The innovations that the Hill Physicians Medical Group (HPMG) employees can be replicated in 2014 and beyond. The purpose of HPMG’s innovation agenda is to improve and transform healthcare delivery through an affiliated, but not fully integrated healthcare group. The innovations that HPMG employed in 2009 can be replicated in 2014 because of some reasons. First, the technology still exists in 2014 in the same, if not improved, status. For example, HPMG uses health information technology approaches to maintain electronic medical records and integrate them into the daily medical practice of the physicians (Emswiler & Nichols, 2009). The physicians in HPMG have office-based EMRs, particularly the NextGen EMR, a paperless system using a Microsoft-based application (Emswiler & Nichols, 2009). This system can be used for the group as well as by individuals.
The second reason why HPMG innovative approaches can be replicated in 2014 is that they have met their objectives and exceeded them. The innovative systems have improved the quality of healthcare and continue to promise future improvements. In the area of screening and testing, HPMG uses Ascender, a system that improves the consistency of these processes. The Ascender system accesses patient data through the internet and can be used by the group’s members from any location. This software indicates the patients due for crucial lab tests or screenings by aggregating data from claims. Mitchell (2014) underlines the importance of recording and tracking screening and testing procedures using IT tools. Such tools enable early detection of disease, speed, cost-effectiveness, simplicity, risk management and ease of recording (Mitchell, 2014).
Thirdly, the systems uphold medical ethics such as patient confidentiality. These ethics are desirable and make the innovative approaches of HPMG replicable in 2014. Regarding communication, HPMG employs secure channels between patients and physicians. RelayHealth, a system that facilitates and encourages improved interaction between patients and physicians. Clinicians send messages to patients via secure internet links (Emswiler & Nichols, 2009). Physicians answer queries, send test results or remind patients of appointments through this tool. Patients can reschedule appointments or make new ones using the method. Further, HPMG maintains patient records in secure online databases that are encrypted for security. These security measures ensure that patient records are safe and cannot be compromised in any way. According to Price (2015), the ethical code of confidentiality ensures that a patient can trust their health care provider not to reveal any information that the patient has provided to get cured (Price, 2015). This high level of security will encourage replication of EMRs as innovative approaches in 2014.
Contribution of Financial Incentives to Overall Healthcare Quality
Financial incentives for physicians do contribute to improved quality of health care. Not only are physicians more motivated by better pay to become better caregivers, but also they are encouraged to meet the targets that they must achieve to receive those incentives (Peabody et al., 2011). HPMG participates in the countrywide Integrated Healthcare Association (IHA) pay-for-performance (P4P) California initiative since it was started in 2002 (Emswiler & Nichols, 2009). Under this initiative, the California health insurance plans provide financial incentives for physicians. These incentives are linked to certain performance measures. HPMG ranks in the group of top performers in healthcare (Emswiler & Nichols, 2009). HPMG adds funds from IHA to its payment structure. HPMG incentivizes its physicians to work harder through a fee-for-service (FFS) structure for payment. The FFS system involves a hybrid compensation formula whereby the physicians receive different percentages of the components of quality based on their predetermined importance to the overall agenda of health care quality. HPMG employs a Population Management Fund (PMF) (Emswiler & Nichols, 2009). The PMF is a system through which physicians are paid based on utilization, performance, clinical performance, participation and performance. Utilization performance is a measure of how well the individual physician utilizes resources. Clinical performance is a measure of the individual physicians’ screening of cancer, management of diabetes, management of low back pain, and childhood immunizations. Participation performance is a measure of the individual physician’s extent of involvement with HPMG’s programs and initiatives (Emswiler & Nichols, 2009). These performance measures have a considerable bearing on the level of healthcare quality to which an individual physician contributes. By incentivizing high performance in these individual measures, HPMG undoubtedly incentivizes overall quality improvement. It is apparent that this incentive has improved health care quality because HPMG is ranked highly in the country. Also, from the diabetes data, it is clear that there is a gradual improvement in health care delivery between the years 2005 to 2007.
Early Lessons to be Learnt
There are several early lessons to be learned from the experiences of HPMG that the federal government may apply to the design or modification of programs and supports to foster, replicate, and enlarge comprehensive health care reform. The first lesson is to earn doctor trust (Emswiler & Nichols, 2009). HPMG has discovered that solving small problems such through prompt payment of physicians and improving communication channels goes a long way in the overall objective of improving healthcare quality. Improvement of doctor satisfaction improves motivation as well. Once doctor trust has been earned, physicians are more open to organizational initiatives that rely on physician performance data to pinpoint areas for improvement. Good working relationships between institutions and their physicians are the foundations for desirable change that can make a considerable difference in patients’ lives.
Another early lesson that may be extracted from HPMG’s model of operation is that their approach is easy to replicate effectively. The model that HPMG employs allows for coordinated care that is not only efficient, but also affordable (Emswiler & Nichols, 2009). Further, HPMG has a formidable for-profit management consulting that underpins the medical group exclusively (Emswiler & Nichols, 2009). This approach focuses on leading from within. Small organized physician groups that want to be more organized may consider HPMG’s successful use of autonomy and management.
Thirdly, HPMG teaches aspiring physician groups to be bold but smart. In this context, being bold involves using daring approaches to solve problems (Emswiler & Nichols, 2009). However, such approaches must be underpinned by proper research and sound thinking. HPMG stands apart from other similar organizations because it is bold. For example, paying physicians for performance is a bold, innovative strategy that is unique. Unlike the common compensation schemes, Hill Physicians stand to make significantly more than their counterparts in similar schemes by complying with quality initiatives (Emswiler & Nichols, 2009). The element of being smart arises from the fact that the staff members at HPMG are wise enough to avoid overwhelming themselves or moving faster than their member physicians who are the most reform-minded.
The fourth lesson is that it is possible to manage physicians. Despite the fact that physicians in the United States have largely resisted the attempt to be enforced under non-physician control, HPMG has proven that physicians can be managed while maintaining their autonomy (Emswiler & Nichols, 2009). HPMG has shown that physician autonomy can be fostered amongst physicians while the same physicians collaborate amongst themselves and with non-physicians to achieve focus goals and improve quality. There are some tools that HPMG has introduced to this end. HPMG’s leaders visit physician offices to show that information technology is user-friendly and scalable. Financial assistance, as well as the building of trust, is very necessary in this regard. Physicians have to feel that their well being is catered for by the management efforts that are in place (Emswiler & Nichols, 2009).
The fifth lesson that one can learn from HPMG is that a system of incentives can improve health care quality considerably in the short-term as well as long-term. HPMG fosters a culture of cooperation and communication. They also employ “sticks and carrots” to foster quality improvement. “Sticks” are equated to the population management fund (PMF) (Emswiler & Nichols, 2009). Physicians who do not comply to the pay-for-performance or attend the quarterly meetings have to forfeit some money. Similarly, those who do not offer the best level of quality care also have to forfeit some of their pay.
Sixth, cultural changes must also be fostered along the financial changes. HPMG realizes that financial incentives are not the only reason why physicians would be willing to change. Money is not always the biggest hurdle to change. Sometimes, culture can be the greatest hindrance to change (Emswiler & Nichols, 2009). Institutions must inculcate a willingness to change in the physicians. Adoption of IT tools such as EMRs should be encouraged through proper training towards a comprehensive culture change within institutions. This approach will lead physicians to have a willingness to change for the betterment of healthcare quality.
References
Emswiler, T. & Nichols, L. (2009). Hill Physicians Medical Group: Independent Physicians Working to Improve Quality and Reduce Costs. New America Foundation, 2(3), 1-14.
Mitchell, T. (2014). Periodontal Screening and Recording: Early Detection of Periodontal Diseases. Dentalcare, 1(2), 1-9.
Peabody, J., Shimkhada, R., Quimbo, S., Florentino, J., Bacate, M., McCulloch, C., & Solon, O. (2011). Financial Incentives And Measurement Improved Physicians' Quality Of Care In The Philippines.Health Affairs, 30(4), 773-781. http://dx.doi.org/10.1377/hlthaff.2009.0782
Price, B. (2015). Respecting patient confidentiality. Nursing Standard, 29(22), 50-57. http://dx.doi.org/10.7748/ns.29.22.50.e9579
