This analysis from HealthLeaders Media describes four hospital systems that are working with physicians to redesign health care delivery that could be the basis for forming and implementing accountable care organizations. The four hospital systems profiled are Gundersen Lutheran Health System, Sanford Health-MeritCare, SSM Health Care and Virginia Mason Medical Center.
The analysis notes some commonalities among these systems:
- A common language and understanding of quality improvement among physician and administrative leaders
- A shared culture of quality improvement, including explicit covenants and compacts with physicians
- Clear goals and strategies, with mutual accountability for reaching quality benchmarks
- Physician leadership, sometimes with organizational structures pairing a physician leader with an administrative leader in a dyad of shared strategic and operational accountability; these physician leaders often still maintain a clinical practice and care for patients
- Useful data, shared by hospitals and physicians, used to streamline care processes to measure patient-centered outcomes
- Shared risk, either through full employment of physicians, non-salaried compensation incentives, or participation in accountable care organization demonstrations
Some of the strategic goals of these health systems are impressive. Among Gundersen Lutheran Health System strategic targets for 2012 include “achieve and sustain all quality measures at the 95th percentile”, “have no preventable deaths, infections, pain, suffering, waiting, or waste”, “achieve and sustain the 95h percentile in all service measures”, and “ensure that all patients get the care they need when they want it”.
At Virginia Mason Medical Center, the organization commits itself to “foster excellence; listen and communicate; educate; reward and lead” while its physicians commit to “focus on patients; collaborate on care delivery; listen and communicate; take ownership and change”. Virginia Mason has developed “patient care bundles” that outline evidence-based processes of care to optimize quality and clinical outcomes.
In a roundtable discussion, leaders from these health systems emphasized that “alignment” between hospitals and physicians requires integration of physicians in the operations, leadership and governance of the health systems, including engagement in clinical decisionmaking, engagement as co-leaders, and financial alignment.
Ignatius Bau 