Catholic Health Initiatives, one of the nation's largest health systems, is an organization that has been focused on acute, hospital-centric care since its formation in 1996. In the last two or three years, that longtime focus on traditional inpatient care has evolved to include a rapid expansion in the organization's ambulatory services and physician enterprise, which has more than doubled its care capacity since 2012.
In the midst of this aggressive expansion, CHI's leaders recognized that the organization did not possess all of the resources and infrastructure needed to incorporate and sustain this ambitious growth. Leaders also realized that the health care system did not possess the specialized expertise in ambulatory settings so vital to ensuring that each practice operates at its most-efficient level, especially in areas such as back-office functions. Creating an infrastructure to develop these processes was essential to engaging and retaining physicians.
The leadership team at CHI took this employed-provider growth as an opportunity to improve physician enterprise performance across the system. T. Clifford Deveny, M.D., senior vice president, physician services and clinical integration, created the vision and foundation for developing a physician-services organization that would represent a model for best practices across the nation. Deveny wanted to create an organization that could draw on both organizational strengths and outside expertise to meet the needs of CHI and its affiliated physicians.
Few CHI leaders were experts in improving practice performance on the ambulatory side. CHI's scale and scope — 105 hospitals and approximately 625 care sites across 18 states — made this transition especially difficult. What's more, CHI's physician enterprise, which represented a fairly small element of the overall organization just a few years ago, now has grown to more than 3,800 providers, including about 2,500 physicians. The enterprise now includes more than 600 practice sites, and the numbers of physicians, advanced-practice clinicians and practice sites are expected to continue to grow over the next several years.
To better manage this growth spurt and ensure efficient, high-quality care, CHI partnered in 2013 with a national leader in ambulatory practice management. As a joint venture, we have developed a systemwide medical services organization called Catholic Health Initiatives Physician Services, or CHIPS, to serve the health system's diverse practice network of employed physicians. Our goal for CHIPS is to take the burden of the business side of medicine out of everyday practice so physicians and staff can focus on patients instead of such routine but important tasks as billing and insurance verification.
A Multiphase Approach
CHI and its predecessor systems have century-old roots steeped in tradition. With such diversity and so many locations, senior leaders were aware there would be challenges in implementing policy changes and metrics. Based on these factors, we opted to implement CHIPS by phases — in two to three markets at a time within CHI's large geographic footprint — rather than all at once. Now, more than halfway through the implementation, that approach has proven to be smooth and effective.
To begin, we identified cultural barriers, where we could accelerate the pace and other improvements for the remaining phases. For example, some practices and markets weren't familiar with the new disciplines, and the metrics we are tracking are new experiences to practice staff. Getting past this normal first reaction to change is always the biggest hurdle. Since then, our implementation plan has added several of CHI's new acquisitions, including Memorial Health System of East Texas and St. Alexius Health in Bismarck, N.D.
Securing full support from CHI's senior leadership team was our first task before starting the initial phase. Since then, this support has been the driving force in keeping the implementation on track. In addition, defining a governance structure early for such a solid physician-led organization was a positive move. The organization also formed a strong board of directors for CHIPS, focusing on administrative and physician regional representation.
CHI and CHIPS leaders made a commitment to be transparent throughout the implementation. Weekly meetings with structured work stream reviews help to keep the group informed. We also foster an environment where leaders openly help each other stay on track.
Five Practice Metrics
A first area of focus for CHIPS was enhancing and standardizing collections — from benefit verification through cash collections. This way, our staff members address the patient's financial level of responsibility before the appointment. Patients know what they need to pay at the time of service, and there are fewer denied claims. We learned that many CHIPS employees were not comfortable asking patients for co-pays, so we trained them on the new procedures and how to request co-pays.
The revenue-cycle improvements have expanded into practice performance and optimization. Even high-performing practices can benefit from consistent metrics. One of CHIPS' goals is to develop standard processes and metrics across CHI's practices to make sure their business needs are met. If a practice controls five metrics [see figure], it can sustain a healthy revenue cycle — and attract new clinics eager to come on board after reviewing the results.
The five key metrics are listed in order of importance
Collaboration and Communication
Any transition of this magnitude is a significant cultural change — especially since it requires standardizing policy and practices across markets. The development of CHIPS served as a change agent to streamline processes across the system and communicate in new ways. For example, clinic employees previously would only receive information locally. Today, they receive national CHIPS initiative updates and newsletters.
Before introducing CHIPS and requesting changes, we collected input on their current processes from regional leaders, administrators and providers. We also evaluated best practices in each market. This collaboration demonstrates that we were sensitive to what each practice had already built and has resulted in a smoother outcome.
CHIPS follows a comprehensive communications plan for the transition to keep key groups well-informed along the way. The communications plan also helps to make sure CHI leadership groups are synchronized. And it puts leaders in the spotlight to deliver consistent messages and actions that rally employees around the CHIPS vision.
Getting Physicians Better Engaged
Part of the CHIPS team's responsibility is to improve physician engagement so it contributes to the success of everyone involved. Early research showed that physicians didn't feel a connection with CHI or CHIPS. While this isn't unusual in large systems, strengthening this connection was an important goal for CHIPS. Physicians tell us they appreciate their new regular meetings with administrators, where they review practice goals as well as seek additional educational resources.
The CHIPS effort is a large investment that is not just about improving the revenue cycle, but rather transforming ambulatory health care across the organization. As such, CHIPS will strive for long-term success with physician engagement. By the time the implementation is complete (anticipated by early 2016), CHIPS and CHI will have transformed health care across the system. We believe the principles for developing CHIPS will be valuable in any practice model. With the right approach, systems across the nation can make it easier to practice medicine and deliver better care.
Beth Cafaro, J.D., is vice president, practice operations, and president, CHI Physician Services, Catholic Health Initiatives. Michael DeMott is chief operating officer, CHI Physician Services, and vice president, MedSynergies Inc., Englewood, Colo.