Content area
Full Text
McManis: Reform is coming. It may be raging incremental reform, but it is coming. But reform alone is not the only reason to build a new medical/delivery system alliance. Enlightened self-interest is another reason.
By the turn of the century, a multispecialty group of 40 physicians will be able to perform in its offices 85 percent of the procedures now done in a 300-bed community hospital. Managed care is transforming the landscape. All interested parties are transferring risk, but the hospital alone cannot assume risk. It requires an integrated delivery system with a continuum of care.
Our health care system will remain fragmented and inefficient until physicians and hospitals are aligned in one delivery system. This is much more than putting physicians and hospitals together. It's putting physicians and hospitals together to form a system of care.
Our task today is to share our collective experience about what we have learned from our various integration efforts that might help other health care executives who are struggling with changes in the health care system.
Pavia: Markets differ across the country. In some places, highly motivated physicians are leading integration, but in many cases hospitals are trying to lead the charge and motivate physicians. The big question is: How do you get started?
Fear is probably a stronger motivator than opportunity. A significant upswing in managed care penetration in the marketplace is an attention getter. For the record, I define managed care as having three components: real channeling of patients, real management of utilization, and real risk-shifting.
Strum: Fear is a strong motivator. A crisis can stimulate a market to change quickly and serve as a catalyst for new relationships with physicians. But what is our role in stimulating that crisis? Stimulating disequilibrium in the marketplace provides new opportunities, but it can also be a career-limiting event.
Pavia: But aren't physicians really motivated by desire for control over their compensation and clinical decision making? Not by preserving assets or even by preserving the way medicine was practiced in the past.
O'Neil: The physician's control over clinical decision making is slowly being taken away by the insurance companies, not by changes in the delivery system. They don't hold hospitals responsible for that. A delivery system that holds...