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Clinical Co-Management: The Right Physician Leadership Model?

July 28, 2011

Physicians are neither trained, nor chosen, for their leadership skills.  Certainly, there are strong physician leaders, but finding them is more often the result of happenstance, than of careful selection and development.

Rather than assessing and developing physician leadership skills, hospitals often get enamored with a leadership “model.”  This is especially true with the Clinical Co-Management (“CCM”) concept.  It is sometimes presented as an alternative to an Accountable Care Organization, or as an alternative to physician employment.  Beware consultants who pitch CCM as THE solution.  (“When the only tool you have is a hammer, everything looks like a nail.”)

What is a CCM? The hospital contracts with an entity (usually a joint venture formed by the hospital and a group of physicians) to manage a defined portion of hospital operations.  (The orthopaedic service line, for instance).  The CCM entity is paid a fee for administrative/management/leadership responsibilities, plus performance bonuses. 

The Benefit? A high level of alignment with physicians as they are responsible for program success.  There is generally an exclusivity component as the entity is restricted from providing similar services for another hospital.

Sounds appealing but consider:

    • This is a significant and potentially expensive business venture.  Choose a partner wisely.
    • Have the physicians demonstrated the ability to provide substantive leadership and work closely with the hospital?
    • Are the physicians willing to invest time and energy into the program or are they just looking for passive income?
    • Physicians rarely have program management and leadership experience or expertise:  Do you have a solid program plan in place with clear goals and responsibilities?  Have you committed sufficient hospital resources to support the program? (Don’t expect the physicians to do the leg work of identifying opportunities or goals, running meetings, evaluating data and developing workplans.)  Do you have program management tools in place to track progress?

The CCM model is not overly complex from either a legal or regulatory perspective.  If you find yourself negotiating for months over the “structure” itself, there is a good chance your answers to the questions above weren’t positive.

If it makes sense, it can be a huge success for the hospital, the physicians and for patients.  If you are trying to fit a square peg into a round hole, however, you will likely waste significant time, money and energy with very little return.  It may make sense to start with something less involved – a physician leadership structure that cedes less control but allows physicians to develop leadership skills and a strong collaborative relationship with the hospital.  When you are ready for CCM, make sure you position your physicians for success, and provide them with tools to develop as leaders.

Reducing Turnover in Healthcare

Bryan Warren Bryan Warren is the President of J3 Personica, a consulting, assessment, training, and coaching firm, and a guest blogger for PSI. Bryan is an expert in progressive talent strategies, with a particular focus on leader and physician selection and development.