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Determining if a Service Line is a Candidate for Co-management: 10 Questions to Ask


There are many physician alignment tools being deployed by small and large organizations to address a variety of market forces and enhance organizational effectiveness. How can a hospital determine if co-management is the right remedy for the symptoms that need to be addressed? The following ten questions provide clues to assess whether co-management is worth evaluating further and pursuing for one or more clinical service lines. If the service line is currently experiencing five or more of the ten issues highlighted below, then co-management can be used effectively to achieve substantive change in areas of operational and brand importance.

1. Is the organization looking to align closer with physicians but must overcome physician mistrust towards the administration/management team? A co-management arrangement can address physician mistrust by creating a level playing field with administration in identifying a vision for the future, deciding which goals are the right ones for the service line, and determining together, with transparency, on how to accomplish them.

2. Is the management team struggling with getting physicians to partner in developing consistent care protocols and metrics? A co-management structure creates a platform for comprehensive service line planning. An integral part of the physician responsibilities as part of a co-management arrangement is the development of a unified approach to how care will be provided in order to improve the quality of care while being cost effective, and therefore increasing value.

3. Do the physicians feel that they have been excluded from leadership roles and the ability to influence service line decision-making? Traditional alignment models have had the flaw of creating a small number of leadership positions that while incentivizing the physicians selected for those roles have also had the effect of alienating some or even all of the other service line physicians. Comanagement has a role for everyone who is willing to put in the time. It still provides an avenue for those physicians that are willing and able to spend more time on administrative duties, but provides a vehicle that encourages a much broader group of clinicians to be involved. The compensation structure rewards engagement and participation, leading to more "our" thinking.

4. Is there concern about how to recognize and develop service line physician champions from the cadre of physicians? Co-management requires physicians to participate and commit their time and intellectual capital. As such, it is a testing ground for all participating physicians to flex their planning and problem-solving muscles, and therefore allows for the physicians with the most aptitude for these roles to stand out. It could be surprising who steps into leadership roles – it might not be the old guard that traditionally is called on to lead.

5. Is there a current climate of "siloed" thinking (individual physicians or groups focused on their own practices) that is keeping the hospital from developing needed niche programs and offerings? Although hospital administrators may view a service line as one entity, it is often made up of smaller subsets that may not be aligned in how they are thinking or acting. A common opportunity cost is that "the parts" never accomplish all that "the whole" could if it worked in a more cohesive fashion. For example, the development of a transcatheter aortic valve replacement program requires a multidisciplinary team of cardiac surgeons and cardiologists. Co-management can break down the walls of the silos that have existed and allow for development of subspecialty programs and offerings that leverage the capabilities of the entire service line rather than just one group or a subset of all service line physicians.

6. Do any of the key service lines lack a unifying vision for physicians, staff, and management to rally around and plan for the future? One of the critical steps of forming a co-management structure is the development of a vision for the service line. It helps ensure recognition that the physicians are "on the same page" as their physician colleagues and hospital administration in terms of both the current state of the clinical service as well as a desired future state.

7. Does the hospital lack the ability to align incentives in order to achieve improved operational efficiencies? Co-management requires the development of metrics that will be tracked to assess whether the management entity has performed the duties they have been contracted to perform. The development of the metrics are a way of ensuring that significant progress is achieved each review period and to provide compensation in addition to the base management fees paid when expected performance is met or exceeded.

8. Are difficult capital expense decisions expected in the near future that could alienate service line physicians if not properly communicated? As previously mentioned, co-management allows for participating physicians to be involved in setting the vision, goals, and strategies for a service line. The next step is deciding between the different approaches that would help achieve the vision and goals. In doing so, physicians are involved in deciding between the capital expense choices that they may have previously seen as capricious decisions made solely by administration.

9. Is the organization considering bundling but lacks the platform to make it possible? Since comanagement is a structure that allows for more cohesive service line planning and is a platform for building trust and developing a consistent care approach, it can be the platform for implementing new payment models, such as bundled payment. As governmental and private payers consider new payment models that require performance improvement across a continuum of care, such as episode of care payments or shared savings, organizations that have a history of co-management and a structure that can organize a joint physician-hospital response are in a much better position to be successful.

10. Do quality outcomes need to improve in order to demonstrate market leadership in providing value to the patients/payers? A key element of co-management is the improvement of care quality and service provided to every patient. When compared to the more traditional approaches to alignment, co-management stands out in terms of the focus on the care elements that impact a patient's outcome, the metrics that will measure whether substantive progress has been made, and the financial benefits to make such progress properly incentivized.

For more information on determining whether a co-management structure is the right choice for a service line and implementing co-management arrangements, please contact Mr. Panos Lykidis at 310.320.3990, x 3958 or plykidis@thecamdengroup.com.