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Beyond the Medical Home: Critical Drivers of Successful Network Transformation

By: rnickerson Wednesday December 20, 2017 comments

David Ehrenberger MD

Chief Medical Officer, HealthTeamWorks

“Ok, but transformation from What to What?”

From What…

Most everyone agrees on the symptoms, findings and diagnosis of the problems that face healthcare today: fragmentation of care providers, healthcare economics that favor hospital, payer and physician welfare over that of communities – and at times, it includes patients, disintegrated and inefficient health information technology, and harried and disenfranchised primary care providers. Oh, and let’s not forget: opacity and disinformation.

Sometimes we have more questions than clear answers: What do people, employers and government (The Centers for Medicare & Medicaid Services) get for their money? What is the healthcare game plan for a given patient – across time and conditions – that should be front of mind for all caregivers?

             

To What.

Most of us can agree that a foundational principle of value-based healthcare design is that all previously siloed providers – from tertiary care hospitals and providers to primary care and behavioral health providers – engage in skin-in-the-game collaboration. Network transformation, then, is the notion of moving to a regional “it takes a community” approach where providers hold themselves accountable for common patient-centered outcomes. And it is not hyperbole to say that our patients, community employers, and the marketplace are all begging for this kind of provider collaboration.

The ‘To What’ can be characterized as integrated delivery networks where regional multidisciplinary providers share common governance, key infrastructures such as health information technology, and assume financial (and reputational!) risk for how well they care together for the people and population they serve. Accountable care organizations, physician hospital organizations, and clinically integrated networks fit this bill. For national exemplars of this collaborative accountability, think: Kaiser Permanente or Advocate Physician Partners; two very different approaches to finding common ground to drive uncommon healthcare value.

 

The How 

In your planning, heed Yogi Berra’s dictum: “If you don’t know where you are going, you’ll end up somewhere else.”

Getting there can be a heavy lift for nascent networks. It begins with clear-eyed commitments from all stakeholders to identify desired outcomes, and results in answers to questions, such as: What are the value-based healthcare services our network will successfully be selling to employers, payers and patients? What will define the culture of the network? (Hint: the result should be in creating a culture that drives provider and team engagement and workplace satisfaction.) And, how will the network’s business model ensure considerable competitive advantage and market success? 

The development of this common vision defines a critical first step or “true north” of successful network transformation. Developing a shared future-state is vital to inform what to do next. High-level priorities include the right business models, approaches to payer contracting that reward value, growth of a large primary care base, and optimized HIT infrastructure.

But how do you make the network sing? What is the mojo, the secret sauce, that builds the right culture and the right form of governance, creates buy-in and ownership across all stakeholders, and that results in an enduring and thriving transformation and market-relevant value? 

Much like evidence-based medicine and clinical care pathways, there is much to gain by following a “what works” approach to network design and development. Based on years of experience studying and building effective value-based networks of physicians, HealthTeamWorks has identified 7 proven levers or drivers of change and performance. It may be unfair to list and not define them—until next month’s blog—but here they are:

 

  1. Glide Path
  2. Learning Organization
  3. Vitality of Practice
  4. Community Integrated Primary Care
  5. Value-Based Efficiency
  6. Human Centered Design
  7. Network Funds Flow

 

These 7 drivers are not just concepts. They are observed and empirically-derived best practices with solid-line connections to network outcomes and performance – and together, they deliver on the Four-Part Aim. What do they mean to you and your work?

For resources before our next newsletter, go to the Network Performance Improvement page and learn more about Domains, Drivers, and Pillars.

About the Author: rnickerson



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