Through healthcare reform, payment modifications, transparency, and a renewed focus on value, the healthcare industry is changing its organizational structure from one of a multitude of individual entities to one of a system-of-care model. This restructuring and subsequent alignment of information presents new risks and opportunities for physicians, hospitals, and other healthcare providers.
Emphasizing effective interactions between physicians and the health system, Physician Alignment: Constructing Viable Roadmaps for the Future examines the different ways physicians and hospitals can create systems to not only survive, but thrive through the changes facing healthcare. It draws on experienced authors in the area of physician purchasing to explain the various integrative models for physicians and hospitals.
- Provides an accessible introduction to the different types of healthcare delivery models
- Covers the various types of integration—starting with the simplest and evolving into full employment models with full integration
- Includes helpful information for doctors considering a transition to physician employment
- Highlights emerging trends in healthcare
Explaining how these systems should be constructed and aligned, the book provides healthcare organizations with a roadmap for planning for the future. The book concludes with a chapter on accountable care organizations and patient-centered medical homes that moves from the conceptual to administrative embodiments of the principles of an integrated health system as we now know it.
Table of Contents
Introduction: How We Got Here
Overview of the Future
Physician and Hospital Trust
Traditional Integration Models
Revenue of the Acronyms: Co-management, IPA, and PHO Integration Structure
Clinical Co-management: Share the Gain
The Independent Practitioners Association: How Exclusive Is the Club?
The Physician Hospital Organization: Venus and Mars Form a Company
What Is Old Is New: Employment
Changing World: Making the Decision
Physician Employment Agreements
From the Physician Side
From the Hospital Side
It Is All About Integration
Physician Service Agreements
Physician Payment Models
Appendix: Cultural Assessment Tool
What Is Clinical Integration?
Legal Limitations to Integration
Accountable Care Organizations and the Patient-Centered Medical Home
Accountable Care Organizations
Patient-Centered Medical Home
How Doctors Want to Be Paid for Providing a Medical Home
Assessing Your Current Alignment Strategy
Examples of Systems Strategic Alignment Initiatives
Methodist Le Bonheur; William Breen , Jr.
Putting It All Together: Full Integration
Blurring of Boundaries
Health versus Healthcare
Demographic and Environmental Factors
Metrics and Transparency
George Mayzell, MD, MBA, FACP, FACHE, is a board-certified internist and geriatrician with over 10 years of patient care experience and over 19 years of administrative health industry experience. Dr. Mayzell assumed the role of chief executive officer of Health Choice, LLC, in November 2010. Health Choice is one of the mid-South’s leading physician hospital organizations, serving the needs of more than 518,000 health plan members through contracts with over 100 employers, insurance companies, and third-party administrators and 1500 physicians through Metro Care Physicians. One of his recent projects is to create an accountable care partnership and an innovative system of patient-focused care.
Previously, Dr. Mayzell was senior vice president and chief patient care officer at Methodist Le Bonheur Healthcare. Methodist is a seven-hospital system with over 1600 licensed beds in Memphis, Tennessee. He was responsible for patient care operations and oversight of regulatory readiness for the system. He also served as chief medical officer (CMO) for Methodist Germantown Hospital. In addition to being a past faculty member at the University of Florida, Dr. Mayzell worked at Blue Cross Blue Shield of Florida, where he was directly involved with medical management activities, including disease management, utilization review, appeals and grievances, case management, pharmacy benefits, pay for performance, and Medicare risk. Dr. Mayzell received his medical degree from New Jersey Medical and his MBA from Jacksonville University. He is the author of Leveraging Lean in Healthcare (CRC Press, 2011).
William R. (Bill) Breen Jr. has over 25 years experience in healthcare network leadership and relationship management. Bill worked at a large insurer from 1984 to 1991, building networks of physicians and hospitals to support managed care contracting. In 1991, he joined Methodist Healthcare in Memphis, Tennessee, to help lead a growing managed care network (Health Choice) that Methodist had built several years earlier. Bill rose to be the chief executive officer (CEO) of Health Choice in 1997 and assisted it through a reorganization as a full hospital/physician joint venture. During his tenure, the network grew to be the commercial market share leader in Memphis and developed numerous payer partnerships that benefitted the hospital system and over 1200 physicians. He also led the development of services to aligned physicians that improved physician practice operations and loyalty to the health system. Bill now serves as the senior vice president of physician alignment for Methodist Le Bonheur Healthcare and is responsible for implementing and managing physician alignment activities for the system and remains as a board member of the physician-hospital organization (PHO). Bill has a bachelor’s degree from the University of Louisville and a master’s in business administration from the University of Memphis. He has achieved his fellowship in the American College of Healthcare Executives (ACHE) and is a certified medical practice executive in the Medical Group Management Association (MGMA).
As one who participates in medical school and health system administration, I recommend this volume for its emphasis on understanding and creating the health system of the future.
—David Stern, MD, Executive Dean, Vice Chancellor of Clinical Affairs, UT College of Medicine