To impact reform and to leverage their skills, physicians need organizations with appeal, reach, and clout.
Among other things, these organizations must make themselves indispensable to payers, consumers, and hospitals; they must be economically efficient, clinically effective, and sustainable; they must satisfy and empower physician cultures who may insist on a degree of autonomy; and they must be situated so they offer convenient access with predictable and affordable prices.
These characteristics are not easy to achieve and require physician leadership, or non-physician leaders who doctors trust. The structure of the organization or practice is also important and must operate within the framework of existing laws and regulations. By 2015, the IBM Center for Healthcare Management foresees four functional generic models for physicians:
Here are a dozen specific examples of innovative physician-based organizations that fall into these categories.
1. Medical homes. This is the latest and hottest organizational development for many reasons. Medical homes may cut costs through coordinated and comprehensive care, they offer care across the care spectrum—office, home, between visits—and provide greater access to primary care. The model may be the salvation of beleaguered primary care practices through restructured payment schemes, which may be a mix of fee-for-service, capitated fees for managing panels of patients, and bonuses for patient responsive services (same day appointments and prompt responses to emails and phone calls).
Medical homes are a potentially huge innovation. Big business payers, all major national primary care organizations, CMS, and many state legislators back them. Furthermore, medical homes provide an organizational structure for managing aging patients with five or move chronic diseases. These patients comprise nearly 25% of Medicare patients.
2. Hospital-based systems with owned and salaried primary care doctors, and, significantly, more employed specialists. This is probably the most prevalent model. It is commonly headquartered in hospitals with regional reputations, emergency departments, and other facilities, and it is on the rise because of the influx and ownership of primary care and specialty doctors seeking employment and relief from overwork, marginal practices with high overheads, and managed care hassles. Hospitalists are the common form of hospital employment for primary care physicians. A related phenomenon is that physicians with MBAs and MPHs and other business training increasingly lead these organizations to gain the trust of employed physicians.