How Accountability & Engagement Drive Medical Group Performance

In my last post, I examined the vital — and often overlooked — role culture plays in determining a high-performance medical group’s success. While quality scores and other metrics are helpful summaries of results, they are also lag measures. Culture is the real-time, daily driver of medical groups’ performance.

While culture is a complex concept to define, I believe there are four core elements as it relates to medical groups. Having discussed the importance of prioritizing the doctor-patient relationship and fostering transparency, I’ll conclude this series by unpacking accountability and engagement.

Promoting Accountability

Transparency is a necessary condition for the third tenet of a high-performance medical group: accountability. You cannot hold yourself, your peers, or your medical group accountable if relevant information is inaccessible or obscured. In this context, there are three levels of accountability.

Individual

At this level, accountability refers to each physician understanding their contributions and owning their results. Every physician should know the key metrics, incentives, benchmarks, and criteria for measures, such as quality scores and Star Ratings.

Peer-to-Peer

Knowledge of individual performance allows for constructive peer-to-peer discussions and collaboration that ultimately boost overall performance. During these physician-led conversations, high performers can share information, best practices, and actionable insights that help elevate lower performers. For example, physicians may share effective protocols for managing diabetic patients or using automated patient-reported quality data to close care gaps.

Organizational

The medical group itself should contribute to its members’ mental and emotional well-being. Data from the New England Journal of Medicine shows that 82 percent of physicians believe organizations should lead initiatives to combat burnout. As 20 percent of physicians consider leaving their practice and the Surgeon General’s warning of rising burnout, medical groups must safeguard members’ mental health. Group administrators should gather members’ feedback to implement tools and processes that lower stress. These services may include:

• Providing virtual scribe software to alleviate documentation burden
• Contracting with a management services organization (MSO) to offload day-to-day tasks
• Hiring population health facilitators to assist physicians in the transition to value-based care
• Groups should also explore physician leadership roles and training. Cultivating leadership can also spur engagement, which supports a group’s sustainability and long-term performance.

Enhancing Engagement

What do transparency, accountability, and the doctor-patient relationship all have in common? Engagement. According to a comprehensive concept analysis published in the Journal of Healthcare Leadership, physician engagement involves empowering physicians to:

• Decide how work is done
• Make suggestions for improvement
• Set goals
• Participate in planning
• Monitor their performance at all levels: patient, organization, and system

The main theme underlying these components is balancing autonomy and involvement. Medical groups should preserve physicians’ ability to operate their practices as they see fit. Staffing decisions, practice operations, clinical schedules, and patient volume are wholly within each physician’s purview. At the same time, medical groups should engage their physicians in strategic decision-making, such as hiring administrative staff, payer contracting, and patient care. Giving physician members a say in the medical group’s operations builds the buy-in needed to thrive amid challenges and changes.

To see what this looks like in practice, let’s dig into payer contracting. Medical groups can — and should — reduce physicians’ day-to-day work with payers. However, physicians should still be apprised of any potential changes and, better yet, actively involved in negotiation strategy. Having the doctor’s perspective present helps drive realistic incentive measures and targets. This push-and-pull dynamic between payer analytics and real-world physician experience yields mutually beneficial results. Furthermore, this involvement allows physicians to relay upcoming changes to their practice and prepare accordingly. If a value-based contract’s quality or utilization metrics are up-to-date, practices can explore population health features in their electronic health record (EHR), analyze different E/M coding strategies, and dig into risk stratification processes to meet the new needs.

Creating a high-performance culture is no easy task for medical groups. Doing so requires continual support, encouragement, education, and alignment. High-performance medical groups are not merely contractual entities but rather a driving force of physician enablement.

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