Transformational Alignment in the CVSL

Thursday, September 19, 2019 | Terri McDonald

Aligned? Not so Much

The historical divide between CV physicians and hospitals/health systems is still alive and well in most programs despite contemporary trends in employment and contracted “alignment” models. We encounter it nearly every day and we often reside in one of two “camps” – the physician camp or the hospital/system camp. We can see how distrust, whether subtle or intense, can influence parallel decision-making processes and leadership structures. Differences are often years, or even decades old – management, infrastructure, compensation, call coverage or all of the above. Although it’s unintentional, this divided culture may cause our work to be more about our needs and managing margins, and less about our patients.

External Pressures 

Aside from the obvious internal drivers for alignment – patient experience, cost and efficiency, to name just a few – external pressures are growing and creating a shift towards an aligned, patient-centric care model within the cardiovascular service line (CVSL). For example, alternative payment models (APMs) driven by value-based objectives are present and growing. Along with orthopedics, CV care is a target rich environment for APMs for the Department of Health and Human Services, private payers, and more recently large employers. The degree to which markets are pressured may vary geographically, but I hope there are no CV providers out there who believe physician-hospital/system alignment will not be a dominant priority in their near future.  The degree to which we can manage the impact of this shift in our programs lies within our ability to work as a team with a shared, clearly articulated vision.

Bridging the Divide

So how do we get there from here? We can start by putting our differences behind us, or at least tabling them for discussion and resolution. This will require innovation and collaborative decision-making beginning at the leadership level. CV physicians must have meaningful leadership roles in strategic planning and decision-making from the executive level down through each frontline committee and work group. In order to be effective, system-level and hospital-level operational leaders must work with CV physicians in a dyad leadership model to operationalize and manage strategic priorities.

Co-Management Models Can Provide Transformational Alignment

Co-management agreements with a dyad leadership model can be highly effective in aligning our goals with patient-centric care and excellent outcomes. Typically designed with an overall governance structure that supports subspecialty physician-led councils (see Figure 1), this model promotes, supports and finances collaborative work. More importantly, it places us all on the same team to set and achieve meaningful goals designed to resolve issues, improve care, provide value and stay ahead of market pressures. This work begins with goals, or metrics, that are “low-hanging fruit,” and over time advances to strategies that support a highly functioning, fully integrated CVSL. Whether through a co-management or other model, I believe transformational leadership alignment within the CVSL is our next great opportunity in caring for the CV population, and to promote a return of joy for our work.

Figure 1:  Example: CVSL Governance and Leadership Model

If you haven’t started the journey to transformational CVSL alignment, or your alignment efforts are faltering, here some steps to take:

1. Start/stoke the conversation

True collaboration takes time to develop and requires trusted relationships between leaders. Approach key CVSL leaders and influencers and start having conversations about operational alignment between practices and the hospital. Begin the discussion about collaboration, a common vision and shared strategies.

2. Analyze the CVSL data

We all have data on cost, payment, care processes and outcomes, patient and care team experience. The data are all interrelated and paint a picture of our performance, especially in APMs. Often, we don’t know what data we have, what to do with it or even how to get it. Find the person who has access to the data and discuss a strategy to review it. Data can become the source for designing short-term goals and longer-term strategies.

If you find yourself challenged with what to do about data, MedAxiom can help. Our consultants have experience accessing and analyzing data that depict CVSL performance, and our new affiliation with the American College of Cardiology adds our specialty's largest body of scientific knowledge and expertise to the equation. Contact us for insight.

3. Socialize the idea of leadership alignment; raise the possibility of practical CVSL integration

Talk with your colleagues to encourage engagement and discuss leadership alignment as a solution. Often, formal agreements are essential to gain and maintain commitment from members of the CVSL for true alignment and collaboration. Formal agreements also tend to fast-track access to data – something we all need to be successful in the challenges we face in care delivery. If you'd like guidance on how to prepare for these discussions, MedAxiom has expertise in negotiating such agreements as well as data sharing between hospitals and physician groups.

We're always here to help! Leave a comment to share CVSL alignment success stories or challenges from your organization.



Illustration: Lee Sauer

About the Author
Terri McDonald

Terri McDonald, RN, MBA, CPHQ is Vice President, MedAxiom Consulting. She brings extensive knowledge and experience in leading, managing and optimizing every level of the cardiovascular service line. Following a clinical career in cardiac and critical care nursing, Terri gained a diverse knowledge of administrative, operations and clinical nursing management in the acute care setting. As VP of Consulting Terri fulfills her lifelong passion for cardiology and cardiovascular care helping her clients succeed through understanding challenges and designing collaborative, practical solutions using evidence-based guidelines and emerging technologies.

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