Integrating the Integration:
How to Successfully Manage the
Challenges of Clinical and Financial Integration
Steven M. Berkowitz, MD
SMB Health Consulting
Austin, TX
512-415-6095
steve@smbhealthconsulting.com
Integrating the Integration:
How to Successfully Manage the
Challenges of Clinical and Financial Integration
Steven M. Berkowitz, MD
SMB Health Consulting
Austin, TX
512-415-6095
steve@smbhealthconsulting.com
2012- 2013 Clients- Two Lessons Learned
2012- 2013 Clients- Two Lessons Learned
Every System is unique.
But… Every System is dealing with the same issues.
So What’s New in Health Care Reform?
Same old wine in a brand new bottle?
Clinical
Integration
Vertical
Integration
Equity
Model
Integrated
Delivery System
Accountable
Care
Organizations
Capitation
U.S. Health Care Organizational Chart
So What’s New in Health Care Reform?
You can always count on Americans to do the right thing…
…after they’ve exhausted all the other possibilities !!”
Winston Churchill
People do not change until the pain of staying the same…
… exceeds the pain of changing.
Anonymous
The Health Care Team
Medicine is a Team effort….
…..Why do we insist on playing Solo !
The Health Care Team
Medicine is a Team effort….
…..Why do we insist on playing Silo !
The Evolution of Health Care Reform
1990’s--
Market Correction
2013--
Market Reconfiguration
Remember, It’s Not Nice to Fool Mother Nature
Health care must follow the same market
rules as all other industries
The Conundrum of Quality in Health Care
“Never, ever think
outside the box”
What Does the Model Look Like?
Form Follows Function
Inputs
Delivery
System
Processes
Results
What Does the Model Look Like?
Form Follows Function
Inputs
Decreased payment:
VALUE vs volume
Some risk
Increased demand:
Greater volume
Aging, chronic
Delivery
System
Processes
Clinical/ Operational
Financial
Infrastructure/ Governance
Results
Transparency of VALUE:
Clinical Outcomes
Patient Satisfaction
Cost Effectiveness
Thinking Like an Engineer
The optimist: The glass is half full
The pessimist: The glass is half empty
Thinking Like an Engineer
The optimist: The glass is half full
The pessimist: The glass is half empty
The Engineer: The glass is too big !!
Winning the Game
What is the best model for your organization?
Any hand’s a winner…. Any hand’s a loser !!
What Does the Model Look Like?
Form Follows Function
ALL MARKETS ARE UNIQUE !!

What are the needs of the community that you serve?
 Quality, accessible, cost-effective care

What are the needs of the physicians?
 Quality medical care
 Practice/ economic stability

What are the needs of the hospitals?
 Quality, accessible, cost-effective care
 Partnership relationship with the medical staff
Fundamental Requirements to be a Winner
Clinical Integration
Financial Integration
Shared Infrastructure and Governance
Fundamental Requirements to be a Winner
X- ABC Health System
X
Clinical Integration
X Financial Integration
X
Shared Infrastructure and Governance
Engaging Hospitals and Physicians
Insights and Actions for Results

Integration
ClinicalClinical
Integration
◦ Embracing data transparency
◦ Implementing best practices
◦ Excel at Pay for Performance
Financial Integration
◦ Enterprise-wide cost reduction
◦ Successful Management of Risk
Shared Infrastructure and Governance
◦ An aligned, long term collaborative relationship
Engaging Hospitals and Physicians
Insights and Actions for Results

Integration
ClinicalClinical
Integration
◦ Embracing data transparency
◦ Implementing best practices
◦ Excel at Pay for Performance
Financial Integration
◦ Enterprise-wide cost reduction
◦ Successful Management of Risk
Shared Infrastructure and Governance
◦ An aligned, long term collaborative relationship
Clinical Integration
The Continuum
Clinical Integration
Engaging Hospitals and Physicians
Insights and Actions for Results

Integration
ClinicalClinical
Integration
◦ Embracing data transparency
◦ Implementing best practices
◦ Excel at Pay for Performance
Financial Integration
◦ Enterprise-wide cost reduction
Shared Infrastructure and Governance
◦ An aligned, long term collaborative relationship
Clinical Integration Imperatives
1.
2.
3.
4.
Embrace Data Transparency
Implement Evidence-based practices
Excel at Pay for Performance
Add the Secret Sauce !!
Clinical Integration Imperatives
1.
2.
3.
4.
Embrace Data Transparency
Implement Evidence-based practices
Excel at Pay for Performance
Add the Secret Sauce !!
Value Based Purchasing
The increasingly informed consumer will make
health care decisions on the basis of VALUE
Value Based Purchasing
The increasingly informed consumer will make
health care decisions on the basis of VALUE
VALUE =
Outcomes + Satisfaction
Cost
Value Based Purchasing
The increasingly informed consumer will make
health care decisions on the basis of VALUE
VALUE =
Outcomes + Satisfaction
Cost
The CONSUMER ultimately determines which
of the above elements constitute VALUE
Read all about it !!
April 2005
Pennsylvania
Coronary Artery Bypass Surgery
2008 - 2009
Released: May 2011
CABG Mortality in Pennsylvania
Results !!
The New York State CABG Experience
Chassin, Health Affairs, 2002
41% reduction in mortality in first four years
Mortality higher in facilities with low volumes
◦ Reduction in hospitals doing CABG
◦ Reduction in physicians performing procedures
 27 surgeons ceased operations in NY
Their combined mortality was 11.9%
( NY state average 3.1% )
Wisconsin
QualityCounts
Report on the Safety
of Hospital Care
Released January 2003
Data Transparency
That which is measured, tends to improve.
That which is measured publicly, tends to improve faster.
“What we concluded was that even when hospitals know their
performance is not good, that's not sufficient motivation for them to do
something. Making it public made a big difference in motivating them to
improve.”
Judith Hibbard, Health Affairs 2003
Core Measures:
Heart Attack
Heart Failure
Pneumonia
Surgical Care Improvement
HCAHPS
CMS Core Measures– the Top Decile
100%
99%
98%
SCIP
97%
AMI
PN
96%
95%
HF
Core Measures:
Heart Attack
Heart Failure
Pneumonia
Surgical Care Improvement
HCAHPS
Core Measures:
Heart Attack
Heart Failure
Pneumonia
Surgical Care Improvement
HCAHPS
The problem with 99% of the lawyers is that
they give the rest a bad name.
Steven Wright
Data Transparency and Accountability
Transparency is the best thing that’s happened to
quality since antibiotics...
…by decreasing variance and improving results
Exposure to and Use of Quality Information
30
Saw
Acted
25
20
15
10
5
0
1996
2000
2004
2006
2008
Kaiser Family Foundation, October 2008
If the other guy’s getting better, then you’d better be getting
better faster than that other guy’s getting better…
…Or you’re getting worse.
Tom Peters
Data Transparency and Accountability
Transparency is the best thing that’s happened to
quality since antibiotics...
…by decreasing variance and improving results
As transparency matures, it will rewrite the book on:
Who is your competitor?
The Role of Transparency
Price
Transparency
Quality
Transparency
The Role of Transparency
Price
Transparency
Quality
Transparency
System Strategic Planning
Who is Your Competitor…. The role of Transparency
Stage I
The “other guy”
System Strategic Planning
Who is Your Competitor…. The role of Transparency
Stage II
All hospitals in Arkansas
Stage I
The “other guy”
System Strategic Planning
Who is Your Competitor…. The role of Transparency
Stage III
The entire nation ?
Stage II
All hospitals in Arkansas
Stage I
The “other guy”
System Strategic Planning
Who is Your Competitor…. The role of Transparency
Stage IV
The whole world ??
Stage III
The entire nation ?
Stage II
All hospitals in Arkansas
Stage I
The “other guy”
Steve’s Three Rules of Data
1. The data is significant, whether it is significant or not.
2. A low score almost always points to a real issue.
3. The biggest gain in performance improvement occurs
when going from NO data to ANY data.
Involve ALL stakeholders in the performance improvement process
Hospitals and Physicians Working as a Team
Share the Data !
Decrease the Variance !
Hospitals and Physicians Working as a Team
Large variances continue to exist amongst physicians and hospitals.
Variances can and do lead to differences in management, treatment,
and outcomes for the patient.
Hospitals and Physicians Working as a Team
Data , not an Indictment !!
Data is NOT Diagnostic !!
Hospitals and Physicians Working as a Team
The great majority of “outlying” physicians are good, caring
physicians who have developed a particular style of practice
which can be improved !
The Role of Transparency
Quality Transparency:
Improved performance
Decreased variance
Price
Transparency
Quality
Transparency
The Role of Transparency
Price
Transparency
Quality
Transparency
Steve has a URI symptoms and feels bad!
Steve has great insurance but a $3,000 deductible
What does he do?
Treatment Options:





Emergency Department
Urgent Care
PCP visit
Local Pharmacy
Self Treat.. rest, OTC meds...
Approximate*:
Out of Pocket
Wait
$ 300
2-3 hrs
150
1 hr
120
1 hr (if available)
80
30 min
10
? none
* The actual cost may not be known until the
evaluation is completed




The physician’s reimbursement for the visit
The nurses reimbursement for the visit
The cost of his treatment to the institution
Any other contractual relationships
◦ Physicians
◦ Vendors
◦ Any other arrangements with the insurance company
Just tell me: How Much Do I Need to Pay !!
Questions for the Leadership Team
Does your organization…
… embrace data transparency ?
Clinical Integration Imperatives
1.
2.
3.
4.
Embrace Data Transparency
Implement Evidence-based practices
Excel at Pay for Performance
Add the Secret Sauce !!
Implementing Evidence-Based Medicine
What Can we Learn from the Airline Industry ?
What Can we Learn from the Airline Industry?
Teamwork: Guidelines and Checklists
Where Do We Find the Best Practices ?
Examine Your Own Specialty Literature
Where Do We Find the Best Practices ?
Examine Your Own Specialty Literature
Guidelines for Guidelines
There will be MORE guidelines in clinical medicine
Guidelines were NEVER intended to apply to all patients and do NOT
take the place of individual physician judgment
Expect physicians to occasionally deviate from guidelines in the daily
practice of prudent medical care
When so…
… DOCUMENT In the medical record that:
The patient was seen and evaluated
The options were thoughtfully considered
The best clinical judgment was used
Discussed with the patient
Guidelines for Guidelines
There will be MORE guidelines in clinical medicine
Guidelines were NEVER intended to apply to all patients and do NOT
take the place of individual physician judgment
Expect physicians to occasionally deviate from guidelines in the daily
practice of prudent medical care
When so…
… DOCUMENT In the medical record that:
The patient was seen and evaluated
The options were thoughtfully considered
The best clinical judgment was used
Discussed with the patient
What Can we Learn from the Airline Industry ?
Elimination of Ambiguity
“the elimination of ambiguity is consistently cited
as a key factor in protocol success and safety”
Degani and Weiner 1993
Most medical guidelines are based upon ambiguity as a
guiding principle of protocol development
Example
“Any of the low or high dose regimens
outlined in table 2 are appropriate”
(0.5 – 6 mU/min every 15-40 min)
“Each hospital’s OB/Gyn department should develop
guidelines for preparation and administration of oxytocin”
“The uterine contractions and fetal heart rate should be
monitored closely”
Example
“ Women with post-term gestations who
have unfavorable cervices can either
undergo labor induction or be managed expectantly”
“Delivery should be effected if there is evidence of fetal
compromise….”
How to Land a 747 in a Strong Cross Wind *
*( Had it been Written by ACOG)
 Use any settings of the plane’s
instruments you feel like
 Every airline and pilot can do it
differently
 Be really careful as you get close to
the ground
Steve Clark, MD
Do Guidelines Help or Hurt?
“Yeah, but Pilots do not have to
worry about Malpractice Suits”
Obstetrician, Texas
Do Guidelines Help or Hurt?
“Yeah, but Pilots do not have to
worry about Malpractice Suits”
“You’re Right,
We Just Die !!”
Obstetrician, Texas
Famous Pilot / Dog
Do Guidelines Help or Hurt?
We keep missing the point….. Simply put…
Evidence-based guidelines:
reduce adverse outcomes !
improve patient care !
Adverse
Outcomes
evidence based
guidelines
Adverse
Outcomes
Questions for the Leadership Team
Does your organization…
…implement best practices ?
Clinical Integration Imperatives
1.
2.
3.
4.
Embrace Data Transparency
Implement Evidence-based practices
Excel at Pay for Performance
Add the Secret Sauce !!
CMS Pay for Performance
CMS Pay for Performance
Hospitals
Physicians
CMS Pay for Performance
What Pay for Performance is NOT:
 A increase in revenue
 A break-even with revenue
What Pay for Performance IS:
 A way to partially recoup some of the REDUCTIONS we will see in
revenue
CMS Pay for Performance
What Pay for Performance is NOT:
 A increase in revenue
 A break-even with revenue
What Pay for Performance
IS:
Core Measures
 A way to partially recoup
some of the REDUCTIONS we will see in
HCAHPS
revenue
Re-admissions
Hospital Acquired Conditions
Meaningful Use
CMS Pay for Performance
What Pay for Performance is NOT:
 A increase in revenue
 A break-even with revenue
What Pay for Performance
IS:
Core Measures
 A way to partially recoup
some of the REDUCTIONS we will see in
HCAHPS
revenue
Re-admissions
Hospital Acquired Conditions
Meaningful Use
Complicated CMS Payment Schedule
CMS Pay for Performance- 2013 and 2014
Domain
Process of Care
Core Measures
Pt Experience of Care
HCAHPS Survey
Health Outcomes
30-day mortality
Totals
FFY 2013 Program
FFY 2014 Program
Measure
Count
Domain
Weight
Measure
Count
Domain
Weight
12
70%
13
45%
1
(using 8 HCAHPS
dimensions)
N/A
13
(2 domains)
30%
1
(using 8 HCAHPS
dimensions)
30%
N/A
3
25%
100%
16
100%
(3 domains)
The Evolution of CMS Value Based Purchasing
From Process  Outcomes and Efficiency
100%
90%
80%
Efficiency- Spending
per Beneficiary
Health Outcomes
HCAHPS
70%
60%
50%
40%
30%
Process Core
20%
Measures
10%
0%
2013
2014
2015
2016*
The Evolution of CMS Value Based Purchasing
Specific Indicators
CMS Pay for Performance- Physicians

In 2015, CMS will begin applying a value modifier under
the Medicare Physician Fee Schedule
◦ Quality
◦ Cost
◦ Value of Care



By 2017, this modifier will be applied to all physicians
who bill Medicare for services
1.5% at risk in 2015
2% in 2016 and beyond
Questions for the Leadership Team
Will your organization…
…excel at pay for performance?
Clinical Integration Imperatives
1.
2.
3.
4.
Embrace Data Transparency
Implement Evidence-based practices
Excel at Pay for Performance
Add the Secret Sauce !!
The Disconnect between Process and Outcome
What’s Missing ?
Manufacturing
Process
Mapping
Hardwiring
Outcome
The Disconnect between Process and Outcome
What’s Missing ?
Clinical
Process
Mapping
Hardwiring
X
Outcome
The Disconnect between Process and Outcome
What’s Missing ?
Clinical
Process
Mapping
Hardwiring
X
Outcome
Patients are NOT Toyotas !
The Disconnect between Process and Outcome
What’s Missing ?
Incomplete
Medical Knowledge
Clinical
Process
Mapping
Hardwiring
(P) Poor Protoplasm
X
Outcome
The Disconnect between Process and Outcome
What’s Missing ?
The Disconnect between Process and Outcome
What’s Missing ?
Incomplete
Medical Knowledge
Clinical
Process
Mapping
Hardwiring
(P) Poor Protoplasm
X
Outcome
The Disconnect between Process and Outcome
What’s Missing ?
Incomplete
Medical Knowledge
The
Clinical
Process
Mapping
HUMAN
Hardwiring
X
Element !!
(P) Poor Protoplasm
Outcome
The Secret Sauce… The HUMAN Element
Communications
Relationships
Valuing the HUMAN side of Medicine
The
HUMAN
Element !!
Questions for the Leadership Team
Does your organization…
…value the Human side of medicine?
The
HUMAN
Element !!
Clinical Integration
The Continuum
Clinical
Integration
The Role of Information Systems
Health Care Information Systems-- We are so far behind !!!
1 Zettabyte =
1,000,000,000,000,000,000,000 bytes
= 10007 bytes = 1021 bytes
The Role of Information Systems
Health Care of the Future…..
…. We can’t get there from here
…. Without Information Systems !!
The Role of Information Systems
EMR and Evidence Based Order Sets are not just another
IT initiative….
…. it is a Clinical Transformation to how we will be
practicing better medicine in the future.
The Role of Information Systems
The EMR will do for health care
What the assembly line did for manufacturing
The Role of Information Systems
Health Care of the Future…..
…. We can’t get there from here
…. Without Information Systems !!
The Role of Information Systems
EMR and Evidence Based Order Sets are not just another
IT initiative….
…. it is a Clinical Transformation to how we will be
practicing better medicine in the future.
Fundamental Requirements to be a Winner
Clinical/ Operational Integration
Financial Integration
Shared Infrastructure and Governance
Financial Integration
The Continuum
Financial Integration
Engaging Hospitals and Physicians
Insights and Actions for Results

Integration
Clinical Clinical
Integration
◦ Embracing data transparency
◦ Implementing best practices
◦ Excel at Pay for Performance

Financial
Integration
Financial
Integration
◦ Enterprise-wide cost reduction
◦ Management of Risk
Shared
Infrastructure
and
Governance
Hospital
Physician
Partner
ship

◦ An aligned, long term collaborative relationship
Enterprise Wide Cost Reduction
Job One !!
There will be a focus on Cost Control like we have
NEVER seen before in our careers
Enterprise Wide Cost Reduction
Job One !!
Today’s Health Care Costs
Admin
Other
Cost Reductions
Post- Reform Health
Care Costs
Rx
Hospital
Physician
????
?
Enterprise Wide Cost Reduction
Job One !!
Today’s Health Care Costs
Admin
Other
Cost Reductions
Post- Reform Health
Care Costs
Rx
Hospital
Physician
????
?
Total Cost of Care- Hospitals
Total Cost of Care- Hospitals
Minimal
Opportunity
Total Cost of Care- Hospitals
Minimal
Opportunity
More
Opportunity
Total Cost of Care- Hospitals
Minimal
Opportunity
More
Opportunity
The Goal: Drive from Point A to Point B
Road – 200 miles
Point B
Point A
The Goal: Drive from Point A to Point B
Cost Reduction Strategies
Road – 200 miles
Point B
Point A
Variables:
1. The cost of gas
2. The cost of the car
3. The cost of lunch on the way
Cost Reduction Strategy:
Negotiate better gas price
Get a cheaper car with better MPG
Eat at a fast food place
The Goal: Drive from Point A to Point B
What We Did NOT Consider
Road – 200 miles
Point B
Point A
Different Road – 100 miles
Variables:
1. The cost of gas
2. The cost of the car
3. The cost of lunch on the way
Cost Reduction Strategy:
Half the amount of gas needed
Get a cheaper car with better MPG
Arrive before lunch
The Goal: Drive from Point A to Point B
Maybe We Can’t Get There from Here
Road – 200 miles
Point B
Point A
Different Road – 100 miles
The best solution for cost reduction may be to get a
better process, not necessarily reduce each individual
unit cost of the existing process
The Successful Management of Risk
Types of Risk Products
Total Health Care Costs
Admin
3. Global with
Incentives
4. Full Risk Cap
Other
Other
Other
Rx
Rx
Rx
1. Global
2. Bundling
Hospital
Hospital
Hospital
Hospital
Hospital
Physician
Physician
Physician
Physician
Physician
The Successful Management of Risk
Negotiated
Rate
First Cycle
“Profit”
Cost of
Care
The Successful Management of Risk
Typical management tactics:
Negotiated
Rate
First Cycle
“Profit”
Cost of
Care
Aggressive third party contracting
Utilization management
Concurrent financial review
Staffing efficiencies
Individual case reviews
Care coordination/ transition mgmt
Three Challenges with Management of Risk
1. Who Owns The “Profit” ?
Negotiated
Rate
First Cycle
“Profit”
Cost of
Care
Three Challenges with Management of Risk
1. Who Owns The “Profit” ?
Negotiated
Rate
First Cycle
“Profit”
Cost of
Care
Stakeholders:
Physicians
Hospital
Employer
Patient
Others?
Three Challenges with Management of Risk
2. What About Next Cycle’s Reimbursement ?
Will rates go down?
Negotiated
Rate
First Cycle
Next Cycle
“Profit”
Cost of
Care
New
Rate
Three Challenges with Management of Risk
3. Paybacks are Heck !!
Can you maintain your cost reduction?
Negotiated
Rate
First Cycle
Next Cycle
“Profit”
Cost of
Care
New
Rate
New Cost
of Care
The Successful Management of Risk
Typical management tactics:
Negotiated
Rate
First Cycle
“Profit”
Cost of
Care
Aggressive third party contracting
Utilization management
Concurrent financial review
Staffing efficiencies
Individual case reviews
Care coordination/ transition mgmt
Most of the tactics have a one time effect
Fixed costs keep rising
Three Challenges with Management of Risk
3. Paybacks are Heck !!
Can you maintain your cost reduction?
Negotiated
Rate
First Cycle
Next Cycle
“Profit”
Cost of
Care
New
Rate
New Cost
of Care
Deficit !!
Three Challenges with Management of Risk
3. Paybacks are Heck !!
Can you maintain your cost reduction?
Negotiated
Rate
First Cycle
Next Cycle
“Profit”
Cost of
Care
New Cost
of Care
New
Rate
Deficit !!
A previously profitable venture
is now underwater
Levels of Coordinated Systems of Care
Risk = Exclusivity
Levels of Coordinated Systems of Care
Risk = Exclusivity
The greater the risk…
…the greater the reward
The Roles of the Health Care System
Delivery of
Care
Finance,
Managing and
Delivery of
Care
Are We an Insurance Company in Disguise?
Delivery of
Care
Finance,
Managing and
Delivery of
Care
If it walks like a duck……..
Are We an Insurance Company in Disguise?
Delivery of
Care
Finance,
Managing and
Delivery of
Care
If it walks like a duck……..
Bottom Line:
We need to THINK more like an insurance company
You should always go to other people's funerals,
otherwise, they won't come to yours.
Yogi Berra
I never said most of the things I said.
Yogi Berra
Fundamental Requirements to be a Winner
Integrating the Components of Health Care Delivery
Financial
Integration
Clinical
Integration
Fundamental Requirements to be a Winner
Integrating the Components of Health Care Delivery
Financial
Integration
Clinical
Integration
Fundamental Requirements to be a Winner
Integrating the Components of Health Care Delivery
Financial
Integration
Governance/
Infrastructure
Clinical
Integration
Fundamental Requirements to be a Winner
Clinical/ Operational Integration
Financial Integration
Shared Infrastructure and Governance
Engaging Hospitals and Physicians
Insights and Actions for Results

Clinical Integration
Clinical Integration
◦ Embracing data transparency
◦ Implementing best practices
◦ Excel at Pay for Performance
Financial Integration
◦ Enterprise-wide cost reduction
◦ Management of risk
Shared Infrastructure and Governance
◦ An aligned, long term collaborative relationship
Accountable Care Organizations
Definition:
An ACO is a health care provider organization that is
accountable for meeting the health needs of a defined
population, including the total cost of care and the
quality and effectiveness of services.
Accountable Care Organizations
Lets get back to basics
Definition:
An ACO is a health care provider organization that is
accountable for meeting the health needs of a defined
population, including the total cost of care and the
quality and effectiveness of services.
Infrastructure- With Whom do you Partner ?
Other Hospital Systems
System
Community
Hospital
Infrastructure- With Whom do you Partner ?
Other Hospital Systems
Tertiary Services
Specialists
Mgmt Expertise
Mgmt Services
Branding
Capital
System
Community
Hospital
Infrastructure- With Whom do you Partner ?
Other Hospital Systems
Tertiary Services
Specialists
Mgmt Expertise
Mgmt Services
Branding
Capital
Community
Hospital
System
Patients !
Infrastructure- With Whom do you Partner ?
Other Hospital Systems
Independent
Infrastructure- With Whom do you Partner ?
Other Hospital Systems
Independent Affiliation
Infrastructure- With Whom do you Partner ?
Other Hospital Systems
Independent Affiliation Joint Venture
Infrastructure- With Whom do you Partner ?
Other Hospital Systems
Independent Affiliation Joint Venture Merge
Infrastructure- With Whom do you Partner ?
Other Hospital Systems
Independent Affiliation Joint Venture Merge Close Down
Infrastructure- With Whom do you Partner ?
Other Hospital Systems
Tertiary Services
Specialists
Mgmt Expertise
Mgmt Services
Branding
Capital
What is the LEAST disruptive solution
Community
System
that will accomplish yourHospital
needs
Patients !
Infrastructure- With Whom do you Partner ?
Physician Strategy
Independent
Affiliation
Joint Venture
Employ
A Final Thought….
1620- Somewhere in the Atlantic.…
Fundamental Requirements to be a Winner
Integrating the Components of Health Care Delivery
Financial
Integration
Governance/
Infrastructure
Clinical
Integration
Engaging Hospitals and Physicians
Insights and Actions for Results

Integration
Clinical Clinical
Integration
◦ Embracing data transparency
◦ Implementing best practices
◦ Excel at Pay for Performance

Financial
Integration
Financial
Integration
◦ Enterprise-wide cost reduction
◦ Management of Risk
Infrastructure
and Governance
Shared
Hospital
Physician Partnership
◦ An aligned, long term collaborative relationship
Opportunity is overlooked by most people because
it is dressed in overalls and looks like work.
Thomas Edison
Engaging Hospitals and Physicians
Insights and Actions for Results

Integration
Clinical Clinical
Integration
◦ Embracing data transparency
◦ Implementing best practices
◦ Excel at Pay for Performance

Financial
Integration
Financial
Integration
◦ Enterprise-wide cost reduction
Infrastructure
and Governance
Shared
Hospital
Physician Partnership
◦ An aligned, long term collaborative relationship
Just when you think everything’s OK…
….You may find that…
When you're finished changing, you're finished.
Ben Franklin
The Meaning of Commitment
The Goal is to have Bacon and Eggs for Breakfast
The chicken is motivated.
The pig is committed !!
To the world you may be just one person,
But to one person you may just be the world.
Unknown