Resolve misconceptions about downside risk. It’s important to identify and work through any barriers before asking physicians to take on additional risk. Historically, risk contracts were driven by physician practice management companies that were topline valued on Wall Street and focused on aggregating as much at risk revenue as possible to show growth. These companies didn’t invest in the infrastructure and were not a long-term success. Savvy and experienced physician leaders carry the memory of failures past and will likely view any attempts to quickly shift to downside risk with a healthy dose of skepticism. Today, however, there are foundational differences that are helping physicians succeed at downside risk. For one, access to actionable data is revealing trouble spots and helping physicians understand early on whether or not a contract is performing.
Make physician leaders an integral part of governance. Ultimately, nothing is ordered or purchased in healthcare without a physician order. The governance structure should allow for genuine ownership by physician leaders and they should take the lead on driving clinical workflows that support downside risk. There must be transparency between the organization and physician leaders who should have access to thoughtful and precise information about risk stratifying populations, including correct funding and cost allocations related to physician performance under risk. These leaders must be disciplined and constantly looking at high level population data to individual physician performance to set expectations and take action.
Give physicians access to tailored information. One common problem across healthcare organizations is a failure to take the time to deliver consistent, usable information about physician performance. Physicians are driven by facts, thus they must believe the data you share is data worth using if they are to be held accountable for performance. A yearly report card is insufficient. Physicians under downside risk require daily, weekly, and monthly reviews on individual performance as well as benchmarking data. The most critical factor in having credibility with physicians is giving them the ability to drill down to the granular details of specific cases that drove an outcome that was outside of the norm. If you want to be viewed as a trusted source of information, physicians need to see that you are not just broad brushing performance.
Identify problems early on. It’s also important to partner with physicians and quickly expose key issues. Potential problems include specialist rates or an inadequate network that is driving patients to receive care in less optimal environments such as the ER. There must be a line of sight back to physician leaders. When you give physicians precise information on what is happening now, what has happened before, and what needs to happen next, you will have strong and willing partners who drive better outcomes.
Ease administrative burdens. I hear a lot about physicians being taxed by administrative burdens. Physicians and their staffs should be treated like customers. You do this by making sure their basic needs are met. Physicians should have timely and accurate pay, smooth authorization processes, and supportive case management. As a result, you can gain their affinity to drive better healthcare outcomes.
Communicate about value. Physicians are more likely to respond to consistent discussions on how to practice from a value perspective (cost, quality and access), rather than a top-down punitive approach to improving performance under downside risk. The corrective action process should include support and education to help physicians understand underlying variations within their control. You must show them the data and strategies that will help them remove barriers to success.