Building a Culture for Successful Physician Preference Savings Presented to AHMMA February 1, 2011

Objectives: Discuss four approaches to physician preference savings and the varying degrees of alignment needed for each approach Identify the barriers to physician alignment Outline critical factors for building a supportive culture

Approaches to Physician Preference Savings Pricing Working with the vendor to obtain good pricing on the products physicians use Standardization Working with physicians to narrow the field of vendors to obtain better pricing Utilization Working with physicians to ensure the right product/service is being utilized at the right time based on the need of the patient (i.e. cost per case) Care Management Working with physicians to develop protocols for the care of patients with similar conditions/circumstances

Physician Alignment Needs Pricing Standardization Utilization Care Management

Barriers to Physician Alignment Lack of support from Administration and/or Physician leaders Lack of trust Lack of awareness or understanding Inconsistent or poorly defined process History of failed attempts Failure to recognize value of alignment Lack of incentives Poor communication

Five Critical Factors for Building a Supportive Culture Executive Support Accountability Physician Champion Process Communication

Communication “The single biggest problem with communication is the illusion that it has taken place.” – George Bernard Shaw Communication Messenger Message Receiver(s) Interpretation Feedback

Vital Communication Points Meet with physicians to understand the purpose of the product/service and their needs as it relates to product or service. Determine the type of contracting approach(es) that are feasible for this initiative—validate this with physicians. Enlist the physician’s help in designing a contracting strategy. Share the results of the RFP with the physicians and ask for their assistance in working with vendors. Enlist support of involved physicians in implementation. Report compliance with contract(s) on a regular basis and ask for their suggestions if commitments are not being met. Physicians will likely speak to patient outcomes and safety, perceptions of patient interests, their own experience and comfort level with the product or service, the support provided by the supplier, and their medical training--not the cost of the product or service, or how difficult it is to procure.

Communication Tips You cannot over communicate Use various methods of communication Use language the physician understands Provide an avenue for feedback during the entire process

Consistent & Transparent Process Accountability Rigor Evaluation Application Analysis Includes: Communication Product research Product evaluation Analysis Implementation Accountability Application Trust & Credibility

Ways to Build Trust Shared experiences over time, Multiple instances of follow-through and credibility, In-depth understanding of unique member attributes, Get to know each other, Encourage empathy and understanding and Discourage unfair and inaccurate behavioral attributions. The FIVE Dysfunctions of a Team, A Leadership Fable; by Patrick Lencioni, 2002

Excellent Communication Skills Physician Champion Champions are an important success factor for your process and initiatives Respected connector Subject Matter Expert Positive Attitude Excellent Communication Skills Open to change Data Oriented

Accountability Economic Credentialing: During the recruiting process During annual evaluations (physician profiling) Physician Incentives

Ways to gain/keep executive support: Educate/Inform Executives about your process Frequently relate the value the process is adding to the organization Keep executives updated on initiatives in process and any potential barriers Explicitly state the support/assistance you need to be successful Channel difficult and politically charged initiatives through the executives before beginning your process Even with the four critical factors discussed thus far, the lack of executive support will lead to failure.

Carol Pennington, RN, BSN, MBA – cpenning@vha.com