3 Ways to Foster Physician Alignment

Experts attending HealthLeaders Population Health Exchange recommend considering physicians' needs before prescribing their roles in population health initiatives.

If you want to achieve physician alignment in carrying out your population health strategy, there has to be some give and take, according to executives gathered at the HealthLeaders Population Health Exchange, held last month in Austin, TX.

Another four clicks in the EHR here, an unpaid hour of charting after dinner there, the burdens on physicians add up, noted Alan Pitt, MD, professor of neuroradiology at the Barrow Neurological Institute, part of Dignity Healthcare in Phoenix.

So when health systems add on a set of best practices to lower utilization costs and support value-based care, physicians often think, "Are you kidding? You've got something else you want me to do?"

In other words, physicians are simply out of bandwidth to take on more work.

"You can't just keep adding weight to physicians," Pitt said. "It's not a trash compactor they're living in."

Fortunately, there are ways to motivate physicians to support your goals. Here are three standout themes from a roundtable discussion during the Exchange:

1. Give Physicians a Voice

One of the most fundamental benefits systems can give physicians is easily overlooked.

"It sounds trite, but it's really true: Shared voice," said Helen Lindsay Macfie, PharmD, FABC, chief transformation officer for MemorialCare Health System in Fountain Valley, California, a 1,600-bed not-for-profit health system that includes a medical foundation and more than 2,500 affiliated physicians.

"One of the things that's really helped is physician governance [is] putting together a structure where physicians are helping us plan this, as opposed to it being an announcement and a surprise," she said.

MemorialCare's physicians' society has existed for 20 years, but has proved especially valuable in the transition to population health. The board of the society spans the entire system, and champions all of its informatics, best practice, and shared physician strategies.

"Obviously we have a big IT department, but [the board members] really provide leadership, serve as superusers, and provide guidance [and] support for everything we roll out," she said.

"And all of our best practices, including protocols, guidelines, and how they interface with the EHR, are all clinically agreed-upon."

Two key population health initiatives sponsored by this physician board include strategic plans around conserving the utilization of precious resources and reducing overdiagnosis and overuse.

2. Give Resources

Next, there are a myriad of ways to help physicians from an organizational standpoint that create win-win opportunities for success, according to Julia Andrieni, MD, vice president of population health and primary care, as well as president and CEO of Houston Methodist's Physicians' Alliance for Quality.

When Andrieni moved from Massachusetts to Texas to align scores of independent physicians flung over a large geographic area, she focused her strategy around understanding what the physicians would need and want to remain independent and to provide high-quality care for their patients.

"I know they want to remain independent, but what is it that I could provide for them that would give them value for their patients and their practice?" Andrieni, a primary care physician, recounted asking herself.

"So I thought, we're going to be the quality consultants for PQRS, Bridges to Excellence, Meaningful Use, Patient Centered Medical Home—any program tied to finance, a CMS regulation, or a private payer."

Related: At Houston Methodist, Population Health is the Real Deal

In exchange for a membership fee, physicians affiliated with Houston Methodist have access to a team of quality program experts in the above-mentioned topics and more. The system also hosts four to six educational dinners per year, where physicians earn CME for a variety of primary care topics.

"And I focus on the value my team can bring to them," she emphasized, "because I'm really trying to form relationships around how I can help them be recognized for delivering high-quality patient care."

3. Give Time-Saving Tools

IT resources are valuable to physicians, but only if they don't create more work than they save. For example, a lot of hospitals don't have the strongest Wi-Fi or cell service throughout the facility, noted Pitt. "This means that if you roll out a new application and expect me to use it, it may fail on my device."

On the other hand, physicians may welcome technologies that allow them spend more time on the work they want to do.

For example, Pitt said he's not threatened by the idea that advanced pattern recognition technology may one day perform much of what he does as a radiologist.

"It probably won't happen in my generation, but I would love it," he said. "If you can get rid of 80% of my work for normal cases and allow me to focus on the 20% that need some sort of human interaction to come up with a reasonable diagnosis, that's probably a good thing."

While an 80% work reduction might not be available anytime soon, ultimately the work/support equation needs to balance out.

So don't focus merely on how to align physicians with your organizational goals. First, consider ways to align your resources with their wants and needs.