Guest post by Christine Mackey-Ross

This is my third post based on my recent interview with two noted physician executives—John B. Chessare, MD, President and CEO, Greater Baltimore Medical Center (GBMC), and S. Rockwell Fredrickson, MD, President and managing director of physician integration of Integris Physicians Services (IPS) in Oklahoma City—about U.S. health care’s move toward Accountable Care Organizations (ACOs). In previous posts, I’ve shared the plans their organizations were formulating and their opinions on the skills physicians will need in order to lead in this evolving health care environment.

In this last posting, I’ll pass on what they said about the importance of electronic health records (HER). I asked them whether or not we’ll see one HER system.

Dr. Frederickson summed the situation up well. “The proprietary companies that created these systems have done so with the purpose of becoming proprietary—and not open source—so they can make more money,” he said. “There will be commercial products that act as interface between systems. It’s all a work in progress, and it’s not pretty.”

Dr. Chessare holds out some hope. “My hope is that the technology will be less about the venue and more about pressure in the market to make things friendlier for physicians,” he said. “I’m not sure there is a perfect system. I think the real issue is to get it out there, get it in use, and have a rich dialogue with clinicians about how we are using the new capabilities to integrate care for patients.”

Given the challenges ahead, both doctors are excited about change and progress. “I personally think this is the greatest time to be in health care in the last 30 years,” said Dr. Frederickson. This is a tremendous opportunity for physician executives, and I also think it’s going to be a lot of fun.” 

Guest blog by Christine Mackey-Ross

Not long ago, I interviewed two noted physician executives—John B. Chessare, MD, President and CEO, Greater Baltimore Medical Center (GBMC), and S. Rockwell Fredrickson, MD, President and managing director of physician integration of Integris Physicians Services (IPS) in Oklahoma City—about U.S. health care’s move toward Accountable Care Organizations (ACOs). I shared the plans their organizations were formulating in a recent post.

They also had some strong opinions on the skills physicians will need in order to lead in this evolving health care environment. Here’s some of what they had to say:

Dr. Chessare pointed out that realigning our organizations to serve a new health care model is not only about physicians. “It will be aligning chief financial officers, CEOs, physicians, everyone,” he said, “because the transition from transaction-based medicine to ACOs is really about integrating care.”

What is the real trick? According to Dr. Chessare, it will be getting physicians to work together toward a unified goal of doing right by the patient—and doing well financially.

Smart systems invest in people

Dr. Frederickson added that smart health care systems will invest in human capital. “We know there is a primary care shortage,” he said, “and there will be shortages in other specialties. There is a price war in the market as systems buy up primary care physicians.” And those physicians will need a much higher degree of management skills.

Dr. Chessare agreed that people will be the key for systems that succeed. Not just physicians, though. “I see bringing people together of varied capabilities and training,” he said. “So you need a physician that understands care delivery; people who understand finance; people with rich operational knowledge; nurses who understand nursing at a granular level. It’s not that every individual has to have every skill, but every individual has to be able to collaborate.”

To practice or not?

Should physician executives still practice? Drs. Chessare and Frederickson disagreed. “If I had my druthers, I would still have doctors participating in care,” said Dr. Chessare.

“Quite frankly, I think the physician executive job is so complex that practicing is a detractor as opposed to being something that would be beneficial,” said Dr. Frederickson.

The doctors agreed that the bottom line in the world of ACOs is this: We need great physician leaders who are great accountability drivers and collaborators.

Guest blog by Lucy Apthorp Leske

Today’s challenged economy places extraordinary demands on campus leadership—and it is equally demanding of search processes. More academic institutions are announcing leadership hires without national searches. Is the calculus on internal candidates and length of searches changing, or is this simply a product of the times?

The costs of an external search include not just direct expenses but also the costs of delays in making key decisions and the risk of a poor fit between an external candidate and the hiring institution.

Then there are the add-on costs of distant candidates to factor in. Geographic mobility is at its lowest since World War II. Adding a trailing partner or spouse to a new job market, maintaining a home that may not sell immediately and exchanging the known for the unknown can de-motivate potential candidates from accepting an offer—or even entering the pool—for a job that requires relocation.

On the other hand, an internal candidate knows the issues and can anticipate how to go about addressing them. He or she will ride a much shallower, swifter cultural learning curve. And if he or she has already demonstrated significant leadership within the institution, an internal appointment can represent continuity and stability.

Hiding in plain sight

Internal succession is a new concept for higher education, but one that is gaining ground. Boards and presidents have recognized that successfully working within governance cultures to shorten the search process by appointing internal candidates is a viable model for leadership transition if key conditions are met. Avoiding any appearance of an inside track can compromise a new leader’s effectiveness, so communication and transparency are essential.

Of course, it helps to have highly competent individuals in the organization who are prepared for broader leadership roles and who are interested in greater responsibilities. Boards and presidents are wise to have leadership transition plans in place across the institution that include criteria and processes for preparing, evaluating and considering internal candidates. The goal: to increase the likelihood that they will see the solution hiding in plain sight.

Guest blog by Christine Mackey-Ross

The move toward Accountable Care Organizations (ACOs) is in full swing. Health care leaders are considering a variety of approaches to realigning or even reconceiving existing organizations to fit new models. I recently interviewed two noted physician executives—John B. Chessare, MD, President and CEO, Greater Baltimore Medical Center (GBMC), and S. Rockwell Fredrickson, MD, President and managing director of physician integration of Integris Physicians Services (IPS) in Oklahoma City—to gain their insights.

In this post, I’ll share their thinking on how their own organizations plan to thrive in this new world.

One seismic shift, two approaches to change

Drs. Chessare and Fredrickson both acknowledged the enormous challenge of transforming from a hospital-centric to a patient-centric model of care. But their organizations’ approaches to change are distinctly different.

“My organization is hospital-centric,” said Dr. Chessare. “We own a 40-FTE primary care physician company, and another 200 primary care doctors work with our hospital at varying levels of alignment. One of our first steps is to figure out the best model to get all of them linked in.”

According to Dr. Chessare, GBMC is transforming its employed model, making its primary care sites better able to accept risk. The medical center’s goal is to be ready to sign up as a level-one ACO this year and be prepared for operations by the beginning of 2012.

In Oklahoma City, on the other hand, IPS plans to offer an independent, rather than employee-only, model in a clinical integration system. But, he cautioned, integrated delivery systems aren’t guaranteed success as ACOs, because integrated delivery systems are not always integrated.

“Physicians are the key to the ACO,” he said. “They can contract the services; they can get the payment and coordinate care in an ambulatory setting. If a patient needs to be hospitalized, they can do that through contractual means. This is going to be an ambulatory-centered world with the patient at the center of care.”

A patient-centric model of care

Both doctors agreed that U.S. health care is moving toward a patient-centric model of care. “We have to make a giant leap from one business model—a transactional, volume-based system—to one of performance-based, bundled care,” said Dr. Frederickson.