The Next Generation of Health Plan Medical Group Collaboration

Transcription

1 The Next Generation of Health Plan Medical Group Collaboration Howard Beckman, MD, FACP, FAACH Chief Medical Officer Focused Medical Analytics February 20, 2013

2 Objectives Review current challenges in health plan medical group partnerships Define the constituents of successful partnerships in the next decade Suggest areas on which to focus for: Both health plans and medical groups Health Plans Medical Groups 2

3 Literature review Data Sources Personal experiences as IPA medical director, CMO of Focused Medical Analytics, Consultant Interviews with Best Practice programs 3

4 The Current State of Affairs What are your experiences with plan/group partnerships? 4

5 The Current State of Affairs All too often: Win Lose mentality Adversarial Distrust Lack of transparency Layers of failed improvement programs Responsible to different stakeholders Anchored in fee for service reimbursement 5

6 The Next Decade: What is Needed for Successful Collaboration? Projects based on shared goals Explicit expectations Data transparency Mutual respect Win Win for participants Redefinition of quality as reducing underuse, misuse AND overuse Acknowledging the crisis in primary care 6

7 Competence What Engages Practitioners? Autonomy Relatedness Within the context of shared valued 7

8 It is difficult to get a man to understand something when his salary depends on his not understanding it Upton Sinclair I, Candidate for Governor; and How I Got Licked Berkeley, CA University of California Press P. 109 Reprinted from the Original published in Focused Medical Analytics, LLC February 12,

9 Suggestions for Both Plans and Groups Need explicit shared goals of the partnership both working to accomplish the same outcomes Know where goals differ, anticipate problems Explicitly define what each organization needs to be successful honesty is key Establish core values transparency and honesty Buy in from top of organizations Employ a NEUTRAL SKILLED facilitator to address conflict and promote solutions to those conflicts 9

10 Suggestions for Both Plans and Groups Create clear, realistic measures that include BOTH underuse AND overuse with strong physician input Focus on appropriateness not cost (include quality measures) Carefully create partnerships be wary of those not committed to change (hospitals) Choose team members with sufficient power and interpersonal skills to promote the partnership effectively Determine how to provide required data How can you change when you don t have data to see how you are doing? 10

11 Suggestions for Both Plans and Groups Use peer comparison data to drive behavior change in advance of financial incentives Involve practitioners in creation of outcome measures early in the process Carefully construct incentives because they do influence behavior You get what you incent Promote internal motivation for changing Publicize successes 11

12 Suggestions for Both Plans and Groups Data is critical and hard to provide. Ensure adequate time and resources to deliver data Evaluate on outcomes without requiring process Carefully construct incentives because they do influence behavior Calculate the a) size of a contract, b) determine the # and % of members within a plan eligible for inclusion. Don t overestimate 12

13 Comments, Additions, Concerns 13

14 Engaging Physicians in Change: All Are Required Core Values Accurate, meaningful data Interpersonal Process Leadership Clear, accessible reporting tools A Reason to Focus 14

15 Suggestions for Plans Create a plan that allows practitioners to succeed (competence) Start with achievable goals Focus on outcomes, encourage autonomy in process Offer assistance, not rules Provide start up funds for capitalizing practice transformation Participate in community wide data bases no competing reports 15

16 Comments, Additions, Concerns 16

17 Suggestions for Medical Groups Acknowledge current attitudes about plans Do you really want me to trust them? No, but give them the chance to be trustworthy. Identify leaders interested in improving care, reducing waste and having the difficult conversations needed to realign culture and incentives Continuously dialog with practitioners about a) goals of the program, b) the measures being used to evaluate success, c) how the measures are being used Attend to team creation it takes a lot of time Be patient, plans move slower than most practices can tolerate 17

18 Suggestions for Medical Groups Set achievable goals early victories Confront practitioner s isolation and desire for independence while building a community of practitioners with common goals, shared values and a commitment to achieving group determined outcomes. Build healthy competition around outcomes, avoid tournaments Provide ACTIONABLE advice Add value: create tools for practices (e.g., registries, flow sheets, decision support, template letters to patients, define and share best practices 18

19 Suggestions for Medical Groups Enter into contracts when the conditions predict success, not when it seems right Enter into contracts when plans demonstrate needed data is available and report ready Look to create similar contracts so that practitioners won t receive mixed messages Accept ED and Hospital use reductions as core to any contract Measure outcomes meaningful to practitioners as early and as much as possible 19

20 Suggestions for Medical Groups Address leakage in a constructive way not you have to use our people, but we want to improve coordination, that requires using specialists integrated into our group, What prevents you from using our colleagues? Incorporate specialists into the process early; creating clear explicit paths to success Help generalists and specialists explore ways of more effectively collaborating autonomy support Don t ignore mental health issues in planning 20

21 Comments, Additions, Concerns 21

22 Take Home Items Your thoughts 22

23 THANK YOU! Howard Beckman, MD Chief Medical Officer Focused Medical Analytics us.com