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Building a Physician Leader Education Program Across a Multi-Health-System CIN
A health network that launched in summer 2015 was a coming together of several hospitals and health systems across a large Southern state. A partnership at this level had never been attempted, and the development of collegiality among physician leaders was critical to the success of the network. The system’s medical director felt it was important to develop a physician leader education initiative that was participative, inclusive, and driven by shared expertise.
Starting with the board of directors and including all the committees and subcommittees, the health network had substantial physician leader involvement from the beginning. In the early days, it was clear that each partner organization was at a different place in its maturity regarding local clinically integrated network (CIN) development and population health initiatives. A few of the organizations were still in the process of developing their networks and had yet to be involved in any value-based-care contracts. Seeing the knowledge gaps and understanding the need to level-set across the entire network, the system medical director launched a physician leader education program that focused on clinical integration, population health, value-based care, and new legislative mandates that affected physician practice.
The infrastructure for the education initiative was simple. Sessions were conducted every other month and were supported by webinar conferencing and PowerPoint presentations. The first session focused primarily on a basic understanding of clinical integration and included aspects of network build, governance, operations, measures, and performance management. Also included was a history of clinical integration and a legal description with reference to opinions that the Federal Trade Commission previously rendered.
After the initial session, follow-up education included the basics of population health, understanding the Medicare Access and CHIP Reauthorization Act (MACRA), and Comprehensive Primary Care Plus (CPC+), a discussion of the Medicare Shared Savings Program (MSSP) and drivers of success, and a review of Medicare Advantage with a focus on downside risk. Following these, the sessions continued with a look at technology, performance data capture, and analysis.
Physician leaders’ initial participation across the network was strong and remained so throughout the program. After the first presentation from the system’s medical director, other physician leaders created presentations to support the participative nature of this initiative. Feedback for all the sessions was positive, and the effect the information sharing was having on the committees and subcommittees became clear as physician leaders were able to speak more informatively regarding critical issues facing the network. Many of the presentations were reused at the local level for frontline physician education. The spread of knowledge was more than the organizers had hoped for.
With a deeper understanding of clinical integration and the need to increase competency within the network, physician leaders used their newfound education to build a sophisticated quality and performance-management plan. The development of participation and performance scorecards at the network, member CIN, and individual physician levels was a shared effort with a focus on consistency and meaningful measures that would drive everyone further down the path of clinical integration. In addition, these leaders adopted a network-wide performance-improvement and remediation plan for all physicians across the network. Evidence-based clinical pathways for common ambulatory conditions were presented and adopted for endorsement by the network.
Today, the physician leader education initiative continues to pay off as the network contemplates new value-based contracts and potential downside risk. Physician leaders are learning about population risk-adjustment factors, better managing access to healthcare in the right environment, as well as the role of supporting technology and analytics, and how to implement risk models to address future population needs and utilization. The realization of the system’s original goal is clear: The network has become a learning and growth organization.
Doug Ardoin, MD, MBA, managing principal for Lumina Health Partners, is a physician executive with more than 14 years of leadership experience serving in large healthcare systems. He is certified by the American Board of Family Medicine (ABFM) and a Fellow of the American Academy of Family Physicians (AAFP).
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