As health care delivery and financing shift from a volume-based to a value-based business model, provider success will be achieved by offering services with the best possible quality, outcomes and access for the lowest cost across the continuum of patient services and sites.

To effectively offer services in a value-based environment, organizations will need enhanced integration with employed and private practice physicians," says James J. Pizzo, managing director of Kaufman, Hall & Associates. Pizzo is lead author of "A Guide to Physician Integration Models for Sustainable Success," a new Hospitals in Pursuit of Excellence publication from the Health Research & Educational Trust and Kaufman Hall. Co-authors are Matthew J. Lambert III, M.D., and Scott J. Cullen, M.D., senior vice presidents of Kaufman Hall.

Properly structured hospital-physician ventures reduce duplication of assets in communities, inappropriate clinical practice variation and overall costs to payers, employers and patients while improving quality, access, and operating and capital efficiency.

Integration models implemented at hospitals nationwide include customer service offerings, contractual ventures, joint venture/shared equity arrangements and employment/practice acquisition models. The HPOE guide provides examples of hospital-physician integration initiatives at organizations of different types and sizes. "There is no one integration model that works for all organizations or all physicians. Because service areas and physician needs are diverse, organizations must offer multiple engagement options, serving multiple physician constituencies," says Pizzo.

12 strategies can guide sustainable integration efforts:

  1. Understand the forces affecting physicians and design strategic offerings to meet their needs.
  2. Understand organizational capabilities and infrastructure in the context of the communities served.
  3. Ground physician-integration efforts on a well-defined strategic financial plan.
  4. Ensure strong physician participation, leadership and governance.
  5. Use technology to connect with physicians.
  6. Ensure objective assessment of organizational readiness for care transformation efforts.
  7. Use a disciplined, integrated approach to practice acquisition and employment.
  8. Document and communicate the level of financial commitment required to employ physicians.
  9. Before employing physicians, model alternative compensation arrangements.
  10. Structure effective, sustainable compensation programs for employed physicians.
  11. Manage employed physicians to achieve goals.
  12. Use a structured process to create a sustainable venture.

Using these strategies, hospitals are better equipped to select integration models that align organizational and physician goals within the constraints of capital resources. "Finding a sustainable balance of strategic and clinical needs, capital constraints, operational capabilities and management competencies is critical," Pizzo notes. Organizations most likely to gain and retain close integration with physicians have common attributes that include deep management expertise, shared hospital-physician leadership and a well-developed integration infrastructure. "Health care organizations whose leaders act early to build these attributes based on solid planning and monitoring are poised for future success," he adds.

To download the guide, visit

Maggie Tryloff Flores is a freelance medical writer specializing in strategic health care initiatives and financing.


New and improved resource

The Hospitals in Pursuit of Excellence website has been updated. Improved search functions help health care leaders access case studies, toolkits, guidelines and other information for performance improvement. Highlighted topics include operational excellence, with such categories as financial management and strategic planning. There are examples of what hospitals are doing to eliminate central line-associated bloodstream infections or catheter-associated urinary tract infections. links to other websites and pertinent articles, making it a one-stop portal for hospital leaders aiming to improve quality and care coordination and succeed in the era of health reform. Go to

Equity of care initiative

The National Call to Action to Eliminate Health Care Disparities was created by the AHA, American College of Healthcare Executives, Association of American Medical Colleges, Catholic Health Association of the United States and National Association of Public Hospitals and Health Systems to affect three core areas: increase collection and use of patients' race, ethnicity and primary language data; provide cultural competency training to clinicians and support staff; and increase diversity in health care governance and leadership. The Equity of Care website features a new video, "Equity of Care 2012 Progress Report," highlighting the initiative's first-year progress. Visit the website, read the bimonthly blogs and watch videos at

Advanced illness management

The AHA's 2012 Committee on Performance Improvement has released "Advanced Illness Management Strategies" to help hospitals develop and implement AIM initiatives, and thereby increase access to services that help caregivers, patients and families throughout disease progression. A future CPI report will focus on workforce education and community awareness strategies to support AIM. Download the current report at