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Saving money by having medical directors carry out effectiveness projects


From NEJM Caralyst:

“Initiatives aimed at optimizing value and decreasing waste are traditionally carried out at a system level. Consequently, physician involvement may not be a key driver of the process, which can affect project outcomes and sustainability. To improve physician alignment with systemwide goals and create a culture of accountability, leaders at Riley Hospital for Children {in Indianapolis} … engaged medical directors by requiring them to carry out at least one clinical effectiveness project a year and present at one of the monthly meetings. The new position of medical director of clinical effectiveness helps oversee this. Within the first year, 26 new clinical effectiveness projects were started, and 75% of medical directors identified a project. This led to an estimated savings or revenue generation of more than $3 million. Another 25 projects were started during the second year, with an additional estimated savings or revenue generation of more than $13 million.”

CMS chief medical officer says equity, quality go together

Lee Fleisher, M.D., chief medical officer for the Center for Medicare & Medicaid Services, discusses CMS’s drive for, in the words of NEJM catalyst, “health-care delivery improvement in quality, safety, high reliability, and equity, and the various levers of its quality measurement agenda.”

Indeed, he says, if we don’t have equity, we don’t have quality.

He tells NEJM: “What we’ve learned from the pandemic is a resilient system. At the lowest, at the baseline level, are our conditions of participation, those minimum standards that we push out to ensure that all health care providers who are covered by Medicare or certified provide that care. We need to rethink how they should include equity, just like we included safety 2 decades ago, that it’s important that governance look at equity. We’ve asked a number of questions in our request for proposals, for information, about how they should change. We then have three levers to improve quality to get to that highest level. One is the payment models, another is the quality improvement activities, but what is really important are those quality measures.”

To read his discussion with Dr. Thomas Lee in NEJM catalyst, please hit this link.

Health-care teams beyond COVID

An article in NEJM Catalyst looks at the health-care sector beyond COVID-19.

The summary says: “In this article, the authors highlight how health-care leaders can guide their teams to a post-pandemic state that is even better than before — by helping them move from recuperation to regeneration. Drawing on management and team research, they recommend that leaders (1) focus on the team, not only individuals; (2) define and mark the moment of transition, imbuing it with meaning and purpose; and (3) spur reflection that enables action. The authors provide specific questions to help team leaders guide high-value reflection in practice. These will prompt productive discussions about identifying work the team can offload or add, clarifying team membership and coordination strategies, revisiting and strengthening team norms (e.g., those that support psychological safety), and improving key processes (e.g., those that promote joint problem-solving). Through this focused reflection, leaders can help their teams liberate, refresh, and create a better future.”

To read the article, please hit this link.

Picking an ACO partner

An article in Physicians Practice by Corey Redding, executive director of the Cumberland Accountable Care Organization, in Tennessee, discusses how to choose ACO partners.

He notes:

“To realize strong clinical and financial results with an ACO model, it is critical to choose one that aligns with your practice’s mission, values, and strategic priorities. In addition, you should look for one that is committed to robust communication and support throughout the relationship.”


“A high-performing ACO must have a dedicated board in place whose members support the payer risk-sharing model, have influence in the local healthcare community and are respected by physician and non-physician peers. All providers participating in the ACO must be excited about the model and know their role in making it successful.”


“To accomplish its mission, an ACO needs real-time data from across the care continuum that providers can use to identify patients with care gaps and guide interventions to close those gaps. The more comprehensive the data, the more likely participating providers will have access to a complete picture of the care happening outside their four walls. This requires a platform that can automatically capture data from disparate sources and normalize it for use within different electronic health records (EHRs), so providers can use it in decision-making without having to toggle between systems.”

To read the article, please hit this link.

Faulty perceptions may slow move to more diversity among health-care leaders

Map shows counties in the U.S. by nonwhite population (i.e., excluding non-Hispanic whites) according to the U.S. Census BureauAmerican Community Survey 2013–2017 5-Year Estimates. Counties with larger nonwhite populations than the United States as a whole are in full purple.

An article in NEJM Catalyst looks at three steps toward more diversity and inclusiveness in the leaderships of health-care institutions.

Among the authors’ remarks:

“Leaders of many medical schools and health systems who are seeking to improve diversity must acknowledge a plain fact: their ecosystem is mostly white and predominantly male. Furthermore, their perceptions of what leadership is or should be may impede progress. … There is increasing evidence that greater diversity among teams is associated with higher performance. The authors offer three recommendations for health care leaders and their boards: (1) recognize that diversity is necessary but will not, alone, create a just and inclusive culture; (2) be aware that every leader is at risk for blind spots; and (3) appreciate that concepts of leadership and stereotypical traits of leaders among existing leaders may limit efforts for cultural inclusiveness and operational success.”

They authors conclude:
“{T}eams …. must also recognize that their perceptions of the inclusiveness of their culture may be influenced by blind spots and unduly optimistic. They also should start questioning whether their definitions of good leaders may be too rigid and narrow. ”

To read the article, please hit this link.

From physician to physician leader

An article on the site of Harvard’s school of public health discusses the best ways to transition from physician to physician leader. Among the observations:

“‘In order to succeed, physician leaders need enough training to know what questions to ask, what they’ll need from others, and what potential strategies they can use,’ says Mary C. Finlay, MBA, Program Director of Leadership Development for Physicians in Academic Health Centers and Lecturer in the Division of Policy Translation and Leadership Development at the Harvard T.H. Chan School of Public Health. ‘They also need to understand broader market trends and changes that could impact their ability to grow or develop their division or department.’

“Once they have a grasp on these key areas, leaders can start to conduct analyses and take stock of potential problems or areas for improvement within their department. In order to succeed, physician leaders need enough training to know what questions to ask, what they’ll need from others, and what potential strategies they can use.”

Hit this link to read the article.

Physician leaders associated with better hospital quality metrics.

A study published in 2019 suggests that hospitals do better in health-care-quality metrics when they’re run by physicians than by nonphysicians, while physician leaders’ financial performance is as high as nonphysicians’.

Hit this link to read about it:,.8.aspx

Chief wellness officers seem particularly useful now

An article in NEJM Catalyst discusses the rising importance of a new kind of senior health-care executive — the chief wellness officer (CWO).

The article notes that “by incorporating CWOs into the emergency command structure, these health-care organizations were equipped to identify and address health care worker needs throughout the {COVID-19} pandemic. CWOs learned important lessons regarding how health-care organizations can best address workforce well-being in the midst of a crisis. Key CWO contributions include identifying evolving sources of worker anxiety, deploying support resources, participating in operational decision-making, and assessing the impact of fluid pandemic protocols on clinician well-being. As HCOs seek to promote post-traumatic growth, attention to the well-being of the workforce should be incorporated into emergency management protocols with the goal of sustaining a resilient health care workforce.”

Hit this link to read the full article.

The Prince, written by Niccolò Machiavelli (pictured), argued that it is better for a ruler to be feared than loved, if you cannot get both.both

BMJ article looks at effectiveness of development programs for physician leaders

The Prince, written by Niccolò Machiavelli (pictured), argued that it is better for a ruler to be feared than loved, if you cannot get both.

Do programs to develop physician leaders actually work? A BMJ Leader (as in British Medical Journal) article notes that “leader development has been the signature feature of leading companies and appears to be a burgeoning interest in healthcare organisations, it is important to assess the impact of such programmes, especially as resources are expended towards them in an era of constrained resources in healthcare. The impact and value of programmes must be addressed individually, and each activity must be contextualised for the culture and priorities of the institution. While some available studies demonstrate value and high organisational impact for such programmes, it appears that rigorous studies are relatively few and that most available studies document self-reported….

“Assessments of the various Cleveland Clinic programmes represent our attempt to assess the impact of physician leader programmes on organisational performance. Future goals for this research are to further examine both the learning, behavioural, and organisational impact of alumni of leader development programmes and to consider their cost-effectiveness (eg, by comparing the programme costs with the financial impact of initiatives led by programme alumni).”

To read the article, please hit this link.

Leveraging implementation science

An article in NEJM Catalyst looks at the major shifts to come over this decade in the design of health systems and health care in general, propelled by digital health, growing consumerism, mounting financial constraints, and accelerated by COVID-19.

The authors conclude:

“It will not be easy to get to this new world, and it will be realized faster in some places and domains than others. However, if payment systems reward organizations and practitioners for doing better, we believe they will find ways to innovate and successful innovations will spread rapidly. Some innovation will rely on digital technology and AI, but much of it will relate to leveraging the techniques of implementation science — the scientific study of implementing research findings in practice, moving care away from hospitals, and bringing together health and social care.”

Please this link to read the article.

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