Today hospitals and health systems face the imperative of fundamental change driven by healthcare reform and economic reality. As these institutions struggle to meet numerous government deadlines for large-scale projects—such as implementing the electronic health record and ICD-10, improving clinical outcomes and patient satisfaction—some of the greatest innovations in restructuring healthcare delivery are being achieved by the medical group practice. These initiatives are improving care—and the bottom line—for the practices and other key stakeholders in the healthcare environment.
Healthcare is abuzz with talk of pilot programs: the ACO and the medical home, and how to make these programs work logistically and financially via a patient-centered environment and population health management. While many healthcare organizations are exploring such programs, more than a few group practice innovators have been creating their own approaches to treat high-risk and chronic-care and patients. The efforts of two group practices offer insights on achieving sustainable results that can benefit not just the practice, but hospitals, health systems, and payers as well.
Care Managers in the Medical Home
“When it comes to strategy, ours is to start doing something now,” says Gregory Spencer, MD, CMO of Crystal Run Healthcare LLP, a 200-provider, multispecialty group practice based in Middletown, NY. The practice is one of a handful in the nation to achieve top-tier (Level 3) patient-centered medical home recognition. Spanning 11 locations in Mid-Hudson Valley, Crystal Run began collecting and analyzing data to enrich the patient care experience and improve disease and health management.
As leaders at large hospitals and health systems know too well, with the number of initiatives that need to be accomplished, there is little time or money for trial and error. However, when done on a smaller scale—such as in the group practice setting—a miscalculation can be quickly corrected or the direction of a project swiftly shifted.
“It’s important to understand that while physicians aren’t necessarily the only ones who can drive change in healthcare, they are uniquely situated to do so. They are responsible for about 90% of the costs just by virtue of the orders they write,” says Hal Teitelbaum, MD, managing partner, CEO, and founder of Crystal Run, “You have to get physicians to work together [to achieve change]… to take a group of physicians with entrepreneurial spirit and get them to move together.”
Unfettered by the bureaucracy that can slow a larger healthcare organization’s pilot projects, an innovative group practice draws strength from having a streamlined decision-making panel. Physicians are generally part of, if not leading, the management and innovation teams, so attaining the often-mentioned “physician buy-in” is rarely an issue.
Teitelbaum says that Crystal Run encourages participation through partnership. “Partnership models, where physicians have the opportunity to be a stakeholder/owner in the practice incentivizes the physicians to align for the interest of the practice,” he says. “I believe that the current models that exist in a typical hospital system—even those with physicians in leadership—don’t have a direct stake in [the system] improving and thriving.”