TMA's Accountable Care Leadership Program Graduates Its First Class
Quality Feature — November 2015
Tex Med. 2015;111(11):49-54.
By Amy Lynn Sorrel
Physicians say health care transformation should be led by the very ones who are delivering the care: physicians. A group of doctors from all around the state are prepared to walk the talk this month as inaugural graduates from the Texas Medical Association's Accountable Care Leadership Program.
Participants in the 10-month certificate program get schooled in topics like communication skills, teamwork, and population health management, meant to help physicians adapt in a rapidly changing environment that demands more accountability and proof of value for the health care dollar. Already, payers are taking notice, with UnitedHealthcare the first on board to sponsor the TMA course with a financial grant.
The course is not meant for physicians looking for a formal, full-time leadership position as a chief medical officer or president of medical affairs, for instance. Rather, it targets early- to mid-career practicing physicians who recognize they need new tools to survive and thrive in the new environment, TMA leaders say.
Oftentimes, physicians feel they are bystanders to change, when really all they are missing is the right equipment to help steer it, says Gregory R. Johnson, MD. The Houston hospitalist and chief medical officer of Sound Physicians is chair of TMA's newly appointed Ad Hoc Committee on Accountable Care, which partnered with The University of Texas at Dallas Naveen Jindal School of Management faculty to develop the leadership program.
The course doesn't point doctors toward a particular value-based care model. Rather, "this is for any physician to be able to understand what is out there, where they can fit in, and more importantly, where they can lead," he said. "The real opportunity here is for physicians to be able to go forward confidently and to drive outcomes, because ultimately we are the ones responsible for our patients."
Those are not skills physicians typically get in medical school, says Jessica Nguyen-Trong, MD. The interventional cardiology fellow at The University of Texas Southwestern Medical Center is about to graduate from the leadership course. Having participated in organized medicine, the member of TMA's Council on Legislation had a general understanding of the alphabet soup that comprises today's value-based care world.
Even so, the course not only refreshed her vocabulary, "but it enhanced my understanding," she said. "With the movement toward quality improvement and more accountable care, it gave me some really practical approaches on how to manage and focus more globally on my patient panel and establish good practices. For me, the course provided a lot of insight into the practice management and business side of medicine. And those are concepts that are taught minimally in our training."
By Physicians, For Physicians
TMA launched the Accountable Care Leadership Program hand in hand with TMA PracticeEdge, a physician services organization designed to support physicians in taking advantage of new payment models. (See "Get to Know TMA PracticeEdge.") Those models require physicians equipped to lead, and Dr. Johnson says his committee conceived the course not only to identify physicians' knowledge gaps when it comes to value-based care, but also to fill them with practical educational tools.
"We wanted to make sure it was focused and accessible for physicians," Dr. Johnson said.
TMA developed the course in partnership with UT Dallas, with a primarily online curriculum adapted from the school's Healthcare Leadership and Management for Physicians certificate program. Physicians can access lectures, readings, quizzes, and case studies 24/7, putting in an estimated 10 hours of homework every three weeks. Ten months later, they earn a certificate from UT Dallas, plus continuing medical education credits from the American Medical Association and TMA. About 20 physicians signed on to the pilot course, and future classes are expected to accommodate 25 to 30 participants.
With all that physicians are responsible for, Dr. Johnson acknowledges the value-based care landscape can be daunting, with its own nomenclature, new technology, and approaches to care coordination that come along with it and the speed at which they all collide.
"The gaps in [physician knowledge] are numerous. But this course gives physicians the opportunity to learn at their own pace, with appropriate guidance from the faculty at UT Dallas and with a peer group," he said. "It really does give doctors a better sense of what the landscape is; what their opportunities are, whether as an individual or as a practice; and not only how to talk about it but also what to talk about."
UT Dallas Professor of Healthcare Leadership and Innovation Michael J. Deegan, MD, leads the program and consults with TMA's Ad Hoc Committee on Accountable Care Leadership. In helping TMA form the course, he and his colleagues recognized only a small subset of physicians ultimately pursue a formal health care management degree. However, "a much larger constellation of physicians, because of the way care delivery and financing is changing, have to take on their practice differently, and that means some are going to have to lead differently."
A New Skillset
The curriculum is divided into three main sections designed to impart practical skills relevant to all specialties. (See "A Course Sampling: TMA's Accountable Care Leadership Program.")
The first unit — Interpersonal and Communication Skills — gives insight into what Dr. Deegan calls physicians' emotional intelligence: how they interact and communicate with others, whether colleagues, family, patients, or insurance companies. That prepares physicians for the second section — Leading and Managing in an Interdependent World.
"As we are designing new care models, autonomy is out and teamwork is in," Dr. Deegan said. "Now we are being asked to change and to become more collaborative. So when it comes to leadership, one of the big skill sets for physicians aspiring to lead today is how to lead equals."
Physicians also learn the difference in the primary responsibilities of leaders versus managers and how the two roles complement each another, as well as how to negotiate and deal with conflict.
The third section of the curriculum — Providing Value-Based Care for Individuals and Groups — addresses the nitty-gritty components and metrics involved in value-based health care, such as population health management, performance improvement, and informatics.
For instance, physicians might have 2,500 patients in their practice but actively see only 500 of them in a year. Population management, Dr. Deegan says, is about looking at all 2,500 patients and stratifying them based on their health status.
"This is about getting doctors to look at how they practice and segment with different levels of care," he said. "Who are my well patients, and how do I keep them well? Who are the patients with risk factors we need to watch? Who are those with chronic illnesses that are not curable but under control? Who are those with several chronic illnesses and problems? And how do I support my patients in a dignified way who are near the end of life?"
Technology enables practices to use that information to their advantage, he adds. "You can't compete in today's world without a reliable EHR [electronic health record]. It's a nonstarter."
Because physicians, even as leaders, can't do everything, the value-based care portion of the course also teaches them to engage their team and hold them accountable to what Dr. Deegan says payers and patients expect nowadays: "And what they are looking for is bending the cost curve."
Throughout the course, physicians also must apply what they learn to a case study they choose at the outset. A popular one involves transitioning a fictional seven-physician internal medicine practice to a medical home. Various exercises challenge physicians to rearrange staffing and write a script for a conversation with a physician who does not want to make the change, mimicking real-life scenarios leaders likely will encounter.
Dr. Nguyen-Trong chose another case study that presented a hospital dilemma and required her to draft a meeting agenda with proposed ideas to address the problem.
Just before graduating in November, aspiring graduates were scheduled to meet in person for a final capstone event to review the course and to conclude with an overview of the business and legal aspects of accountable care, such as contracting options and forming governance committees.
Leading Where You Are
Keller family physician Gregory Fuller, MD, enlisted in TMA's Accountable Care Leadership Program after his practice joined Catalyst Health Network. The Dallas-Fort Worth network of independent primary care physicians banded together to form their own accountable care-type organization (ACO) in an area of the state dominated by hospital-run ventures.
Catalyst asked Dr. Fuller to serve on its board of directors, "so I felt like this course would really help prepare me for that kind of role. Looking at different leadership styles, you become introspective and ask yourself: What qualities do I already have in place as a leader? What do I need to improve? And how do we make our organization better?"
The course content on population health management and performance improvement, he adds, was critically relevant "because those are important components of what we are going to have to do at Catalyst" to secure value-based care contracts with commercial payers.
The program is not just for physicians aspiring to join an ACO.
It dovetails with the TMA Council on Health Care Quality's overall goals to prepare physicians for any type of value-based payment proposition and ensure those efforts are physician-led and patient-focused, says Dr. Fuller, the council's chair.
"In Texas, we feel very strongly that physicians — not nonmedical folks — need to be leading quality and the definition of quality and development of quality programs," he said. "The big leap physicians are going to take — especially primary care doctors — is in getting away from reactionary medical care and moving toward proactive, patient-centered medical care. That's going to be the difference to succeed."
Indeed, payers are quickly transitioning from traditional fee-for-service payments to a variety of performance-based models, and physicians play a key collaborative role in making that shift successful, says Thomas J. Quirk, chief executive officer for UnitedHealthcare in Texas and Oklahoma. Payers have the means to provide comprehensive data and analytics to physicians to better manage their patient panels, and TMA's Accountable Care Leadership Program gives physicians the means to act on it.
"Right now, there is significant fragmentation in the market. And if physicians had a better way to understand how patients are moving throughout the health care system, and if technology can be infused in that type of environment, we think that the shift to an outcomes-based or performance-based model can happen more efficiently and effectively," Mr. Quirk said. "We understand there is a significant learning curve, especially for smaller independent physician offices. When we found out that TMA was partnering with UT Dallas, we wanted to step in and provide resources to be able to help facilitate that educational process. We commend TMA for taking the initiative and leading in providing the medical community with a core curriculum that will help all physicians gain a fundamental understanding of how care is going to be delivered in the future."
From United's perspective, those delivery models don't stop at ACOs but run the gamut from incentive payments for primary care improvements to more sophisticated risk-sharing and capitation arrangements.
"Wherever physicians feel comfortable, we want to support them across that continuum," Mr. Quirk said.
As Dr. Nguyen-Trong finishes her fellowship, she's not quite sure where on the spectrum she will land.
Wherever that is, she says the exposure to new business models, practice analysis tools, and a goal-setting mindset leave her well-positioned at a critical juncture in her career. "It helps me be a stronger patient advocate knowing I have the ability to institute changes in my own organization to allow me to deliver better care to my patients."
Amy Lynn Sorrel can be reached by phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.
A Course Sampling: TMA's Accountable Care Leadership Program
Section 1: Interpersonal and Communication Skills
- Self-awareness and adaptability
- Relationship management and teamwork
- Effective communications
Section 2: Leading and Managing in an Interdependent World
- Roles and responsibilities of leaders, managers, and followers
- Adaptive leadership
- Conflict and negotiation
Section 3: Providing Value-Based Care for Individuals and Groups
- Practice-based population health management and performance improvement
- Informatics and clinical decision support
- Defining value
Section 4: Live Capstone Event
- Contract options
- Network organization, i.e., governing boards and committees
- Coding and documentation for patient risk adjustment
Are you interested in TMA's Accountable Care Leadership Program? Email Christina Shepherd. The next class is expected to begin in the first quarter of 2016.
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Get to Know TMA PracticeEdge
TMA PracticeEdge is a company TMA launched in February 2015 to provide physicians the technology, expertise, and investment needed to take advantage of new health care payment models. In addition to providing independent physicians strategic options to design their own future, TMA PracticeEdge is beginning to partner with other, like-minded vendors that offer products or services that:
- Enhance the quality of patient care;
- Pay the physician appropriately and timely;
- Do not disrupt the physician's normal clinic flow; and
- Pose little or no financial risk to the physician to implement.
TMA PracticeEdge plans to expand its service mix in early 2016, offering practices the ability to take part in and to be paid for Medicare's Chronic Care Management program.
To learn how TMA PracticeEdge can help your practice, visit www.TMAPracticeEdge.com, email info[at]tmapracticeedge[dot]com, or call (888) 900-0334.
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