During our annual Healthcare Symposium, FORVIS dedicated a learning track to cover important topics related to physician enterprise. As we navigate into a post-public health emergency world, we have found that a number of concerning trends accelerated over the last three years. Those trends include provider burnout and turnover, increased costs, lack of professionalized management, and reimbursement uncertainty among others. However, instead of lamenting the changes, our team shared insights on how to move forward by focusing on the future of physician collaboration and alignment—the use of analytics and improving data transparency—and the strategic use of “Triple-Aim” physician contracts.
The Future of Collaboration: Independence versus Interdependence
Striking a balance between physician independence and interdependence has proven to be important in a fractured but increasingly collaborative care delivery and reimbursement environment. By understanding the elements of a clinically integrated network (CIN), FORVIS has created a new vision of physician alignment via five P's:
- Physician-Led Engagement: developing physician-friendly systems and processes to assist in monitoring the progress of an organization in meeting its strategic goals
- Positioning: understanding practice viability by assessing post-pandemic navigation and analyzing fee-for-service volume, value-based payment leverage, and clinical team engagement
- Platform: providing agility capabilities and managing risk by layering resources when delivering population health services
- Partnerships: helping facilitate long-term success by initiating partnerships with medical groups, retail health, and new “payviders”
- Prevention: using transitional care management, Annual Wellness Visits, and Chronic Care Management services to improve patient care and manage costs of care
Successfully navigating relationships with both independent and employed providers in an "all options on the table" approach requires a commitment to principles and a flexible playbook to deliver on strategic objectives. CINs can help deliver on that goal; however, these principles also have a broader application to physician enterprise strategies.
Driving Performance: Improving Data Tools and Transparency
Having the right foundational relationships, such as a CIN or other provider workforce strategy, is key to meeting an organization’s market objectives. In order to manage “execution risk,” organizations must provide timely, relevant data to physicians, management, and staff. This democratization of data allows for multiple levels of an organization to be empowered to make data-driven decisions.
- To help keep data usable, the volume, availability, accessibility, complexity, and timeliness of the data must be assessed based on the needs of the end user.
- Data transparency empowers senior leadership, providers, middle management, and analysts to be a data-driven force for change.
- Expanding the use of analytics can cause friction points in an organization, but processes such as data normalization and helping users understand metrics and how they impact them can help overcome these obstacles.
- Implementing best practices for dashboard development provides tailored dashboards that do not overwhelm users.
- Utilizing software as a service can help accelerate data-driven decision making, eliminate process errors, and provide insight. Consider applications such as STa2T for insights on provider operations and Simpliphy, Inc. for calculating and managing provider compensation.
Creating and managing a single source of truth elevates conversations with providers both in strategic decision making and driving operational excellence.
Accessing & Driving Value: Strategic Use of the New “Triple-Aim” Physician Contracts
The evolving regulatory and reimbursement landscape has made partnering with and co-leading care excellence with physicians possible at a higher and more customizable level compared to historical provider contractual arrangement structures. When looking to develop value-driven physician contracts, it is necessary for leaders to understand new value-based Stark Law exceptions and how to structure physician compensation models to achieve Triple-Aim alignment.
- New Stark Law exceptions for value-based remuneration to physicians are available at three levels of financial risk: (a) full financial risk, (b) models with meaningful downside risks to physicians, and (c) more straightforward “value-based arrangements.”
- Triple-Aim physician compensation structures are tied to improving population health, quality of patient experience, and lowering costs of care.
- When solutioning physician compensation structures, be sure to design success for core talent and remember there is no perfect start.
These types of contracts are ideal for operationalizing value-based care. For example, if length of stay performance is a concern, a value-based arrangement with hospitalist providers can help incentivize the type of care management, coordination, and post-discharge care that can improve outcomes. That type of work effort can be assessed and rewarded under a value-based arrangement utilizing one of the identified exceptions to the Stark Law noted above. There are more legal concerns and other nuances to these arrangements, but these types of contracts are certainly achievable with a reasonable level of intent and focus.
Committed to keeping our clients and professionals up to date is one of the best ways we serve physician enterprises. FORVIS will continue to assist our clients in adjusting to the impacts of COVID-19 with the new opportunities and solutions that are available. From defining the future of physician collaboration and understanding the best ways to make data meaningful to structuring physician compensation models to tie with value-based strategic goals, we will manage the present and prepare for the future. That’s the FORVIS forward vision.
For more information, reach out to a healthcare professional at FORVIS or submit the Contact Us form below.