Understanding Why Hospitals, payers and physicians must work together
If we want to continue to increase the value to those we serve; it is crucial to recognize that partnerships are necessary. Thus, it is essential that physicians, hospitals, and payers work together in innovative ways and cost-effectively elevate care and services. Historically, not only has each focused on improvement through their individual lens and actions, but the healthcare environment and regulations have pinned these groups against each other. Hospitals are continually negotiating with payers; physicians believe that payers inhibit care; payers focus on reducing costs and view both physicians and hospitals as cost drivers. Although none of these perspectives are incorrect, they don’t lead to a cohesive model of care and services. With the fear of price fixing, regulations are in place to prevent physicians and hospitals from working too closely together.
So how do we overcome these issues?
At the heart of the matter is the question of whether all three constituents have the patient’s best interest at their core? I believe the answer is a resounding YES. Nonetheless, if we all have a common purpose, what prevents us from coordination? When engaging in relationships, trust becomes a primary focus. However, do we sincerely trust each other?
Trust builds on three foundational factors: competence, transparency and motive.
These three ideas can be compared to the three legs of a stool. You can’t have one without another, all three are dependent on each other. Regardless of whether a payer, physician, or hospital, our competence in our core functions is paramount, it is imperative to be transparent concerning our activities, and vital that our motives remain pure and transparent in their own right. Equally important, we also need to recognize these characteristics within each other. As a physician, if I do not consider the possibilities and trust my peers in healthcare partnerships I cannot collaborate in a meaningful way.
It is requisite that we realize that we have some shared goals and some disparate, but if we want to work together and create common ideals, we also need to challenge each other and ask questions since the outcome directly affects those that we serve.
Considering all of the things mentioned above and respecting and trusting all the individual players in support of care, how do we move forward?
First, remember why we are here and whom we serve. Second, each sector should focus on doing its core business optimally. Third, transparency, let’s make processes more transparent by using coordinated data. Fourth, understand the other’s intent, limitations, and challenges. This latter point is critical for a partnership to be effective. A working definition of collaboration should include methods of how I help you succeed within the context of your objectives while you assist me in obtaining my goals within the context of my needs. Presently, our coordination looks more like “How do I persuade you in helping me with my issues without my indicating concern about yours.” But this framework will not allow us to progress in working together for the betterment of those we serve.
At the end of the day we must remember that it is not about us. Let us have a shared covenant understanding that there will be dynamics that strain our relationship, but overcoming them is our calling.