Why Your Provider Workforce Plan Isn t Working

Transcription

1 Why Your Provider Workforce Plan Isn t Working Providers are the cornerstone of the health system, leading disease management and care delivery for patients and communities as well as serving as a primary engine for growth and system expansion. Yet, for such an important strategic and operational asset, many health systems have a limited view into the comprehensive needs of their provider workforce. System leaders must be able to address a broad set of questions and considerations. Examples include: What percentage of the system s providers are expected to retire in the next three years? How could a system s physician recruitment gap be closed by increasing adoption of independently practicing advanced practice providers (APPs)? How many physicians reduced their clinical time or left the system last year because of burnout? How will new care models that are steadily emerging for the chronically For such an important strategic and operational asset, many health systems have a limited view into the comprehensive needs of their provider workforce. ill, complex and frail patient populations impact our provider needs? How will technology-enabled care, perhaps the strongest disruptor of medical practice, impact the health system s engagement of patients and providers? Rather than tackling these questions comprehensively at a system level, many hospitals and integrated networks rely on onedimensional medical staff plans or, in the absence of a plan, reactively address provider challenges as they emerge. Most hospitals can no longer afford to take this one-dimensional approach. Many systems struggle with significant operating losses in the medical group, driven by a variety of reasons that manifest as sub-optimal performance and inadequate patient access. Additionally, a rapidly changing industry requires health systems evolve the way they manage the provider workforce. Physician and nurse shortages are pervasive. Physician burnout is a growing problem. Meanwhile, the rise of more informed and demanding consumers is sharply shifting the site of primary care delivery from in-office visits to urgent care and virtual visits, changing the complement of providers needed in traditional nine-to-five office settings. The move to value-based care is also affecting provider demand, shifting utilization in several specialties and requiring different provider distribution patterns to meet payor contract network sufficiency. Finally, changing care models and the evolving use of APPs and technology alter the number of physicians needed and how they are engaged. Health systems must develop an extensive, system-wide provider workforce plan that incorporates all these variables. On the vanguard of healthcare

2 Why the Current Plan is Unworkable Most health systems are not organized to tackle the questions above. There are several potential reasons why an organization s provider workforce plan may not be functioning successfully, including: 1 THERE IS NO COMPREHENSIVE WORKFORCE PLAN TODAY Few health systems have invested the time and leadership focus required to establish a comprehensive, proactive approach to workforce planning. Even for organizations that do not own medical groups or foundations, these plans are critical for assessing the strength of the provider platform and identifying areas of opportunity for community physician alignment, as well as areas of risk for community physician retirement and retention. 2 CONTEMPORARY WORKFORCE PLANNING ISSUES ARE NOT SUFFICIENTLY REFLECTED IN PLANS Traditional physician demand calculations have often been just that a calculation. The approach has been formulaic, a one-size-fits-all methodology across specialties that is often created first for legal analysis and then recycled for strategic planning purposes afterwards. Too often, the analyses focus solely on physician need, using decades-old, population-based physician demand ratios. Health systems today face a wide array of competitive threats and market forces that require them to have a significantly more nuanced, dynamic and comprehensive approach. 3 THE RIGHT STAKEHOLDERS ARE NOT AT THE TABLE One of the greatest threats to the success of a health system s workforce plan is the existence of multiple plans. Correspondingly, one of the most impactful strategies for workforce planning is to include leaders across diverse functional areas at the same table to discuss the plan. Consider the many differing perspectives illustrated in Figure 1 and how challenging it is to plan for provider need when reconciling across siloed viewpoints. Bringing relevant stakeholders together to discuss market forces, weigh pros and cons to making a hire, and agree on the final number of specialists to be aligned or recruited is a critical factor in successful workforce planning projects. Figure 1: Poor Workforce Planning Rollercoaster (Illustrative Example) The physician leader in orthopedic surgery believes the system needs five more surgeons to reduce the burden of call coverage for the local group. Medical group leadership thinks the group is not as productive after recent compensation plan changes and wants to re-think hiring more surgeons. +0 The strategic planning team wants to expand into three new markets and believes there is a need to hire two orthopedic surgeons for each market. The director of contracting believes surgical utilization should drop under new value-based contracts and argues that the group is carrying too many surgeons. +0 Final answer: uncertain Caught in the mix, the physician recruitment office negotiates a target hiring number that doesn t satisfy anyone.? +5 +6? Page 2

3 Work Out Your Next-Generation Viewpoint Overcoming the workforce planning challenges highlighted above requires a thoughtful, system-wide discussion of the issues impacting each medical specialty. In launching the discussion, it is critical to have a common analytic understanding of the specialty current state to ground the conversation. The analytic model must consider a wide range of next-generation factors, including the following: Figure 2: Key Considerations: Next-Generation Provider Workforce Planning Evolving care models Demographic changes by submarket Emerging markets and partnerships Varying provider productivity Provider aging and retention Changing patient access demands Next-Generation Provider Workforce Planning Key Considerations Dynamic consumer needs Strategic growth Transition to value-based care and utilization shifts DEMOGRAPHIC CHANGES BY SUB-MARKET How is the population changing in target markets, and how will those changes impact provider need? It is important to evaluate not only changes in size, but also sociodemographic characteristics. One client found that the national physician demand benchmarks it used had to be adjusted to reflect the additional physician coverage needed for the area s large snowbird retirement community. EMERGING MARKETS AND PARTNERSHIPS How should the system address provider demand coming from new markets and strategic partners? Systems must often find a balance between actual community demand and the initial provider investment required to build a presence in a strategically critical region. Page 3

4 STRATEGIC GROWTH What is the vision for growth in each service line, and what are the resulting provider needs? Provider workforce planning can serve as an intermediate step between a broader enterprise strategic plan and a detailed service line strategy. It allows system leadership to develop a vantage point across all specialties and evaluate priorities without delving too deeply into each service line s specific strategies, while also forcing service line leaders to develop a vision consistent with the enterprise strategy. TRANSITION TO VALUE-BASED CARE AND UTILIZATION SHIFTS As payment models shift health system economics, how will demand for services be impacted? Leading health systems use actuarial projections and proprietary databases to model how inpatient and outpatient utilization may shift over the next three to five years. In the absence of detailed data, organizations should analyze the market s pace of change to value-based care and estimate potential utilization shifts by specialty. DYNAMIC CONSUMER NEEDS How will shifting consumer trends change the way the system delivers care and geographically positions providers? While the potential impact of this variable will differ considerably by market, health systems should consider local trends regarding how consumers expect to receive care and engage with physicians, such as the impact of retail clinic growth on regional primary care provider demand. CHANGING PATIENT ACCESS DEMANDS Where are immediate access constraints that could be addressed by better provider planning? Patient access hurdles are often a potential indicator of provider need. While patient access issues can be driven by operational challenges unrelated to provider need (e.g., front desk staff shortages), they should be further evaluated to test for provider staffing issues. PROVIDER AGING AND RETENTION What is the health system s retirement/retention risk by specialty? What percentage of providers are within retirement age range? How will the system address burnout? Understanding and addressing retention issues in each specialty allows the system to not only proactively mitigate service gap risks, but also thoughtfully approach succession planning for retiring physician leaders. Page 4

5 VARYING PROVIDER PRODUCTIVITY Where do opportunities exist to improve productivity and increase the effective FTE supply of providers? Organizations should seek to understand the operational factors that may be limiting providers ability to maximize their own individual efforts. EVOLVING CARE MODELS Where are additional opportunities to better leverage APPs and change the way the system serves patient needs? This variable is one of the most critical ways system leadership can ensure their provider workforce plans reflect contemporary trends. Care models in each specialty must be carefully assessed to seek opportunities to creatively rethink the approach to patient care and reposition the responsibilities of each care team member. Workforce planning is both art and science. While the effort must be rooted in advanced, comprehensive analytics, qualitative factors must be woven together with the analytic results to model implications on provider recruitment, care model transformation, compensation plan redesign and operational improvement. Rather than ending the conversation with the analytic exercise, health system leaders should view workforce planning as a starting point to address the full set of issues facing providers. Time for a Workforce Workshop While it may seem daunting to develop a comprehensive provider workforce plan, there is little debate a highperforming health system needs it. The call to action can come from any mix of executive leaders but is most often initiated by chief medical officers and medical group presidents. Below are some initial steps to launch the planning process: STEP 1 GATHER THE DATA Conversations grounded in market facts and actual health system trends will create a common understanding and advance the discussion. While collecting data across the different areas highlighted above may feel overwhelming, planning teams can begin the journey by analyzing information in just one or two specialties. Key data to review includes: provider rosters, market share trends by sub-specialty, physician productivity data, operational metrics such as OR utilization, and key medical group performance indicators such as physician practice capacity, efficiency and APP utilization. Use these to drive an initial viewpoint on how many employed and aligned physicians and APPs are needed. Page 5

6 STEP 2 INVITE THE RIGHT MIX OF CONSTITUENTS TO THE TABLE Bringing together key stakeholders will ensure strategic hiring decisions are aligned with operational realities, including capacity constraints. In addition to the health system operations team, the planning group should also include physician and administrative leaders from the medical group, health plan, strategic planning, medical staff office, physician recruitment and outreach and finance. Launch the group with a two-hour kick-off meeting and schedule an initial series of three to four biweekly meetings. STEP 3 CHALLENGE YOUR TRADITIONAL NOTIONS Counterintuitively, discussions should not begin by asking how many physicians need to be hired. Advancements in medicine, shortages in physician supply and challenges in health system economics now require leaders to instinctively look at traditional care models and flip them on their head. For example, if the system cannot find enough psychiatrists or even psychiatric nurse practitioners, is there an opportunity to make the master s-trained therapist and social worker the center of the behavioral health care model? If provider shortages are driving up primary care wait times, can the health system seek innovative digital health solutions and retail clinic partnerships to help alleviate pressure? Consistently challenge the team to think creatively to develop a workforce plan that is both lean and feasibly implemented. STEP 4 CHARGE PHYSICIANS TO DRIVE CHANGE For the workforce plan to be actionable, physicians must lead the case for evolution. Position key physician leaders as the executive sponsors of the workforce planning project. Consider asking medical directors and service line leaders to hold work sessions with small groups of physicians in each specialty to understand their needs and concerns. Remove economic barriers to change by aligning compensation plans with health system goals. Physician ownership of workforce planning decisions will ensure that costly investments to implement recommendations will not be made in haste or waste. STEP 5 REFRESH AND REPEAT REGULARLY While it may be easier to launch a workforce planning initiative in just one or two specialties, it is important to repeat the process and complete the plan across all areas to ensure consistency across the health system. It will be critical to refresh the plan on at least an annual basis, likely with more frequent quarterly or semi-annual touchpoints with the same crossfunctional workgroup. Achieving optimal system performance and growth requires that organizations engage provider and administrative leadership in a cross-functional, dynamic and analytically based conversation around the full set of provider workforce issues. Doing so will ensure that the provider workforce plan comprehensively addresses the provider needs of the health system and sets the organization up for strategic success in a rapidly evolving industry. In other words, it creates a workforce plan that actually works. Page 6

7 About the Authors Michael Tsia Principal Michael Tsia is a Principal with The Chartis Group. He serves as an advisor to executive leaders at leading academic health centers, children s hospitals and community-integrated delivery networks on numerous topics, including enterprise strategic and financial planning, provider workforce planning, payor-provider partnerships, clinically integrated network design and organizational economic alignment. Mr. Tsia has been a leader in management consulting with The Chartis Group for over 10 years and regularly speaks on a variety of healthcare strategic planning topics. He also serves on the Board of Directors for Methodist Hospital of Southern California. Mark Werner, MD Director, Clinical Consulting and Chartis Physician Leadership mwerner@chartis.com Mark J. Werner, MD, CPE, FAAPL is a Director with The Chartis Group leading Clinical Consulting, the Chartis Physician Leadership Institute and our work with the physician segment. In this role, Dr. Werner leads clinical consulting efforts across the firm focusing on: enterprise physician alignment and leadership, medical group performance, adoption and change management, performance innovation, population health, provider-payor relationships and the translation of strategy into clinical operations. Michelle Moratti Director and Leader of the Integrated Delivery System Segment mmoratti@chartis.com Michelle Moratti is a Director with The Chartis Group and leader of the Integrated Delivery System segment. She has over 25 years of line management and consulting experience working with healthcare provider organizations. Ms. Moratti has provided strategic and operational consulting services to healthcare provider clients, as well as led service delivery organizations at companies providing solutions to healthcare providers. Ms. Moratti s areas of focus include strategic planning, accountable care strategy, development of clinically integrated networks and partnership portfolio design and implementation. Page 7

8 About The Chartis Group The Chartis Group (Chartis) provides comprehensive advisory services and analytics to the healthcare industry. With an unparalleled depth of expertise in strategic planning, performance excellence, informatics and technology, and health analytics, Chartis helps leading academic medical centers, integrated delivery networks, children s hospitals and healthcare service organizations achieve transformative results. Chartis has offices in Atlanta, Boston, Chicago, Minneapolis, New York and San Francisco. For more information, visit Atlanta Boston Chicago Minneapolis New York San Francisco 2018 The Chartis Group, LLC. All rights reserved. This content draws on the research and experience of Chartis consultants and other sources. It is for general information purposes only and should not be used as a substitute for consultation with professional advisors.