Frontiers of Health Services Management - Summer 2013 - (Page 33)

revising those policies could be equal to or even greater than the impact of current bundled and aco payment designs. recent studies have shown that cost variation in post-acute settings is significant (MedPac 2013; Schmitz and Simon 2009), so, as noted, bundling may become a more sustainable payment model even though it too is based on the current underlying payment system, including fee-for-service payment for physicians. this need applies to physician, hospital diagnosis-related group, and hospital outpatient payment policies. the UnityPoint Health investment in home care will potentially be strategic. i would like to address the many references made by PHc and UnityPoint Health to the importance of culture. Billings clinic dealt with its own version of this important but difficult issue following its merger with Deaconess Medical center in 1993 (Billings clinic 2006). Both culture and leadership are critical to the development of future models of healthcare delivery, though they are not as easily defined and measured as are, for example, financial benchmarks. James reinertsen is a former ceo of Park nicollet in Minneapolis and a longtime faculty member of the institute for Healthcare improvement. He has facilitated retreats for Billings clinic leadership on several occasions and shared with us the graphic in exhibit 1. generated out of his and others’ work at the institute for Healthcare improvement, it depicts the key elements of leadership for transformation. the building blocks of setting direction, establishing the foundation, building will, Final Thoughts as i reflect on the current criticism of quality and waste in US healthcare, i think it is also important to look at what we are doing well. PHc and UnityPoint Health should be congratulated for their vision, tactics, and significant efforts to develop more value for patients through service line and system integration. of course, that does not diminish their need to develop good metrics for evaluating and reporting improvements over the coming years. i have personally admired the transformational efforts of organizations such as geisinger, virginia Mason, Mayo clinic, Denver Health, Henry ford, Scott and White, and Kaiser Permanente, to name a few. all have very different patient populations, payer mixes, and health plan relationships, yet at the core all are multispecialty physician group practices. this leads me to two final observations. first, physician collegiality and the relationships across diverse specialties are key N ic hol a s Wolt e r • 33 C o m m e n t a r y Culture and Leadership generating ideas, and executing change must be addressed by all organizations as they develop their culture and leadership strategies. in reinertsen’s opinion, it takes two or three generations of leadership teams to sustain and deliver a large-scale organizational vision and its underlying methods of continuous improvement. reinertsen’s lengthy timeline is probably more realistic than the five- or ten-year timelines of the current health reform initiatives. accordingly, to achieve sustainable transformational change, PHc and UnityPoint Health will need to continue investing in leadership training and related initiatives over the next 10 to 20 years.

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Summer 2013

Frontiers of Health Services Management - Summer 2013
Contents
Editorial
At the Heart of Integration: Aligning Physicians and Administrators to Create New Value
Volume to Value
Physician-Led Models of Accountability and Value: Observations on Payment Policy and Culture
Collaboration Across Clinical Silos
Breaking Down Clinical Silos in Healthcare

Frontiers of Health Services Management - Summer 2013