A health system that is scaled can support services and initiatives that individual organizations cannot. 规模经济使系统能够在更大的收入基础上分摊开销, 战略性地利用资源和配置资金, 并在更动态的合同模式中取得成功.
Healthcare executives and hospital boards across the country are realizing that they must build greater scale within their organizations if they want to remain competitive. Yet many healthcare leaders are still trying to determine how exactly to achieve the desired scale.
凯文·福斯特是心电图医疗保健-旧金山实践的领导者, and his 15-plus-year consulting career has emphasized hospital strategic planning and business development, 云顶集团40011官网/医院关系, 对医疗集团/云顶集团40011官网网络进行详细的财务和业务评估. As healthcare organizations attempt to position themselves to deliver care in a value-based environment, their leaders engage Kevin to address key issues related to scale and strategic positioning, 从收购/合作到地域扩张.
作为我们正在进行的 系列 关于基于价值的企业的对话, Kevin shares his insights on the advantages of scale and the challenges that health systems encounter as they strive to achieve it.
In the ideal scenario, without any limitations, what does it mean for an organization to be “scaled”?
It means the organization is large enough to provide distinct or significant performance advantages. 我认为这些优势体现在几个方面. 获得资金是最常见的. 然而, 鉴于向以价值为基础的护理的转变及其相关影响, 获得人才和基础设施可能更为重要. 如果规模足够大, organizations can realize unit cost advantages that can significantly impact the bottom line. Then just the depth and breadth of service line offerings that a larger organization can have versus a smaller one. 让我们面对现实吧, 成功的组织需要能够使云顶集团合理化, 那些有规模的公司会更容易做到这一点.
很明显, 并不是每个组织都做到了这一点, 许多人在到达那里之前还有很多工作要做. 那么从更实际、更现实的角度来看,这是什么样子的呢?
组织正在建立一个护理系统和云顶集团系统, 这些云顶集团可能是临床的也可能是非临床的. 在大多数情况下,重点是在非临床方面. But they’re putting together a system of support services that start to look scaled or are starting to get to some of the benefits we noted above, 比如基础设施, 人力资本, 单位成本优势. 他们注意到有形的价值,因为它允许他们, 在很大程度上, 降低成本,降低成本, 哪个在增加价值方程.
I think the next step is organizations starting to put in place a system of care that differentiates them. 在很多方面, 规模较小的云顶集团40011官网可能具有早期优势, as it may be easier to implement care protocols and eliminate waste and unwarranted clinical variation over a smaller number of providers. 然而,这需要资源,并且通常需要规模来负担这些资源. Most systems are at the tip of the iceberg when it comes to creating a scaled system of care. Some of the long-standing HMOs and risk-bearing provider groups are pretty far down the path, 但总的来说, 这个行业仍然非常分散,没有意识到规模的好处.
什么系统在这方面做得很好?
一些较大的营利性组织在支持方面做得很好, 但他们在临床方面有巨大的机会. 非营利组织也在效仿, with more and more centralization of support services and greater “systemization” in general, 但是再一次, 这个行业在这方面仍然落后.
在你见过的客户或你知道的组织中:1-10分, 1 .完全独立, 10是最大的规模), 他们实现规模经济的平均水平是多少?
I think there are very few organizations that are at a size where they’re really getting a considerable difference or significant performance advantages because of their scale. 我想说大多数组织都在2到3之间.
从临床角度来看,规模化系统的优势是什么?
一致的结果. 他们可以发展出更大的深度, 更大的专业知识, 以及经验的增加,因为他们做了更多相同的事情. 大多数研究表明,这可以降低成本,取得更好的效果, 因为你一直在应用最佳实践, 循证医学, and clinical protocols across an organization as opposed to being siloed and doing it differently in each location.
一个规模化的系统能享受到什么样的财务优势呢?
当然是获得资本的途径. But also unit cost advantages and operating efficiencies in being able to spread fixed costs across a larger footprint. 规模较大的组织也可以更好地利用劳动力资源. 你不会受到体积变化和波动的影响, 因为你可以在更广泛的基础上协调你的人力资源.
当我们谈论规模时,通常是指云顶集团40011官网. 这是否适用于小型企业? 比如说,社区医院? 医疗集团?
对于一家社区医院来说,我绝对认为这是密切相关的. 他们将继续处于财政困境, 操作, 合规压力, 规模当然是他们解决这些问题的一种方式. They’re also under pressure from their communities to provide a depth of services and at a reasonable cost basis, 规模是他们解决这些问题的一种方式. 这通常是社区医院寻求与更大系统联系的推动力.
医疗集团方面也是如此, 我认为市场表明规模很重要, 你可以看到,小型的个人诊所不断减少,变成更大的诊所, 独立的医疗团体或雇佣的云顶集团40011官网网络, and they’re absolutely doing that for many of the reasons we mentioned around the advantages of scale – the cost advantages, 基础设施和建设基础设施的能力, 应对日益复杂的云顶集团40011官网所需要的人才. 我认为这在云顶集团40011官网方面比在医院方面更为明显. 购买者希望简化他们的决策, and we’ve seen instances where even good-sized medical groups – in the 50- to 100-physician range – have been shut out of narrow networks.
如果你是一个系统,你的处理方式和医疗集团有什么不同?
无论在哪个组织,都有一个相同的流程, 但考虑的因素开始有点不同. In a medical group they’re going to be evaluating more of the direct or specific financial implications to the individual shareholders or the individual physicians, whereas a health system’s going to be looking at the overall financial stability of the organization and their ability to provide services to the community. 他们都必须处理真实的或感知的控制问题, 关于他们如何达到这个规模,同时保持他们期望的自治水平.
What are some of the common roadblocks that organizations might encounter when they’re looking to achieve scale via alignment or integration?
我认为对于较小的组织来说,一个关注的问题是领导层的支持. 领导们担心他们在一个更大的组织中的位置. They may fear loss of the influence they enjoy in a smaller organization, or even losing their job. 另一个障碍是董事会层面的控制权丧失. 社区医院给当地带来了巨大的自豪感. 董事会担心维护社区资产是合理的. 但必须考虑到所有的问题, it’s equally important to judge what the benefits might be; how the community could be better off.
但还有另一个障碍,我打个比方. 想想25年前的银行业吧. 无论你住在哪里,附近都有很多当地银行. 现在当地的银行非常少——它们都是少数几家大型全国性连锁银行的一部分. I think one of the barriers in healthcare is that we haven’t quite gotten to the burning platform, 从财政压力的角度来看, 推动大规模的努力, 就像你在银行业看到的那样, 如果你不是一个更大系统的一部分,那么你现在在哪里很难竞争. And certainly some of the implications of the ACA have moved in the direction of scale being important in terms of ability to manage a population, 承担风险, 并支持实现价值所需的基础设施. But there’s still enough money flowing through the system that smaller organizations are surviving; they may not be thriving, 但是他们活了下来, 这是一种障碍, 因为原地不动比改变容易.
如果没有实现规模经济,系统会遇到什么风险?
别误会我, there are and will continue to be successful health systems and hospitals that are relatively small. 但平均而言,我认为规模在未来几年将变得更加重要. Without scale, organizations will struggle to meet the downward financial pressure that is mounting. Scale will be an important strategy to drive value and meet both employer and consumer demands.
“规模”与价值导向型企业的其他支柱有何关系?
规模需要更大 响应性因为随着规模和资源的增加,管理结构也会变得更加复杂. Some of the large organizations we work with have developed intricate organizational structures with system, 区域, 当地的, 以及矩阵资源来帮助他们理解这一切. 其中一些人可能觉得他们一生都在开会, but these systems are also able to do things like introduce new clinical protocols much more easily. 它还允许更大的合理化, 因为在一个非常小的组织里很难找到合理的方法. So what happens in our system is that we have five independent organizations in a community, 都想成为所有人的一切. 随着规模的扩大, 当我们更加融合, 您可以根据最小有效规模对云顶集团进行合理化. 信息获取的作用越来越大. Scaled organizations have the infrastructure to both capture and decipher or use this information, 以及更容易地识别内部最佳实践. 简而言之,规模较大的组织可以获得更多信息. Similarly, scaling also sets the stage for greater integration, both clinically and nonclinically.
2015年6月17日出版