Stoyanoff, an advisor for this report, says that even though only 32% of respondents place physician retention among their top three physician alignment objectives (sixth highest of eight response options), retention is a top mission for her. "In most of the markets I'm in, physician retention is a big reason behind our physician alignment strategy. We need to create effective models."
Deveny expects that the new dynamic will improve outcomes and lower costs. "Where the physicians become organized and are using data, they're in a position of strength. They've got a choice on health systems, and they can move populations overnight, based on cost and quality. I think it's going to be a healthier environment for everybody—we should have healthier communities and at least some flattening of the cost curve."
Which model? All of the above
Near-term shifts in organization models indicate that hospitals and health systems will place more emphasis on collaboration. One-fifth of respondents (22%) include clinical integration among their top three staffing models now, but three years out, twice as many, or 46%, expect to be involved in clinical integration.
"We're going to be doing more partnering with physicians rather than employing or just underwriting them," Deveny says. "It will be a shared-risk or pay-for-performance structure. We're going to come together, share data, and present ourselves as a network. Collectively, we will either all succeed or fail." On-staff physicians will have to be more collaborative as well. Clinical comanagement agreements stand at 15% now, and respondents say that will increase to 30% in the three-year time frame.
As clinical integration and clinical comanagement gain more support in the coming years, medical staff appointments, hospitalists, and paid directorships are finding fewer proponents. Overall, the result of these shifts is a broadening of support for a variety of models. Says Deveny, "The bottom line is that people do see physician engagement as being important. And they don't see employment as a be-all, end-all. Survey results confirm that there is still a lot of diversity of thought, and not everybody's betting the farm on one model."
Nygaard of Lee Memorial, a report advisor, keeps the mission in mind as alignment choices are examined. "If we can prove that we're providing pretty good access, whether through employment or partnerships, I'm not really wedded to a given model per se," he says. "How do we know when we've succeeded? When we've fulfilled our mission, which is to meet the healthcare needs and improve the health status of the people of southwest Florida. I'm open to a lot of those staffing models, but we have to achieve the goal."