3.11.14
随着支付模式逐渐从数量转向价值, 学术医疗中心 face additional pressures relative to their non-academic health system peers due to their unique mission of delivering patient care, 教导下一代的医疗bet8娱乐提供者, 从事医学研究. 另外, 资产管理公司面临着复杂的组织结构带来的挑战, 根深蒂固的政治和文化敏感性, 平衡高成本的教学和研究任务.
Despite notable examples of academic institutions that have made early investments in tools and infrastructure that promote clinical integration, early predictions on whether or not AMCs can survive and thrive in a post-reform environment tend to cluster somewhere between “uncertain” and “cautiously optimistic” — even the most bullish prognosticators acknowledge that many will face an uphill battle. 除非资产管理公司能够在这个新时代重塑自我, 正如一家大型AMC的首席执行官直言不讳地指出的那样, “其他医疗体系只会吃掉(我们的)午餐。”.
This reinvention needs to begin with bold organizational changes that leverage AMCs tradition of innovation toward the development of organizational and financial structures to achieve greater integration among component entities. The graphic below and corresponding synopsis introduces five specific areas of opportunity where innovative structures can be leveraged to support increased alignment. While these areas are perhaps more conducive to AMCs that are not already fully integrated, many 综合资产管理公司 可能是一个整体,但没有功能集成. 因此, opportunity remains for all academic medical centers to examine how they will strike the right strategic alignments to deliver both mission and margins in a value-based care era.
1. 大学/医学院与初级教学医院之间的伙伴关系
Many affiliation agreements fail to adequately describe the value of the partnership between the school of medicine and teaching hospital or to clearly define the tangible commitments and expectations that each must provide to promote their mutual success. 有机会发展更现代的安排, including an overhaul of financial structures to create clear “lanes” of funding for areas such as GME和程序开发. 更具创新性的风险分担模式, 据此,可自由支配的美元与业绩挂钩, should also be strongly considered as the days of negotiated “mission support” dollars from the hospital to the medical school, 没有对ROI的理解, 是结束了还是即将结束. 这些变化使医院能够确立明确的价值, 问责制, 以及投资组合的透明度.
2. Alignment of Clinical Enterprise Between Faculty Group Practice(s) and Teaching Hospital(s)
资产管理公司也不能幸免于市场上正在发生的快速整合. The business and organizational relationship between teaching hospitals and practice plans (for those not already under single ownership/governance) arguably represents the greatest potential for tighter alignment for most AMCs – ranging from community-based AMCs to large-scale, 完善的机构. Navigating a growing web of contracts between these entities to balance the economics and growth programs is not sustainable. 而不是, these entities should seek to coordinate their investments and share risk more directly to more effectively align financial incentives, 反过来, 战略利益. 另外, there is a range of contemporary organizational options available that can better align the clinical enterprise while addressing the common concern and false perception that a clinically driven strategy will harm the academic enterprise.
3. 附属社区实践与amc之间的一致性
有开放式医护人员的教学医院, and those that rely heavily on community practices for key service lines or regional coverage, are as active as their nonacademic peer hospitals with respect to direct employment or exclusive contractual arrangements with community physicians. 这就提出了许多问题, 在某些情况下是担忧, for the medical school and practice plan regarding the balance between nonacademic practices and clinical faculty. There are extensive organizational and strategic opportunities to better align the two groups and drive growth of the system, ranging from coordination of outreach strategies to service line development. 至少, AMCs should proactively consider how community practices may coexist with academic counterparts and participate in population health management through a clinically integrated physician network.
4. 编程对齐/集成
The vast majority of high-ranking institutes and Centers of Excellence (库斯) across the country are found at AMCs. 然而, 他们中有太多只代表一个虚拟的中心或品牌, 没有真正的战略和财务一致性. 这使得基于资产管理的项目处于危险之中, 因为没有更正式的结盟, 经济增长将受到抑制, 成本将无法控制, 竞争对手(e).g., community-based programs with a more patient-centered approach), will gain market share. 资产管理公司有机会为机构设计更综合的模式, 库斯, 和/或主要bet8娱乐线路(如.g., 心, 癌症, 神经科学, and orthopedics) that creates centralized 问责制 and aligns incentives between the participating departments and divisions, 不损害系主任的权威.
5. 教师实践计划整合
AMC的科室包括临床科室很多 教师实习计划 在全国范围内, 因为想要独立而臭名昭著, and it is often difficult for AMC leadership to challenge or change this culture. 这是可以理解的, 主席希望保持对非医师员工的控制, 制定自己的薪酬政策, 尽可能多地保留他们的底线(在一定程度上是积极的), and in many instances independently negotiate contracts with affiliated hospitals. The benefits of having a more integrated and empowered physician organization with practice-wide policies and aligned financial interests will outweigh the short-term, 系系主导的观点在当今太多的机构中都存在. There are innovative structures that strike a balance between promoting an entrepreneurial spirit in the department and ensuring the broader interests and health of the physician organization. Increased indepartmental integration can create tangible benefits within many practices.
Today’s rapidly evolving healthcare market requires streamlined decision making and organizational structures that support clinical and financial integration. AMCs should be prepared to reexamine their current business models or have their lunch taken.
这篇文章最初出现在 雅典娜卫生保健领导论坛 - 2014年2月10日.