Building High Performing Provider Networks

Episode Description:

In this episode of Value Based Care Insights, Daniel J. Marino and Shaillee Chopra introduce Dr. David Bordo, chief medical officer, emergency medicine physician and former president and founder of a hospitalist group. The trio dives deep on building high-performing networks around governance and aligned incentives, driving value by maximizing the domestic network, and understanding the key next steps to ensure organizations have the right infrastructure to support new operational realities.

Episode Overview:

Lumina Health Partners Daniel J. Marino and Shaillee Chopra welcome Dr. David Bordo, an emergency medicine physician, founder and former president of a hospitalist group, and current Regional Chief Medical Officer of AMITA Health, for an engaging conversation about how best to build a high-performing provider network. 

Daniel and Shaillee dive into the discussion with Dr. Bordo about what he has learned over his 20-year career as a leader in creating high-performing service lines and medical groups. He draws from his experience in founding the Triad Hospitalist Group and later as chief operating officer of a healthcare system.

The conversation is part of Lumina Health Partners’ ongoing study of how to align incentives and build a practice model that ensures sustainability and success under value-based care.  

Episode Discussion Areas:

1. Governance and aligned incentives

• Integrated, multi-layered governance
• Physician and operational leadership roles 
• Incentive alignment 

2. Maximizing your domestic network  

• Common challenges
• Referrals  
• Technology-strategy alignment

3. Infrastructure needed for success

• Revenue-cycle leadership involvement
• Importance of accurate diagnosis (ICD-10 and HCC) coding 
• Technology and cost management  

8 Key Takeaways to Building High-Performing Provider Networks

1. Successful provider networks begin with a focus on the IHI Triple Aim:

"Start with patient safety and then quality outcomes, while achieving those goals at the lowest cost possible."
– Dr. David Bardo

2. Many organizations immediately want to enter a value-based contract.

• It’s a great place to start, but first you need to establish the right physician compensation model to support that type of contract. Provider compensation and incentives must reward the behavior modification that you want to achieve.  

3. Provide the right education and incentives for physicians to use technology and code correctly. 

• Buy-in and engagement from providers greatly improves the likelihood that the group will adopt new behaviors.

4. Improve the efficiency of care and cost models by keeping referrals and patients in your network. 

• It’s imperative to be in tune with your patient population and their desired locations, needs and preferences.

5. Create a cultural shift toward analytics and use data in decision-making.

• Analytics help you think about expanding a network across the care continuum, linking in post-acute and ancillary services – and even additional providers in the community.

6. Market demands force providers to embrace innovation more than ever.

• As care moves beyond the hospital – through community-based clinics, virtual visits, retail medicine outlets and the like – data must be available to the right people at the right time to manage care properly.  

7. Care management professionals are essential.

• Though often overlooked in network planning stages, care management professionals play a vital role in moving patients through the continuum of care successfully. Asking physicians to take on care management duties in addition to their current responsibilities is a guarantee for failure.

8. High-performing provider networks have the right technology infrastructure.

• Information technology must provide the data you need for establishing efficiencies such as patient profile categories, cohorts and even identifying candidates for proactive care models. More risk is not necessarily bad, provided you can have the right technology and analytics that provide actionable insights that can drive successful performance under risk. 

Resources mentioned:

• The IHI Triple Aim
• Our Lady of the Resurrection Medical Center
• Holy Family Medical Center

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasing value-based care payment environment. Hosted by Dan Marino and Shaillee Chopra, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners.