Blog Post August 14, 2019 Reviving Your Worn-Out Comanagement Arrangement Authors John Fink Comanagement arrangements have been with us for a long time, and their popularity as a hospital-physician alignment tactic intensified early this decade. Many organizations saw comanagement as a way to quickly improve the overall performance of certain service lines and be ready to perform better under bundled care and other value-based payment arrangements. For most, mission accomplished; quality has improved, patient satisfaction scores are better, and costs are better managed. For others, there was often improvement for a couple years but the effort required to continue beyond the initial low-hanging fruit just wasn’t there. Sometimes the payouts to physicians became an expectation even without the hoped for improvements in service line performance. So, what do we do now? It’s time to fish or cut bait. Going Fishing If you’re choosing to fish, you’ve decided that if done right comanagement can help you achieve your objectives and it’s worth the effort to try again. Perhaps comanagement can be a key component of a broader alignment strategy that will advance your strategic position. A good first step is learning from organizations that have experienced success with comanagement. Top Five Lessons Learned from Successful Comanagement Arrangements 5. Assign a dynamic service line administrator. The most impactful position influencing the success of a comanagement arrangement is the administrative leader responsible for coordinating the program. The person filling this role must be versatile and flexible; they will coordinate with quality, IT, finance, therapy, and nursing while communicating effectively with all providers in the program. Regardless of how you have structured the comanagement arrangement, the participating physicians should have an influential voice in the selection and retention of the administrative leader. 4. Commit to measuring and reporting the right things. True, not everything that impacts a service line can be measured, especially not some characteristics that lead to greatness. But we’re trying to fix failed arrangements. Metrics should be supported by all parties, make a meaningful impact on the cost and quality of care, and improve the perception of the service line. A review of the quality measures impacting your reimbursement is a good place to start. 3. Design an impactful committee structure. Committees can be clinically focused (e.g., spine, joint replacement, trauma), functionally focused (e.g., quality, cost, outreach), or a combination of both. The critical success factors are whether meetings occur, how constructive they are, and if members are held accountable for advancing their committee’s initiatives. 2. Make the arrangement more rewarding to all parties. The more valuable the arrangement is to the hospital, the more the hospital can afford to reward physician participants. Accomplish this by expanding the scope of the arrangement (e.g., include call coverage as a responsibility) and focusing efforts on impactful initiatives (e.g., sustainable cost reductions). Organizations can also emphasize the rewards: improved public perception and reputation, better trained nursing and OR staff, and capital investments the hospital could afford to make in the service line. 1. Develop physician leadership. Comanagement arrangements typically include leadership roles for physicians who direct committees or programs within the service line. Solicit support from your chief medical officer and other experienced clinical leaders; they can mentor the physicians taking on these roles. Provisions should be included in the arrangement to facilitate the transition of responsibilities to new physicians. Term limits encourage current physician leaders to support the development of others and avoid any potential political conflict associated with asking a physician to step down from a leadership position. Choosing to go fishing and incorporating strong leadership, accurate metrics, and a clear structure into your comanagement arrangement and committing to continuous improvement will enhance your service line performance. If you’re not able to commit to these five features, then it’s likely time to end the arrangement. Learn how to build off your successful comanagement arrangement.Cutting Bait If you’re choosing to cut bait, there isn’t adequate support for the comanagement arrangement or the benefit is simply not worth the effort. Changing tactics is frequently the right decision under the following conditions: The service line is not a top priority of the hospital; it is not an area where the hospital can be the preferred provider in the community.Bundles and/or your ACO are higher priorities and have greater opportunities for alignment with the physicians in the service line.The management company is unwilling or does not desire to effect positive change by tackling the second- and third-level initiatives that take more focused work effort.The service line’s physicians also perform cases at one or more competing facilities and are uninterested in committing exclusively to your facility.Remember, under a comanagement arrangement, the hospital is outsourcing management of a service line to a separate company or organization. You wouldn’t put up with underperformance from your outsourced billing company. Don’t accept it from your outsourced management company.