Physician Engagement Presentation

1. Physician Engagement
What's Your Role
Jeff Brickman
Brian Nester
Andrea Simon
Kriss Barlow, Facilitator

2. Agenda
• Defining physician engagement
• Framework: trends in our world and the market
• Methods and models
• The physician’s view
• Tactical implementation
– Needs for a successful organization
– Cultivating relationships
– Marketing’s role
– Evolving relationship strategy

3. Healthcare Revolves Around Physicians
Opening line…
“The words “alignment” and
“coordination” have been tossed
about as the government and
the healthcare industry wrestle to
provide more value for every
healthcare dollar spent. Under
those words, every strategy to fix
the problem revolves around one
thing: physicians.”
HealthLeader's Media Breakthroughs. Aligning Hospitals and Physicians toward Value.
Dec. 2009. In collaboration with PricewaterhouseCoopers.

4. Leader Defined Physician Engagement
• Healthcare Revolves around Physicians
• Health System moving from System focused
on volume to system based on value
• To be successful every strategy to adapt to
this new reality revolves around one thing:
• Physicians

5. Leader Defined Physician Engagement
• Physician leadership engagement needed
to:
• Redesign existing processes of care to improve
efficiency
• Integrate physician thought leadership in market
based strategies to address needs
• Address supply chain initiatives
• Align financial and strategic incentives to address
population needs

6. The Physician Conundrum
■ I’m 55 years old…I lost it all
• “SEP?, 401?...I have my real estate”
■ I’m 40 years old…how do I get out of this
• Is it too late to change careers
■ I’m 32 years old…what have I done
• My student loan payment will outlast my jeans

7. Clinical Integration - after decades of FFS, let’s get
Doctors & Hospitals to work together
Yeah, Right !

8. Understand the physician
network in your market
■ Who are the influencers?
• Formal (Med Staff President) and Informal (Respected
Clinician)
■ Confederations or onesy-twosy?
• Size matters
■ Is there an IPA?
• Functional? Aggregator? Contracting Experience?
■ Is there a PHO?
• Viable? What’s the history? Raise from the dead?

9. “Marketing Defined” Physician Engagement
But Engage Which Doctors?

10. And for Which Hospital?

11. How are the doctors organized?
 In a group practice?
 A PHO?
 Were they bought by the
hospital?
 Employed by the hospital?
 Or are they solo practitioners?

12. How do you know?
Not
Fully Engaged?
Engaged?
Engaged?
Actively
Disengaged?

13. Market Expectations and
Realities

14. Engagement at a Market
Levelexpects better alignment, shared payment and transparency. What
The market
can we learn from the data?
• 75-85% of the decisions that drive quality and cost are
determined by physicians
• Malpractice and manpower shortages concern doctors
• Margins from private payers have barely covered the
negative, payment to cost ratios from Medicare and Medicaid
• Alternative income sources are scrutinized and disallowed

15. And for Hospitals…
• 25% of community hospitals have had
negative operating margins
• Mounting regulatory requirements
• Technology upgrades
• Utilization is steady but rates for days have
declined
• Cherry picking by free standing facilities

16. Why does it matter?
 Changing business environment
 Demographic shifts
 Patient Changes in expectations
 Financial Challenges for healthcare
institutions
 Financial Challenges for physicians and
ambulatory centers
Plain Old Change!!

17. By 2011, Gallup research…
 Shows how it matters.
 Reported a drop of 5 percent in the
number of physicians who are fully
engaged.
 An increase of about 10 percent in
the actively disengaged.
 Worries about the impact of value-
based purchasing, and changing
reimbursement and incentives.

18. Engagement matters
 Gallup reported at one health system,
outpatient volume increased +17.5
for engaged physicians in the top
quartile for improved engagement.
 Disengaged physicians in the bottom
quartile, their outpatient volume
declined -11.7%.

19. Morehead research
 Morehead has found some association
between high-performing hospitals and
physician engagement.
 “Typically, when we see physician
engagement move, we see other important
metrics move,” Morton said. “Physician
engagement is the lynchpin of many
strategies in the organization, and without it,
[those strategies] will not happen.”
 Morehead reported a shift in balance, with
physicians treated less as customers and
more like partners in patient care.

20. Will I know it when I “feel” it?
 How do you know an “engaged” physician
from a “fully” engaged physician?
 Is it shifting or constant?
 Is it situational?
 Do they have linguistic or body language
that tells you?
 Will you know what to look for? How to feel
it?

21. How are you engaging with your physicians?
 Share with us some of the ways you might be
building an engagement strategy today?
 What kinds of experiences?
 Communications strategies?
 “Feeling” opportunities?
 By whom?

22. This is work!
WHY IS “ENGAGEMENT”
SO CHALLENGING?

23. All about our Brain and our Culture
 Brain Hates  Culture Binds
Change You Together
23

24. When you are getting “engaged”
 It is like a new role you must play
 Think about what you will:
 Do more of?
 Do less of?
 Start?
 Stop?
 Never Change?

25. Models and Methods
Physician arrangements
Choosing the model
Understanding cause and effect

26. Business Imperatives Yesterday & Tomorrow
■ Yesterday (FFS)
– Aligned Physicians (heart-strings)
• Referrals to hospital & ancillary services
• Referrals to aligned specialists
■ Tomorrow (Value-based reimbursement)
– Aligned Physician Network (business rationale)
• Principally primary care
• Shared savings

27. High
Splitters
1,200 docs
• Brian, add your slides here to address the he
physician arrangements and business
strategies100% Alignedat alignment
Private Practice aimed
• Management Services
Business models and degree of800 docs
alignment risk
Agreement physician and the hospital
for the
CCIA
Lease
Employment
Low
High Low

28. Physician Arrangements: Characteristics
■ Employment (Married)
– High control and low risk (?)
■ Lease (Long Engagement)
– Hospital TIN, CI, Exclusivity
■ CCIA (Going Steady & Serious)
– Stipends ($$$), CI, Exclusivity
■ MSA/PSA (Dating)
– Stipends ($), CI

30. PHYSICIAN ENGAGEMENT – CHANGE
IN CULTURE
Hospital – Centered → Physician - centric
• Redefined Senior Team’s Focus to Physician
Based Initiatives
• Redefined mid-level interactions
• Restructured physician liaison focus
• Changed leadership structure to focus on
physician intel and alignment priorities

31. Structured for Organizational Success
• Leadership Goals established
• Growth Council
• Growth Reports
• Service lines established
• Physician leaders created
• Physician sales retrained and expanded

32. Tracking Physician Engagement
E
ATIV
NTIT
QUA Target List: Physician loyalty trending
• Volume
• Revenue
• Payor Mix
• Surgery vs. Medicine (or desired case types)
• Elective vs. ED
• Quality
 Order Set compliance; Morbidity/Mortality; Infection Rate; ED
Call coverage
• Efficiencies/”Workshop” Improvements
 CMI; Cost per Case; Supply Compliance;
On-time Starts
• Hospitalist &/or Specialist referrals
• Ancillary utilization
• Program participation/Leadership roles
• Competitor share (splitting)

33. Tracking Physician Engagement

34. Tracking Physician Engagement
• Weekly Sales Summary report
• Competitive Intelligence (≠problem collection)
E
ATIV
QU ALIT • New skills/credentials/interest
• Revenue streams (equipment; screenings)
• Real estate (renewals, leases, investments)
• Competitor-created “opportunities”
• Referral source changes
• Practice ownership/mgt. changes
• Payor plays (HMOs, PHOs…)

35. Tracking Physician Engagement

36. Let’ s take a look: Case Study
How Doctors Engage & How
to Engage Doctors

37. Situation
 Hurley Medical Center in Flint, MI
 Opportunity to build a physician services
approach to engage physicians from a
region in the growth of a hospital.
 Two competitors in the local area: Genesys
and McLaren
 And, not far away, many major medical
centers intent on drawing patients from the
region.

38. First We went Exploring
 Listened to their Stories
 Ethnographic approach
 Narratives tell you what surveys cannot
 And building it from the doctor backward, not
the hospital outward.

39. What did we hear?
 Stories about how the other hospitals
treated them.
 How the other PHO made it a
financial “sin” to refer elsewhere.
 How they were closely tied to the
other hospital and thought it was
unnecessary to go elsewhere.
 Had self-selected to belong to the
other institutions.

40. On the other hand…
 For Hurley, we had to listen better!
 This hospitals treated the doctors differently,
in the voice of the doctors.
 Hurley had to work on service issues and
concerns with the future investments of the
hospital.
 IT
 Medical Records / Patient Charts
Transcription Services
 Nursing
 Equipment/Technology

41. What were we going to do?
 Engage!
 Bring the doctors into the hospital differently.
 What could we do to help them?
 Not us!

42. Emotions matter
 Shared values, beliefs and behaviors create
active culture—which makes us humans.
 We buy with emotions and justify with logic.
 This was a great deal about how the doctors
“Felt.”
 The problems seemed functional.
 The reality was very emotional.

43. Functional changes
 CEO visits
 New technology and a new Emergency
Department
 New Electronic Medical Records, Heavy
Physician involvement.
 Physician Leadership engaged
 Engagement in the Strategic Process

44. Emotional Changes
 Launched a new physician services program to
change the way it felt to be part of the hospital.
 Shifting from service recovery approach to a support
and practice development approach.
 Key: “what do you, doctor, need and how do we help
you?”
 What will enhance your reputation?
 TISP: Trusted, Important, Special and Pleased

45. Marketing
 What can you do to help them grow their
practices and in turn, your services?
 What can you hold in their offices or for their
patients?
 How can you attract more patients with and
for them?
 How do they help tell your story and how
does it help them tell theirs?
 All within regulatory environment?
 Then we Measured.

46. All about “Beliefs”
 What you “Believe is What you Will See!”
46

47. What Does it Mean for Me?
Obligation
Implementation
What works, what doesn’t

48. Successful Engaged Organization of the
Future
• Move to greater integration of physician
leadership in governance
• Physician Enterprise
• Employed Physicians
• Independent Physicians
• Align Financial & Strategic Interests
• Focused on Meeting needs of
Population, Local Businesses & Payors

49. Successful Engaged Organization of the
Future
• Collaboration & Integrated Decision Making
• Elevate Physician Leadership in
organizational Role to
• Improve Quality & Safety
• Improve Efficiency
• Redesign Patient Processes of care across
continuum

50. Change In Leadership Expectations
• Leadership Development of Physicians
• Greater Integration of Physicians in
Designing & Managing “Second Curve” of
Health Care
• Sharing of Leadership
• Change in Focus on Value
• Cost
• Quality
• Convenience
• Service

51. Tactical Organizational
Commitments
■ Dedicated resources
– MOST
Liaisons IMPORTANT:
– Clout (VP) Know the vision
for your
– Physician leadership organization and
what it needs to
– Market intelligence accomplish with
its physician
– Business analysts base.
– Relationship with finance

52. Brutal Fact #1
Revenue
Maximization is
nearly “dead”

53. Revenue Outlook
Operating Margins
will suffer
Risk Based
Revenue
TODAY TOMORROW

54. Volume-to-Value
■ “Pay-per-Click / Hamster wheel Transactionism moves to
Population Health and Payment for Outcomes”
Decades of (perverse) FFS incentives leave hospitals and physicians
ill-prepared for a necessary economic/reimbursement paradigm shift
Quality (Q)
Value (V) =
Cost (C)

55. Accountability – there
must be a good
political solution
NOT !

56. Balancing Relationships
 Engaging physicians as “vital partners”
 These are changing times.
 Can we partner our way forward?

57. Physician Services and Marketing
“4 I’s”
1.Insight: Come from listening to our physicians and
their customers?
2.Innovation: Add value in innovative ways.
3.Integrating: Let’s not sell the factory. Let’s integrate
with our physicians and our customers so together we
do better.
4.Implementation: Execution wins!

58. Tactically that means…
 Different ways to listen and act together.
 Leadership involvement and broader
empowerment.
 Outreach Program/Coordinators
transformed from liaisons and problem
solvers to relationship builders.
 What do the physicians need, not what
can we sell them?

59. Tactical Plans cont’d.
 How do we help them by sharing and
educating on changes.
 Communications are changing, have we
changed ours—while sustaining those for
older physicians and using new ones for
younger ones. Text versus fax?
 How does social media and mobile
applications tie us together.
 Data. Who has it? How do we use it? How
do we think about it?

60. Model might look like this…
Physician Services Outreach
Programs
Physician Needs and
Hospital Needs and Priorities
Priorities •More Patients
•More Patients •More Revenue
•More Revenue Patient •More Collaboration
•More cross-selling Relationships •More Hospital
and Referrals
of services
•More Quality Satisfaction •More Resources
•More Referrals Increase •More Back Office
•More Services Support
•More Technology •More Technology
More Revenue for Both
Doctors and Hospitals

61. Tactical Implementation

62. Growing What You Need
Have a plan: Recruitment and Retention
•You can’t wait and don’t always want those that come to you.
•Onboarding is your chance to learn their expectations of
engagement
•Don’t wait until they arrive. Plan and define the handoff. It is
easier to keep business than to grow new. Tend to your most
loyal.
– Remember they love you enough to whine
– Respect their level of connection

63. Physician Relations
• Think outside the hospital
• Seek new information
• Internal obligation to define the physician business
strategy
– Market softening
– Validation
– Pure intelligence
– Optimal experience
– Earned growth in clinical area

64. What Credentials Do Doctors Find Most
Important in a Physician Relations Rep?

65. The Right Level of Impact
• What do doctors want?
– How do you earn value?
– How do you reinforce this?
• What do leaders want?
• What do you want?

66. How Helpful Do Doctors Find the Topics the
Physician Liaison Discusses With Them?

67. Vision
• Can’t live in limbo
• Create the vision for today
and follow with a plan, but
be nimble
• Talk about their vision

68. Engaged and at Your Peak
• What does “engaged performance ”look like?
• What did you do within the last week that
demonstrated your work to better engage your
medical staff?
– Qualitative
– Quantitative
• What can you do to achieve this level with more
consistency?

69. Your Observations and Questions
• Surprises?
• Obligations
• Topics still open
• Comments

70. “Peak performers develop powerful
mental images of the behavior
that will lead to the desired results.
They see in their mind’s eye
the result they want, and
the actions leading to it.”
- Charles A. Garfield

71. Thanks!
Jeff, Brian, Andi and Kriss
Kriss Barlow RN, MBA
Principal
651 Old Hwy 35 South
Hudson, WI 54016
(715) 381-1171
kbarlow@barlowmccarthy.com