Successful physician partnering in a rapidly changing healthcare environment.

I am very pleased to write this commentary for two reasons. One reason is that the Baylor Health Care System (BHCS) and I personally have been participants in the Center for Health Management Research directed by Dr. Howard Zuckerman, as well as the Center for Organized Delivery Systems directed by Dr. Stephen Shortell, for the past five years. The other is that the main theme of this article-physician partnering-is a major strategy being used by BHCS in its effort to become a sustainable integrated delivery system (IDS). Much of the information and research shared by Dr. Zuckerman et al. in this article parallels the findings and conclusions that BHCS has drawn in adopting specific strategies to best align our physician partners with the healthcare system. Therefore, this commentary will concentrate on sharing what has been BHCS's approach to physician partnering. While many of the concepts and principles that have been put forth by the author will match BHCS's, strategies for physician partnering still must meet a specific local healthcare market's requirements, particularly the needs of the local physicians who may wish to align with a local healthcare organization or system. By way of background, the Dallas-based Baylor Health Care System, a $1.2 billion not-for-profit corporation, includes nine owned hospitals, one leased facility, five affiliated hospitals and 34 primary care delivery sites. There are 2,467 physicians who have medical staff membership at one or more of the hospitals within the System. The mission of BHCS is "to operate as an integrated healthcare system which exists to serve people as an extension of the Christian ministry of healing by offering a continuum of quality services with a commitment to patient care, medical education, research and community service." Four cornerstones of integration-vertical, horizontal, clinical, and physician integration-have been identified in BHCS's effort to become a fully integrated system. Figure 1 shows these cornerstones in detail. The first of five objectives adopted by BHCS to further development of the IDS model is to create and enhance alliances with physicians. Building on a more than 90-year history of being doctor friendly and a strong commitment to partner with physicians, the system adopted specific guiding principles to achieve this objective: the partnership must be based on shared vision, trust, and communication; there must be meaningful involvement of physicians in management and governance; the partnership must allow for aligned economic incentives, including accepting and managing risk; there must be a mutually beneficial partnership (win-win!); and the ultimate focus must ensure the highest level of quality care for the patient. It was determined that these principles must be continually updated, validated, and shared with all physicians associated with the system. The definition chosen for the System's objective on creating and enhancing alliances with physicians to reflect these guiding principles states that "BHCS and physicians will together design and offer a menu of win-win alliances that enhance trust, strengthen one another and provide increased access to patients throughout the eight-county metropolitan area served by BHCS." The specific strategies that are a part of this objective are to: Personalize BHCS to physicians through coordinated communications that explain physician leadership opportunities and BHCS business strategies while increasing mutual trust. Develop multiple arrangements with 1,400 primary care physicians and extenders. Identify and establish sustainable specialty physician arrangements that align economic and patient care objectives and satisfy market needs. Support physicians in establishing relationships with quality alternative healthcare providers that help meet the needs of customers. Metrics are tied to these strategies, enabling the System to measure its progress in meeting this objective: the actual number of physicians aligned with BHCS; and overall physician satisfaction with BHCS, based on a survey of the System physician partners. …