Engaging physicians in your value-based care journey

By Laura P Jacobs,
Vizient Senior Advisor, Consulting

The critical importance of physician leadership, involvement and support in an organization's value-based care (VBC) journey is well-known and much discussed. Yet in these times of staffing shortages and physician burnout, it's an enormous challenge to make the idea of more change, responsibility and, yes, more meetings, appealing to even the most stalwart VBC supporters.

With the success of any VBC strategy on the line, it is imperative that organizations continually address the factors that may create reasons for disengagement while reinforcing the positive aspects of achieving the goals of VBC. In most cases, physician engagement is affected by how VBC activities impact:

• Patient care and clinical decision-making
• Physicians' time
• Sense of control (or lack of it)
• Compensation and available financial resources

Here are some issues that your organization may need to confront to create a positive culture for VBC transformation. Many of these factors are interrelated, so consider how changes in one area may impact another.

Make patient care and outcomes better

While the vision of VBC is to achieve the quadruple aim — greater affordability, better patient experience, healthier populations and increased clinician satisfaction — physicians can feel like there is too much focus on the financial aspects. They want to deliver better care for their patients, so the VBC effort must include care transformation efforts that optimize the physician's role. It goes without saying — but should be emphasized, regardless — that care transformation activities must be driven by clinicians and their team members.

For example, assure clarity around the roles of each member of the care team, their respective responsibilities and authority levels. Determine what actions require physician approval and which do not once protocols have been established. Also, streamline communication processes such as making referrals simple, facilitating primary care/specialty/hospitalist communication, and eliminating unnecessary emails and alerts.

Through affordable care organizations (ACO), independent physician associations (IPA) or clinically integrated network (CIN) quality committees, physicians must lead the design of quality metrics and reporting based on payer requirements and organizational standards for patient experience and outcomes. Spend the time and money to assure reporting is accurate and meaningful — if not perfect. Transparency, communication and feedback loops are critical. Physicians will disregard analytics that no one acts on, are inconsistent or grossly inaccurate, or seem irrelevant. Regular and frequent education and feedback forums to discuss both organizational outcomes and individual performance are key.

Optimize physicians' time

One of the unintended frustrations that VBC initiatives can create is the additional tasks added to the physician's day with more detailed documentation requirements, use of virtual tools and additional meetings. Care redesign initiatives must take this into consideration and seek processes that optimize technology/EMR templates, identify tasks that care team members can do to offload activities that don't require physician input, and centralize functions that can reduce office "buzz." Consider streamlined ways to handle emails from patients and virtual visits so that physicians aren't interrupted with multiple types of patient interactions. Simplifying processes in the clinic can decrease stress levels and create a better working environment for the entire care team.

Meetings are a necessary "evil" of management, including VBC, and it is important that physicians have a seat at the table for most aspects of VBC transformation. For the benefit of everyone, consider a self-review of meeting effectiveness, meeting schedules and meeting assignments. Do the same five physicians participate in most committees? Do meetings go on for hours and revisit decisions from prior meetings? Assure that chairs have support and training on setting agendas and leading effective meetings. Eliminate unnecessary or redundant committees or meetings that rehash the same issues without resolution.

Empower physician decision-making and leadership

Most health systems engage physicians in decision-making throughout the organization, but often the focus is on clinical issues alone. VBC requires a physician-management partnership that integrates the clinical, operating and financial models. The governance structure of ACOs and CINs must be physician-led, but it also requires a mutual respect between the clinical and administrative leaders to co-create a successful strategy. Active physician participation on all committees, including payer strategy and financial performance, facilitates a broader understanding of how all elements of VBC interact. The clinical-administrative partnership must be felt at all levels of the organization. For example, often the role of physician clinic leaders is considered a weak spot because their role in physician performance management and communication is unclear or not supported.

Another tenet of management is effective feedback and communication mechanisms among all levels of the organization. This is especially key when driving the change necessary for VBC. Frustration felt in the field can sometimes go unacknowledged for too long, feeding dissatisfaction with the changes or even the whole concept of VBC. With so many changes occurring at once, unintended consequences are bound to happen. Making sure there are processes and feedback loops to recognize problems and address them promptly will mitigate the negative aspects of change.

Follow the money

A core aspect of VBC is changing the way that payers reimburse providers for care delivery. While it's not the only aspect of VBC, a change in financial incentives should reinforce the other elements of VBC (care delivery and operating structure). Much has been written about the importance of aligning physician compensation with the goals of VBC, and there will continue to be debates for years to come on exactly how best to do that.

Suffice it to say that physician engagement can be significantly affected by how VBC impacts physician compensation. A major source of frustration comes from the disconnect that occurs between compensation formulas that are heavily weighted on productivity and the expectations of VBC (patient access, outcomes and affordability). Sometimes compensation formulas are designed to gradually increase the weighting of non-productivity measures but evolve so slowly that many physicians don't notice. Be aware of the effect that the incentive structure has and ensure that the evolution of compensation is aligned with the VBC timeframe and models.

Another aspect of funds flow that can impact physician engagement is the resources that are allocated for support staff, care management and analytics. With reference to the points made above, without adequate funding for resources that support physicians and an efficient care delivery model, VBC strategies can foster physician frustration as much as a confusing compensation model.

Rely on the tenets of change management

Overall, the challenge of optimizing physician engagement through your VBC journey can be addressed through the essential principles of change management:

• Clarity on the "why": What is the vision for VBC and how will it impact physicians and their care team? Outline the "what's in it for me?" to all participants.
• Assure leadership is providing consistent messaging: Alignment among health system leaders on VBC strategy must be continuously reinforced.
• Be honest about expectations for the future: A realistic assessment of the positive change VBC will affect, as well as the difficulties and uncertainties that lie ahead, must be articulated.
• Communicate, communicate, communicate: This includes feedback and response mechanisms.
• Acknowledge the failures or missteps: Make rapid course corrections when necessary.
• Recognize accomplishments, however small: Herald the leaders of change, whatever their role in the organization.

Success in VBC requires the engagement of the entire team, so many of these factors must be considered for other stakeholders including clinicians, operational leaders and support staff. The value-based care experts at Vizient can provide expertise on ways to enhance engagement and optimize your VBC journey — wherever you are on that path.

If your value-based care strategy needs assistance, the Vizient Value Transformation & Payer-Provider Alignment practice can assist with unlocking your potential and utilizing data in creative ways to illuminate and improve your value as a care partner.