Healthcare Executive - September/October 2013 - 72

On Physician Relations

In This Together
Two “masters” of healthcare leadership share
strategies to achieve physician alignment.
Marisa J. Paulson

In 2008 William B. Leaver, FACHE,
began as CEO of Unitypoint Health
(formerly Iowa Health System), headquartered in West Des Moines.
Then, the eight-region system had
700 physicians in nine different
employee groups with nine unique
cultures and infrastructures. Today,
those 700 physicians compose a single physician enterprise.
Christopher D. Van Gorder, FACHE,
has been president and CEO of Scripps
Health in San Diego since 2000. When
he started at Scripps, the health system
was so siloed that hospitals just one and
a half miles away from each other—one
with an integrated physician group
practice, the other a facility of independent physicians—were duplicating
programs. Now, 600 of Scripps’ 2,600
physicians are in an integrated model,
and that number is steadily growing.
Leaver and Van Gorder shared their
strategies for achieving these results
and transitioning from hospitalcentric systems to physician-driven,
patient-centered systems during a
full-house Masters Series session at
the 2013 Congress on Healthcare
Leadership in Chicago.
Create a Roadmap
When Unitypoint began its journey
toward physician integration in 2009,

Healthcare Executive
SEpT/OCT 2013

its board arrived at a couple of conclusions about its future. First, the
external factors: Fee-for-service would
either cease to exist, or be so scaled
down in terms of rates that
Unitypoint would no longer be financially viable in a volume-focused
world, and both employers and the
federal government would be
demanding a solution to fragmented,
episodic-based care. Second, many
Unitypoint primary care physicians
were voicing frustrations about the
volume of patients they needed to see
in order to cover their overhead, pay
their staff and pay themselves. A lot
of them said “I’m thinking about
doing something else,” says Leaver.
“We made a couple determinations in
2009: We said being an expert in feefor-service will no longer be our recipe for success longterm,” he says.
“What we need to be really good at,
and to provide a national solution, is
connecting the dots between the
silos—hospitals, physicians and home
care. The only way we are going to
do that is care coordination.”
Leaver notes care coordination is
impossible without putting physicians at the center. After many
board and stakeholder discussions,
Unitypoint succeeded by implementing a physician-friendly

environment in each of its regions,
creating co-management agreements, and integrating care coordination into primary care and letting
the primary care physician function
as the manager of care.

“Do not underestimate the
cultural shift and the
recognition required by our
leaders to say, ‘You know
what? This is the right thing
to do. I’m going to give up
control; I’m going to give up
some of the power that I
have. But this is the right
thing for us to do to serve
our communities and serve
our state.’”
—William B. Leaver,
FACHE, UnityPoint Health
Leaver adds that an integration road
map is not a “get to point A, then
move on to point B” type of plan.
Unitypoint’s long-term goals are to
align physicians, create value in
terms of care coordination, demonstrate to payors that it can do that
and, ultimately, produce results.
“These are all happening simultaneously,” Leaver says. “They’re all happening at the same time in a
somewhat ambiguous environment.”
Get Executives on Board
Leaver and Van Gorder agree that
the key to effective hospital-physician relationships is convincing

Healthcare Executive - September/October 2013

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