As health care delivery and payment shift toward models focused on providing greater value, a one-size-fits-all model of governance no longer will be sufficient to guide the work of more complex and focused health care organizations. Barry Bader, a health care governance expert and senior governance adviser to the American Hospital Association and its Center for Healthcare Governance, has proposed three models for governing specific health care entities: health systems, clinical enterprises and community-based health care organizations.

Broadly, he posits that boards of health systems would be strategically focused and composed primarily of individuals with expertise needed to effectively guide these organizations into the future. Boards of clinical enterprises, such as physician-hospital organizations or independent practice arrangements, would focus on overseeing care delivery and payment mechanisms, and enhanced community boards would provide local perspective and linkage between health care organizations and the communities they serve.

As health care systems increase in number and size, these models of governance will move from theory to practice. Already, boards within systems and in freestanding health care organizations are beginning to focus their composition, structure and function to better oversee the work of the specific entities they govern.

System boards, especially those that govern multistate systems such as Ascension Health, will be smaller in size, with members selected for their business acumen, knowledge of health care delivery and financing, and understanding of the evolving health care environment. These boards will focus on how their organizations will grow, diversify and innovate; gain access to the capital necessary to pursue their strategies and priorities; and manage the risks associated with transformational change.

As health care providers and insurers increasingly assume risk for clinical care delivery tied to financial success, boards of clinical enterprises will be more operationally focused on providing care that optimizes outcomes and efficiency. These boards, where permissible, will comprise engaged clinicians and executives collaboratively overseeing the development of care paths and new models of care delivery, such as patient-centered medical homes and hospitals at home. They also will oversee relationships and contractual arrangements between the clinical enterprise and other providers and payers to reduce waste, improve outcomes and become the preferred provider of care in their service areas. Advocate Physician Partners based in Rolling Meadows, Ill., is one such organization.

As governance roles and responsibilities shift among boards in systems, debate is underway about the need for community-based boards. Some health systems already have centralized governance functions and eliminated boards at hospital subsidiaries. Those that retain boards of community delivery systems, such as Presbyterian Healthcare Services based in Albuquerque, N.M., will focus on how they contribute value to the entire enterprise and serve as fiduciaries for quality of care and community needs. These boards will ensure that the voice of local stakeholders is heard and translated into action, and serve as a link among their communities and both the local and system health care enterprises.

Visit, and for additional resources on how care systems and their boards are evolving to add value to health care.

John R. Combes, M.D. (, is senior vice president of the American Hospital Association and president and chief operating officer of the AHA’s Center for Healthcare Governance.

News from the AHA

Umbdenstock: Hospitals have embraced the ‘Triple Aim’

Hospitals are improving the individual care experience and health of populations while reducing per capita cost, a “Triple Aim” that holds great promise for the future of health care, AHA President and CEO Rich Umbdenstock wrote in a column Aug. 5 for the online Morning Consult. “Every day, they are employing new and better ways to deliver care that achieve better outcomes for patients,” he noted. “And every day, they are making progress in making communities healthier and bending the cost curve.”

AHA joins project to address high-priced prescription drugs

AHA in August joined the National Coalition on Health Care’s Campaign for Sustainable Rx Pricing, a project that aims to spark a national dialogue about the need to find market-based solutions to the problems caused by the onslaught of new high-priced prescription medicines. “Access to affordable prescription drugs is an important piece of the cost-reduction puzzle,” says AHA President and CEO Rich Umbdenstock. “And ensuring [that] patients get life-saving medicines at the right time can avoid future hospitalizations, which lowers our nation’s overall health care expenditures. That’s why the AHA is joining this effort.” According to the project, the issue of the high costs of specialty drugs reached critical importance when Sovaldi, a drug used to treat patients with hepatitis C, was reported to sell for $1,000 per pill.

Strategy pros to meet

The Society for Healthcare Strategy and Market Development of the AHA will bring together health care strategy professionals for its annual conference Oct. 12–15 in San Diego. Visit

ASHRM conference coming up

Health care risk managers and patient safety professionals will gather in Anaheim, Calif., Oct. 26–29 for the ASHRM annual conference and exhibition. Visit