The U.S. healthcare system is fighting its way through the transition from fee-for-service (FFS) to value-based care. In an environment resembling controlled chaos, the healthcare industry has become unpredictable, as powerful mergers, influential acquisitions, and government mandates consistently shift the landscape and the rules. Adding to the difficulty, there is a palpable sense of urgency to get a handle on unsustainable healthcare spending, and physician networks across the country are trying to figure out how to achieve low-cost, high-quality care while remaining financially profitable. Here’s how the high-performing physician networks are getting it done.
In 2016, Athenahealth partnered with American economist and Harvard Business School professor Len Schlesinger to research, identify, and understand what drives the highest performing health systems, physician groups, and primary care physician organizations among Athenahealth’s nationwide database of 88,000 providers. What Schlesinger and the Athenahealth team uncovered is that top performers exemplify best practices of the service-profit chain management theory. This theory suggests that business profitability and growth are driven primarily by customer loyalty and that customer loyalty is a byproduct of customer satisfaction. Furthermore, customer satisfaction cannot exist without employee productivity, which is an outcome of employee loyalty and satisfaction. In other words, employee satisfaction, customer loyalty, business growth and profit are linked in a “reinforcing cycle of engagement” (Schlesinger, “Keeping…”).
When applying the service-profit chain theory to healthcare, the research team identified a capability cycle, similar to other service industry businesses, that is comprised of key attributes that top performers share and that are core to financial performance and clinical quality. These attributes align under three categories: physician and staff capability, patient capability, and leadership. Based on the success of their high-performers, the Athenahealth team established a “framework,” or approach, for healthcare organizations to adopt that focuses on engaging and enabling patients, physicians, and staff to do what they do best. This approach suggests that healthcare leaders should intentionally design and drive the development of physician, staff, and patient capabilities to engage and inspire people so they can perform at their best, in turn engaging and inspiring one another. Moreover, when physicians and staff are inspired, they will provide better patient experiences, and satisfied patients will motivate physicians and staff in a reinforcing capability cycle (Gray, “What Makes…”). The Athenahealth team has written extensively about their findings, which are cited below, offering specific examples of what their high-performing physician networks do to achieve success. Here’s an overview of how they excel in the capability cycle.
Physician and Staff Capability
High-performing physician networks help doctors and staff feel capable of delivering great care by creating sustainable workflows that allow physicians and staff to work at the top of their licenses. They engage in ongoing performance enhancements, providing resources and training to physicians and staff to facilitate continuous quality improvement. In addition, they foster a spirit of healthy competition by having a policy of radical transparency regarding performance data. While allowing for autonomy, high-performing networks set clear expectations for physicians and staff regarding quality thresholds, workflows, and processes, and these networks maintain accountability letting physicians and staff know if they are performing well or under-performing. Additionally, high-performing networks provide strategic incentives that align physician and staff compensation with quality and financial goals. When physician and staff capability improve, then so does engagement, satisfaction, and productivity, which has an enormous impact on patients.
High-performing networks focus on the total patient experience in population health, and they intentionally engage and activate patients in their own care by giving them the access and education to feel capable of succeeding at the “job of the patient.” High performers recognize that to gain patient loyalty, patients need easy access to and rapid response from their providers. Not only does every traditional touchpoint matter, but high-performers are intentional about providing multiple new channels for patient connections. The implementation of texts, patient portals, kiosks, mobile apps, virtual office visits, and remote monitoring involve patients in a higher level of collaboration and education, increasing patient satisfaction and loyalty. Furthermore, high-performing physician networks close care gaps. They are intentional about recognizing gaps in patient care and they are proactive in developing processes and solutions that improve patient capability and involvement, raising the level of quality care at every point along the care continuum.
Finally, high-performing physician networks have leadership capable of motivating physicians and staff with an inspiring purpose, a “galvanizing vision,” that drives every decision and the overall culture of the network. High-performers are relentless in communicating the vision, and they include and rely on input from clinically active physician leadership to make strategic organizational decisions. Leaders in high-performing physician networks understand that too much growth, too quickly, can create operational diseconomies of scale and cultural mismatch. Physician alignment and staff chemistry is essential, so acquiring new providers, staff, or organizations that are the wrong fit or too large for smooth integration may undermine the economic gains of consolidation and growth, so high-performing networks grow with specific and strategic intent. Finally, high-performing physician networks communicate and execute within defined accountability structures, intentionally empowering leaders to “own,” or be responsible for, achieving improvement in specific business and clinical goals.
In spite of the erratic healthcare climate, high-performing physician networks have found a way to succeed and thrive by intentionally focusing on physicians, staff, and patients, helping them to excel in their capabilities, thus linking them in a reinforcing cycle of engagement, satisfaction, loyalty, and purpose. By investing in this “capability cycle” approach, high-performing networks are able to increase business profitability and growth, achieve low-cost, high-quality care, and position themselves for the transition to value-based care.
APEX is a High-Performance Collaborative Physician Network comprised of independent specialists working together to improve outcomes and reduce the overall cost of healthcare in the United States.
Bush, Jonathan. “Do What High-Performing Physician Networks Do: Make More Money.” HealthcareITNews.com. February 14, 2017. https://www.healthcareitnews.com/news/do-what-high-performing-physician-networks-do-make-more-money
Clain, David and Lia Novotny. “5 Leadership Attributes of High Performers.”
Athenainsight.com. June 16, 2017. https://www.athenahealth.com/insight/5-leadership-attributes-high-performers
—. “4 Patient Capability Attributes of High Performers.” Athenainsight.com. June 16, 2017. https://www.athenahealth.com/insight/4-patient-capability-attributes-high-performers
— “4 Staff Capability Attributes of High Performers.” Athenainsight.com. June 17, 2017. https://www.athenahealth.com/insight/4-staff-capability-attributes-high-performers-0
Gray, Josh. “What Does it Take to Achieve Quality?” Athenainsight.com. March 28, 2017. https://www.athenahealth.com/insight/what-does-it-take-achieve-quality
—. “What Makes a Physician Network High-Performing?” Athenainsight.com. January 20, 2017. https://www.athenahealth.com/insight/high-performing-physician-network
Schlesinger, Len. “Designing the ‘Job of the Patient’.” Athenainsight.com. June 21, 2017. https://www.athenahealth.com/insight/designing-job-patient
—. “Keeping the Turbulence out of Healthcare.” Athenainsight.com. February 7, 2017. https://www.athenahealth.com/insight/theory-healthcare-service-profit-chain