There is little doubt that the Patient Protection and Affordable Care Act is inspiring major changes in health care delivery. Perhaps the most significant is the transition from a fee-for-service reimbursement model to one that rewards cost savings and quality outcomes. Health care organizations understand that their best chance for operational success lies in physician alignment, a sentiment recently summed up by AHA Senior Vice President John Combes, M.D.: "Hospitals are recognizing that they need to partner with physicians to improve the delivery system and increase health care value to better serve patients across the continuum of care."
Like many other large enterprises, UMass Memorial Health Care interacts with a diverse mix of medical professionals — employed physicians as well as affiliated providers. Comprising seven unique and relatively independent facilities spread over central Massachusetts, UMass Memorial has a medical staff of approximately 1,700 physicians who service 60,000 inpatients and more than 1.4 million outpatients annually.
As the organization moved toward a patient-centered mindset and explored the implications of accountable care, leaders at UMass Memorial realized the health system needed to connect its facilities electronically so caregivers could share patient data more easily. They also aimed to align more tightly with regional physicians. Leaders knew that successfully collaborating with a wider network of providers would improve access to services for patients in the community, but it would require the organization to deploy a platform for seamless information exchange.
Addressing the Human Element
UMass Memorial leaders knew their goals required an organizational transformation that would not come easily; managing the human element was a noteworthy concern. Namely, physicians and hospital administrators needed to set aside their differences; change day-to-day activities; and support common operational, clinical and technical goals.
UMass Memorial faced a particular challenge in convincing physicians of the need to revamp their workflows and adjust to new patterns and expectations. In fact, early resistance threatened to derail the project's timelines and undermine the broad-based support necessary for success.
UMass Memorial had to gain physician buy-in by creating a value proposition. In this case, leaders were able to lower physician defenses and encourage participation by removing patterns, processes and approaches that interfered with the effective delivery of care. The ability to deliver useful information within their workflow, they reasoned, would help clinicians make better decisions at the point of care.
The health system also enacted a communications plan to explain the benefits of communitywide connectivity. Ultimately, these discussions became the impetus for a strategic plan to provide physicians with access to patient data via an interoperability platform that would link a variety of care settings and offer a unified view of care. The platform was later developed by dbMotion, a vendor of health interoperability solutions based in Pittsburgh and Israel.
The health system has been acting on its strategic plan for alignment and rolling out its interoperability solution in phases since 2011. It began by connecting already tightly knit, hospital-affiliated physicians. As a next step, UMass Memorial plans to deploy the platform to geographically dispersed community providers. Leaders continue to communicate the ultimate goal of alignment: to ensure that providers who accept more financial risk in an accountable care environment are able to understand and collaborate on their patients' care plans at any given time, regardless of the electronic health record or clinical technologies in use.
As its transformation continues to evolve, UMass Memorial is looking for new strategies and tools that encourage tactical point-of-care decisions. Among them, the organization envisions connectivity technology that alerts a physician when patient events occur, such as when they visit the emergency department. This will provide a more complete view of the patient's medical history and create the context for physicians to collaborate on care strategy.
Another promising option is to integrate commercial insurance data with patient records in the EHR, giving physicians an additional resource for understanding the health of their populations. While payers and providers traditionally have balked at wholesale information-sharing, the development of ACOs and other risk-sharing care delivery models demands that these two constituents set aside differences and work toward quality-enhancing solutions.
Ongoing Cultural Enhancements
UMass Memorial continually strives to ease the disruptions caused by operational change while ensuring that physicians are engaged as valued partners. A recent survey published by PricewaterhouseCoopers analyzing physician-hospital alignment offers valuable insights for UMass Memorial and similar health care organizations. More than 90 percent of physician respondents believe they should be involved in hospital governance activities such as serving on boards, assuming management positions and taking part in performance improvement.
UMass Memorial strongly encourages physicians to become more involved in hospital governance. It sees potential in offering services such as continuing leadership education and compensating these individuals for the time they spend handling administrative tasks.
The organization also is trying to gain community physicians' support of technologies that enable connectivity, including EHRs and health information exchange platforms. Understanding that the technology itself won't change physician behavior, organization leaders believe that educating providers about the benefits of clinical and interoperability applications, and training them to use the tool most efficiently and effectively will change their actions.
Changes in the health care industry are forcing hospitals and physicians to collaborate in increasingly creative ways. UMass Memorial and other organizations that are more tightly integrating physicians into the hospital culture have overcome many operational challenges in achieving their goals by understanding physicians' desires and aligning incentives appropriately. By supporting these providers with technologies that promote connectivity, UMass Memorial is confident that its strategy will pay dividends for years to come.
Michael Bakerman, M.D., M.M.M., F.A.C.P.E., F.A.C.C., is the chief medical informatics officer for UMass Memorial Healthcare Inc. in Worcester.