Physician EngagementWhat's Your Role

Jeff BrickmanBrian 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.”

HealthLeader's 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 ConundrumThe 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

■ 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 get Doctors & Hospitals to work together

Yeah, Right !Yeah, Right !

Understand the physician network in your market

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?

■ 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 Engagement

But Engage Which Doctors?

And for Which Hospital?

How are the doctors organized?

In a group practice?

A PHO?

Were they bought by the hospital?

Employed by the hospital?

Or are they solo practitioners?

How do you know?

Fully Engaged?

Engaged?

Actively Disengaged?

Not Engaged?

Market Expectations and Realities

• 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

Engagement at a Market Level The market expects better alignment, shared payment and transparency. What can we learn from the data?

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?

WHY IS “ENGAGEMENT” SO CHALLENGING?

This is work!

All about our Brain and our Culture

Brain Hates Change

Culture Binds You Together

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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 MethodsPhysician arrangements

Choosing the model Understanding cause and effect

Business Imperatives Yesterday & TomorrowBusiness 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

■ 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

• Brian, add your slides here to address the he physician arrangements and business strategies aimed at alignment

• Business models and degree of alignment risk for the physician and the hospital

Employment

High

High

Low

Low

LeaseCCIA

Management Services Agreement

Private Practice 100% Aligned

Splitters

1,200 docs

800 docs

Physician Arrangements: CharacteristicsPhysician Arrangements: Characteristics

■ Employment (Married)– High control and low risk (?)

■ Lease (Long Engagement)– Hospital TIN, CI, Exclusivity

■ CCIA (Going Steady & Serious)– Stipends ($$$), CI, Exclusivity

■ MSA/PSA (Dating)– Stipends ($), CI

■ Employment (Married)– High control and low risk (?)

■ Lease (Long Engagement)– Hospital TIN, CI, Exclusivity

■ CCIA (Going Steady & Serious)– Stipends ($$$), CI, Exclusivity

■ MSA/PSA (Dating)– Stipends ($), CI

PHYSICIAN ENGAGEMENT – CHANGE IN CULTURE

Hospital – 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

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)

QUANTITATIVE

Tracking Physician Engagement

Tracking Physician Engagement

• Weekly Sales Summary report• Competitive Intelligence (≠problem collection)

• New skills/credentials/interest• Revenue streams (equipment; screenings)• Real estate (renewals, leases, investments)• Competitor-created “opportunities”• Referral source changes• Practice ownership/mgt. changes• Payor plays (HMOs, PHOs…)

QUALITATIVE

Tracking Physician Engagement

How Doctors Engage & How to Engage Doctors

Let’ s take a look: Case Study

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!”

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What Does it Mean for Me?

ObligationImplementation

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

Tactical Organizational Commitments

■ Dedicated resources– Liaisons– Clout (VP)– Physician leadership– Market intelligence– Business analysts– Relationship with finance

■ Dedicated resources– Liaisons– Clout (VP)– Physician leadership– Market intelligence– Business analysts– Relationship with finance

MOST IMPORTANT:Know the vision for your organization and what it needs to accomplish with its physician base.

Revenue Maximization is nearly “dead”

Brutal Fact #1

Revenue OutlookRevenue Outlook

Risk Based Revenue

TODAY TOMORROW

Operating Operating Margins Margins will sufferwill suffer

Volume-to-ValueVolume-to-Value

■ “Pay-per-Click / Hamster wheel Transactionism moves to Population Health and Payment for Outcomes”

■ “Pay-per-Click / Hamster wheel Transactionism moves to Population Health and Payment for Outcomes”

Value (V) =

Quality (Q)

Cost (C)

Decades of (perverse) FFS incentives leave hospitals and physicians ill-prepared for a necessary economic/reimbursement paradigm shift

Accountability – there must be a good political 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 and their customers?

2.Innovation: Add value in innovative ways.

3.Integrating: Let’s not sell the factory. Let’s integrate with our physicians and our customers so together we do 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 Needs and Priorities•More Patients•More Revenue•More Collaboration•More Hospital Referrals•More Resources•More Back Office Support•More Technology

Hospital Needs and Priorities•More Patients•More Revenue•More cross-selling of services•More Quality•More Referrals•More Services•More Technology

Physician Services Outreach Programs

Patient Relationships

and Satisfaction

Increase

More Revenue for Both Doctors and Hospitals

Tactical Implementation

Growing What You Need

Have 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 of engagement•Don’t wait until they arrive. Plan and define the handoff. It is easier to keep business than to grow new. Tend to your most loyal.

– 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 Most Important 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 the Physician 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 behavior

that 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, MBAPrincipal

651 Old Hwy 35 SouthHudson, WI 54016

(715) 381-1171kbarlow@barlowmccarthy.com