There is historically a culture of distrust that comes from a lack of transparency, a lack of understanding of each other’s perspectives. In most hospital systems the physicians have never been given the data in a way that allows them to be held accountable.
Creating alignment: Depending on the market and the situation, I find that clinical comanagement works well, sometimes as a subset of a joint venture. In joint ventures, we would give the management of the joint venture option to the physicians and we would find that they did a good job with driving down costs and improving satisfaction. There was an extra incentive as managers. In the models where there is just clinical comanagement, it works with a sophisticated group of physicians who are integrated and willing to work together as a team. When you have a fragmented medical staff or group of individuals, it is harder to drive that because you have to create some kind of legal structure.
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