Hospital-Physician Integration Strategies
• Co-Management
• Physician Leadership Academy
• Organizing Medical Groups into a Single Group
• Patient-Centered Medical Home
• Employed Physician Compensation Methods
• Clinically Integrated Network
• Population Health Management
Source: HFMA
11. Physicians’ Considerations in Hospital
Choice
• Strategy
• Strategy Execution
• Market Position
• Capital Resources
• Service Levels
• Market Management
• System Relationship(s)
• Financial Performance
• Information Technology
Source: Halley Consulting Group
12. Evolving Alignment Models
• Accountable Care Organization (ACO)
• Patient-Centered Medical Home
• Quality Collaborative
• Clinically Integrated Network (CIN)
13. Precursors to Clinical Integration
• Call Coverage
• Clinical Co-Management/Service Line
• Equity Model
• Foundation Model
• Independent Practice Association
• Joint Venture
Source: Max Reiboldt
14. Precursors to Clinical Integration
• Management Services Organization
• Medical Directorship
• Physician Employment or Staff Model
• Physician Hospital Organization
• Physician Recruitment
• Professional Services Agreement
Source: Max Reiboldt
16. History – Differentiators
• Earlier to Market – Ahead of HMO Curve
• Vision to Establish Market and Integrate to Health
System – Versus HMO Purposes Only
• Establish Pipelines for Future
17. History – 1993
• Cumberland Valley Medical Services (CVMS)
Established – 2 Physician Practices
• Focused on Primary Care (Family and Pediatric
Medicine)
• Main Goal – Recruitment of Primary Care Physicians to
Franklin County
• 6 Primary Care Practices by 1996
18. History – 1999
• Summit Surgery Center Established
• Main Goal – Create Joint Venture with Community
Surgeons
19. History – 2004
• Cumberland Valley Specialty Services (CVSS)
Established
• Surgical Based Practices – Orthopedics and General
Surgery
• Established to Develop a Separate Company from the
Family Physician Group
20. History – 2010
• Summit Physician Services (SPS) Established
• CVMS and CVSS Merged to Form SPS
• New Board of Directors
• Hired a Medical Director, CMIO and 2 Directors
• Developed a Physician Advisory Council
• Implemented an Organizational-Wide Electronic Medical
Record
21. Current – 2017
• Multispecialty Group
• Physician and Administrative Dyad Leadership Teams
• Serving All of Franklin County – Growing Market in
Southern Tier
• Organizational-Wide Standard Work and Processes
22. Driving Forces – Health System
• Medical Staff Recruitment and Development
• Capture Market Share
• Improve Care Processes and Quality Outcomes
• Increase Physician Loyalty
23. Driving Forces – Providers
• Stabilize Income
• Decrease Call Coverage
• Increase Outpatient Presence
• Decrease Office Overhead
• Pay Off Student Debt
• Increase Access to Capital and Technology
25. Imperatives
High functioning, truly integrated medical groups
have six characteristics:
1) Physician Leadership Hierarchy
2) Common Infrastructure
3) Alignment with System Goals and Values
26. Imperatives (continued)
4) Operating at Benchmark Productivity and Efficiency
5) Evolving Physicians to Lead Patient Care Teams
6) Compensation Systems that Reward Individual and
Group Performance
‒ Productivity
‒ Quality
‒ Service
‒ Citizenship
27. Physician Leadership Hierarchy
• Traditional Organized Medical Staff
– VPMA/CMO
• SPS Leadership Structure
– Chief Medical Officer for Physician Services
• Lead Physicians
– Operational Directors
• Site Managers
• Corporate Expansion of Physician Leaders
– 3 VP’s on Senior Management
– Paid Medical Director Structure
28. Common Infrastructure
• Electronic Health Record
• Infrastructure Solutions
– Human Resources
– Revenue Cycle
– Policies
– Standard Operation Solutions
– Lean Management
29. Alignment With System Goals/Values
• Physician Culture Change
• Adopting Evidence-Based Medicine
– Clinical Guidelines Committee (SPS)
– Medical Director Council Clinical Improvement
Council (SH)
30. Productivity, Efficiency and Operational
Improvement
• Sharing of Operational Data with Providers to Engage
Them in Improvements
• Ongoing Discussions about Financial Integration of
Providers, Hospitals and Health System
• Reducing Clinical Variation
• Reducing Overhead via Economies of Scale as Part of
the Health System
• Supporting the Revenue Cycle and Corporate
Compliance
31. Physician-Led Patient Care Teams
• Patient Centered Medical Homes
• Ambulatory Flow Teams
• Outpatient Care Coordination
• Inpatient Unit-Based Teams
• Possible Future Hospitalist-Led Unit Teams
• Medical Director of Patient-Family Care
32. Evolved Compensation System
• Salary vs. Productivity Ratio Individualized
• Aligned Incentives
• Resources Available for Leadership
33. Size and Scale Matter
• Population Health
• Patient Centered Medical Home
• Spread Fixed Cost
• IT Investments
• Aggregation of Practices to Drive Down Cost and
Increase Quality
34. Payers Shifting Risk to Providers
• MACRA
• Value Based Purchasing
• Bundles
• Accountable Care Organizations
35. Contacts
• John Massimilla
COO – Chambersburg Hospital
jmassimilla@summithealth.org
• Niki Showe
Sr. VP, Physician Services – Summit Health
nshowe@summithealth.org
• Dr. Frank Mozdy
VP & CMO – Summit Physician Services
fmozdy@summithealth.org
• Kimberly Rzomp
VP & CFO – Summit Health
krzomp@summithealth.org
