These networks will succeed or fail on the strength of their leadership, says T. Clifford Deveny, MD, senior vice president for physician practice management at Catholic Health Initiatives, the 73-hospital system based in Englewood, CO. "Someone has to become the convener and create a vision, a burning platform, for why we have to move to population health management," he says. The convener may be the health system board or perhaps the lead insurance payer.
Without this guiding force, the trust necessary to shared risk and data is likely to be lacking. "This is difficult ... It's not 'Can't we all get along,'" Deveny says. Trust takes time and a "matured relationship." "The sharing of information is going to drive a lot of this ... and if there's not trust to exchange information, then everything breaks down."
Most deeply affected by shifts to PHM will be physicians—employed and independent, primary care and specialists all to some degree. "'Primary care transformation' is our internal term for the cultural change that needs to happen" for primary care physicians, says Christopher Stanley, vice president of care management for Catholic Health Initiatives. "The specialist world will be quite different than it is now. There will be different payment mechanisms. How will specialists work in a team around bundled payments?"