Risky business for providers: Strong leaders, appropriate structure needed

Taking on patient risk requires careful planning and the right leadership to carry it out. That’s why developing the correct structure is the second of five actions that allow your organization to take on medical risk.

My last post was about assessing your market. It’s critical to determine how local demographics and regional and/or national events affect your local market. Once you have that information in hand, you must next decide what kind of organization will allow you to bear patient medical risk successfully. Will it be an Accountable Care Organization (ACO), a clinically integrated network (CIN), or some otherMiles Snowden, MD, MPH, CEBS Chief Medical Officer, OptumHealth structure? Once these guidelines are in place, leadership will next identify the network structure for physicians and incentive models to ensure providers are aligned with the organization’s vision.

Define the vision, governance, and operating models with clarity and confidence. Regardless of the structure, health care leaders must be visible and united as they transform into a new type of organization.

A great example is Cornerstone Health Care, a physician-led multi-specialty provider North Carolina. Longtime CEO Grace Terrell, MD, led the charge in building Cornerstone’s infrastructure to better manage high-risk populations. By summer of 2013, all of the group’s payer contracts included a fee-for-value sharing element. According to Cornerstone, it is performing better than its market and better than the average national ACO in its Medicare Shared Savings Program results.

With strong leaders and a well-defined vision in place, organizations are ready to take the next step in assuming increased patient medical risk. My next post will cover population-based planning—how to determine where the greatest need exists and where the greatest return on investment will come.


“Risky Business” previous posts:


Miles Snowden, MD

2 thoughts on “Risky business for providers: Strong leaders, appropriate structure needed

  1. Pingback: Risky business for providers: Population-based planning in provider risk-bearing arrangements | Healthcare Exchange

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