Integrated Governance & Management: A Leadership...
Transcript of Integrated Governance & Management: A Leadership...
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Integrated Governance & Management:
A Leadership Challenge!
Presented by:
Marc D. Halley, MBAChairman and CEO
The Halley Consulting Group, Inc.
Percival Kane, MHASVP & Network AdministratorNorth Oaks Physician Group
Healthcare Financial Management Association
Region 5
February 20, 2015
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Discussion Topics
I. Our Business Imperatives
II. The Physician Integration Continuum
III. The Critical Role of Governance
IV. Management Styles and Power Bases
V. Vertical Governance: The Council Model
VI. Horizontal Governance
VII. Q&A
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Our Business Imperatives
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Strategic Imperatives – Organizations
Must Do These Things
Attract Market Share
Demonstrate Quality
Have Access to Capital
Be Productive
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The Concept of “Value”
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Clinical
Process
Clinical
Outcome
Patient
ExperienceEffective
Cost
Per
Unit
Utilization Efficient
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The Physician Integration Continuum
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Common Integration Options
(Multiple “Plugs”)In
tegra
tion
Sustainability/ Infrastructure
Medical Staff
PHO/IPA
Medical Directorships/
Co-management
Joint Venture
Independent Contractor/ PSA/SBS
Employee
H
HLHalley, Marc D. 2011. Owning Medical
Practices: Best Practices for Sustainable
Results. Chicago, IL: AHA Press. 67. 7
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Physician Integration Economics –
Fee for Service
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Capture &Retain
Market Share
Hospital Capital
Generator
Capital Preservation &
Investment
Market Manager
Potential
Capital Loss
Potential
Capital Drain
Potential
Capital Drain
Referral Path
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© 2008 The Halley Consulting Group, LLC
Halley, Marc D. 2011. Owning
Medical Practices: Best Practices for
Sustainable Results. Chicago, IL:
AHA Press. 10.
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Physician Integration Economics –
Risk Payment Model
Panel Size Access
Time & Materials
Hospital Risk Pool
Capital Potential
Capital Preservation &
Investment
Market Manager
Potential
Capital Loss
Potential
Capital Drain
Potential
Capital Drain
Referral Path
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© 2008 The Halley Consulting Group, LLC
Halley, Marc D. 2011. Owning
Medical Practices: Best Practices for
Sustainable Results. Chicago, IL:
AHA Press. 10.
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Moving Up the Integration Pyramid
PHM
Clinical Integration
Functional Integration
Structural Integration
• Population-centered care
• Personal accountability for healthy
behaviors and lifestyle
• Population health management
• Chronic disease prevention &
management
• Access and information = value
• Risk-based payment
• Choreographed care (Accountability)
• Improving process and outcomes
• Clinical quality commitments
• Transparent flow of clinical
information across care continuum
• Managing an episode of care or
chronic disease using clinical metrics
• Individual and joint accountability to
live by established metrics
• Collaborative care (Trust)
• PCMH & “Choice” Initiatives
• Vital behaviors
(“We”/“Our”)
• Service quality extension of
referring provider’s office
• Information lubricates the
Referral Path
• Referral management
• Coordinated care (Silos)
• Basic form of integration
• Legal
structure/Organization
chart
• Payroll silos (“Me”/“You”)
• Referral leakage
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© 2013 The Halley Consulting Group, Inc.
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The Critical Role of Governance
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Fiduciary and Operational
Governance
• Select and evaluate
the chief executive
• Enterprise vision &
strategies
• Capital formation and
allocation
• Mergers & acquisitions
• Regulatory compliance
• Enterprise financial &
quality oversight
• Enterprise policy
• Etc.
• Sponsor, direct &
oversee
implementation
• Operating policies,
procedures
• Performance
improvement tactics
and timing
• Key stakeholder
engagement
• Performance
accountability12
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Vertical Governance
(Formal Authority or Authorization)
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Owners
Or
Fiduciaries
Employees
Management
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Horizontal Governance
(Common Consent)
Patients*
Primary Care Physicians
and Providers
Specialty Physicians
and Providers
Ancillary Services
Departments
Hospital-Based
Providers
Acute Care Facilities
and Services
Post Acute Facilities
and ServicesPayers*
(* Potential future members)
Service Line Council (SLC)
Clinical Process Teams (CPT)
(Functional Integration)
(Clinical Integration)
14© 2014 The Halley Consulting Group, Inc.
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Management Styles and Power Bases
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“Knowledge Workers…”
• Own the means of production – unique knowledge and practiced skill
• Highly mobile
• Independent judgment (“professional”)
• Need tools of production – capital investment
• Exceptional clinical opportunities = loyalty
• Compensation “hygiene” factor
• Define their own level of contribution
• “Cannot be supervised effectively”Adapted from: Drucker, P. 1998. Peter
Drucker on the Profession of Management.
Boston: Harvard Business School
Publishing. 122-124.16
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Power Bases
• Legal Power: official authority &
position
• Expert Power: knowledge, ability,
information
• Reverent Power: respect, personality,
charisma
• Reward Power: ability to give or
withhold incentives, capital, etc.
• Punitive Power: impose penalties
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Gilson Leadership ScaleWays Leaders Make Decisions
• Tell: Identify the problem, discern the
alternatives and make the decision
• Persuade: Add “sell” to above
• Discuss: Identify the problem, discern the
alternatives, propose a tentative solution,
gather input from those who will need to
implement the solution, make the final
decision
• Consult: Present the problem and background
to the group, solicit alternative ideas and
solutions from the group, leader makes the
final decision
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Gilson Leadership Scale (Continued)
Ways Leaders Make Decisions
• Join: Manager participates as a member of
the group in identifying the problem and
alternatives, while agreeing, in advance, to
carry out the decision of the group
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Matching Leadership Styles and Power
Bases
• Tell Legal, Expert, Punitive
• Persuade Reverent, Reward
• Discuss Reverent, Reward
• Consult Expert, Reverent
• Join Expert, Reverent
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The Council Model: “Partnership” Led
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Network Operations Council (NOC)• Composition
– Physician Chair
– Physician representation from Primary Care Clinics,
Medical Specialty Clinics, Surgical Specialty Clinics &
Hospital-based Services
– Executive Team representation: Executive VP/COO,
SVP/Chief Legal Officer, SVP/CFO, SVP/CMO &
SVP/Network Executive
• Purpose
– Provide governance for overall physician network
– Determine the strategic direction of the physician
network
– Make clinical/quality, operational, financial, strategic &
policy decisions globally for the physician network
• Value
– Decision-making forum for the entire physician network
that inherently has credibility & buy-in from other
network providers
• Tools
– Agenda comprised of standing reports from subcommittee
chairs & SVP/Network Executive, a review of monthly
financial performance & new business.
– Supporting information: dashboards, Net 1, Net 2
Financials, action plans, policies, etc.
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Network
Operations
Council
Practice
Operations
Council
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Practice Operations Council (POC)• Composition
– Physicians within the practice
– Mid-level providers within the practice
– Practice Leadership Team: Practice Manager, Supervisor,
Regional Director & SVP/Network Executive
• Purpose
– Provide governance for the practice
– Determine the strategic direction of the practice
– Determine how to adopt & execute NOC-approved
directives
– Make clinical/quality, operational, financial & strategic
decisions for the practice
• Value
– Provider engagement with decision-making for the
operations of the practice
– Provider awareness: operations, policies, performance,
initiatives, challenges, etc.
– Accountability
• Tools
– Site-Specific Action Plans
– Net 1, Net 2 Financials
– Supporting materials: dashboards, policies, presentations,
etc.23
Network
Operations
Council
Practice
Operations
Council
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Network Operations Council
Subcommittees
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•PURPOSE: Focuses on establishing & enforcing the expectations of being an employed provider within the physician network
•PURPOSE: Focuses on evaluating & improving the financial performance of the overall physician network
•PURPOSE: Focuses on enhancing our EMR system & its associated workflows & leveraging technology to provide optimal care
•PURPOSE: Focuses on achieving clinical compliance, ensuring quality & evaluating new clinical services
CLINICAL QUALITY & INNOVATION
SUBCOMMITTEE
AMBULATORY PHYSICIAN
INFORMATICS SUBCOMMITTEE
PERSONNEL RELATIONS
SUBCOMMITTEE
FINANCE SUBCOMMITTEE
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The Extension of the Physician Governance
Model into General Operations
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Clinical Shared Governance Team
Employee Engagement Council
Managed Care Contracts Committee
North Oaks
Physician Group
Governance Structure
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Horizontal Governance
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The Limits of “Pay for Performance”
• Mind or heart?
• When you pay for everything you get,
you get only what you pay for…
• From incentive to entitlement
• Upping the ante…
• Stifles innovation
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Horizontal Integration
• A common interest
– Chronic disease
– Episode of care
– Referrals
• Clear and compelling vision
– Common cause is the glue
– “An offer too good to refuse”
– Overcomes tactical disagreement
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Horizontal Integration
• Shared tenets (ground rules)
– Clinical quality
– Service quality
– Productivity
– Collaboration
– Cost per unit
– Process efficiency
– Utilization
– Financial viability29
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Horizontal Integration
• Working together
– Individual roles
– Shared commitments*
– Performance targets
– Performance management
– Individual accountability
– Joint accountability
– Appropriate incentives/rewards
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Shared Commitments…
• N,W,P’s
– Needs (clinical)
– Wants (preferences)
– Priorities (constraints)
• Written Service Commitments
– Extension of PCP
– Referring physicians/providers/staff
– “Their” patients
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Shared Commitments…
• Clinical integration
– Chronic
– Complex Chronic
– Episode of Care
• Clinical protocols/processes
– Clinical Management Teams
– Care Management Teams
– Standards of care
– Best practices
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Shared Commitments…
– “Certification”
• Clinical outcomes
– Effectiveness
– Efficiency
• Critical nature of self-reporting
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Questions and Answers…
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