As payment models increasingly shift from volume to value, 学术医疗中心相对于非学术医疗系统的同行面临着额外的压力,因为他们肩负着提供患者护理的独特使命, teaching the next generation of providers, and pursuing medical research. Additionally, AMCs face challenges stemming from complex organizational structures, deeply rooted political and cultural sensitivities, and balancing cost-intensive teaching and research missions.
尽管有一些著名的学术机构在促进临床整合的工具和基础设施方面进行了早期投资, 关于资产管理公司能否在改革后的环境中生存和发展的早期预测往往介于“不确定”和“谨慎乐观”之间——即使是最乐观的预言家也承认,许多资产管理公司将面临一场艰苦的战斗. Unless AMCs are able to reinvent themselves in this new era, as one chief executive of a leading AMC bluntly put it, “other healthcare systems will simply eat [our] lunch”.
这种重塑需要从大胆的组织变革开始,利用amc的创新传统,发展组织和财务结构,以实现各组成实体之间的更大整合. 下面的图表和相应的摘要介绍了五个特定的机会领域,在这些领域中,可以利用创新结构来支持增加的一致性. 虽然这些领域可能更有利于尚未完全整合的资产管理公司,但许多 integrated AMCs may be corporately one unit but not functionally integrated. Therefore, 在以价值为基础的医疗时代,所有学术医疗中心都有机会研究如何实现正确的战略联盟,以实现使命和利润.
1. Partnership Between University/Medical School and Primary Teaching Hospitals
许多合作协议没有充分描述医学院和教学医院之间伙伴关系的价值,也没有明确界定双方必须作出的切实承诺和期望,以促进双方的共同成功. Opportunities exist to develop more contemporary arrangements, 包括对金融结构进行彻底改革,为诸如……等领域创造清晰的资金“通道” GME and program development. More innovative shared risk models, whereby discretionary dollars are linked to performance, 还应强烈考虑到从医院到医学院谈判的"特派团支助"美元的日子, without an understanding of ROI, are over or soon coming to an end. These changes allow hospitals to establish clear value, accountability, and transparency across their investment portfolio.
2. 教师集体实践与教学医院临床事业的对接
AMCs are not immune to the rapid consolidation occurring in the market. 教学医院和实践计划(对于那些尚未处于单一所有权/治理之下的医院)之间的业务和组织关系可以说是大多数amc(从基于社区的amc到大规模的amc)加强协调的最大潜力, well-established institutions. 在这些实体之间不断增长的合同网络中导航,以平衡经济和增长计划是不可持续的. Instead, 这些实体应寻求更直接地协调其投资和分担风险,以更有效地协调财政激励措施, and in turn, strategic interests. Additionally, 有一系列当代组织选择可以更好地协调临床企业,同时解决临床驱动战略会损害学术企业的普遍担忧和错误看法.
3. Alignment Between Affiliated Community Practices and AMCs
Teaching hospitals with open medical staffs, 以及那些严重依赖社区实践的关键bet8娱乐线路或区域覆盖, 在与社区bet8网站备用的直接雇用或独家合同安排方面,是否与非学术性的同行医院一样积极. This raises many questions, and in some cases concerns, 对于医学院和实践计划关于非学术实践和临床教师之间的平衡. 有广泛的组织和战略机会来更好地协调两个组并推动系统的增长, 从外联策略的协调到bet8娱乐线的发展. At a minimum, amc应积极考虑社区实践如何与学术同行共存,并通过临床整合的bet8网站备用网络参与人口健康管理.
4. Programmatic Alignment/Integration
全国绝大多数高级研究所和卓越中心(coe)都位于amc. However, far too many of them represent only a virtual center or brand, without true strategic and financial alignment. This places AMC-based programs at risk, because without more formal alignment, growth will be stifled, costs will not be contained, and competitors (e.g.(以社区为基础的项目,采用更以患者为中心的方法)将获得市场份额. AMCs have an opportunity to design more integrated models for institutes, COEs, and/or major service lines (e.g., heart, cancer, neuroscience, 以及矫形外科),它创造了集中的问责制,并在参与的部门和部门之间协调激励机制, without undermining the authority of the department chair.
5. Faculty Practice Plan Integration
AMC departments, including clinical departments of many faculty practice plans nationally, are notorious for wanting independence, AMC的领导层通常很难挑战或改变这种文化. Understandably, chairs wish to maintain control of nonphysician staff, develop their own compensation policies, retain as much of their bottom line as possible (to the extent its positive), 并且在很多情况下,独立地与附属医院谈判合同. 拥有一个更完整、更有权力的bet8网站备用组织,拥有广泛的实践政策和一致的经济利益,其好处将超过短期利益, department-dominated view seen at too many institutions today. 有创新的结构,在促进部门的创业精神和确保bet8网站备用组织的更广泛的利益和健康之间取得平衡. 增加部门整合可以在许多实践中创造切实的利益.
当今快速发展的医疗保健市场需要精简的决策制定和组织结构,以支持临床和财务整合. 资产管理公司应该准备好重新审视它们目前的商业模式,否则就会被人抢去午餐.
This post was originally featured on the athenahealth Health Care Leadership Forum – February 10th, 2014.
Published March 11, 2014