Leadership

Manage for Population Health or Volume — Not Both

Article · March 24, 2017

A strong health care center or system requires its leaders to demonstrate financial stewardship and a solid business case. How should that stewardship be conveyed to direct reports, the board, or others in your organization?

“We can’t hide things. We must be completely transparent,” says Akram Boutros, President and CEO of The MetroHealth System. “At my board retreat earlier this year, I said to them, ‘I’m either going to manage this organization for population health and what’s coming, or I’m going to manage it for volume. You get to choose.’” Boutros told them he couldn’t do both because he did not want to send conflicting messages. He also noted that although MetroHealth had been doing well financially, they would likely lose money over the next couple of years. Despite this, the board agreed to focus on reducing MetroHealth’s readmission rate — which dropped by 2,000.

“That’s $18 million that we’re not going to recapture every year from this point on,” says Boutros. “When we talk about our financial stewardship, we ask our executives if they’re doing the right thing. And if they’re doing the right thing, we think there’s a cost that we can bear sometimes in moving through that transition.”

“Our goal is to align our overall strategy with our future financial success,” adds University of Utah Health Care CEO Vivian Lee. “All of us, whether we’re on the clinical side of the enterprise or the academic, are interested in the financial success of our hospitals and clinics.” University of Utah has made an effective case for this, notes Lee. For example, the organization’s patient satisfaction efforts have led to significant growth in referrals, network development, and regional hospital partnerships, and the organization’s annual growth is higher than ever — everyone wants a great patient experience.

“That word of mouth, the reputation that disseminates, is incredibly powerful for driving volume,” says Lee. “At the same time, a lot of times we struggle with the potential downstream impact of cost management.” If you’re monitoring costs and no one orders MRIs, for example, what will happen to your radiologists? “It’s not perfect in every regard,” she acknowledges, “but there can be good alignment between financial benefit and what we’re trying to do to transform health care.”

Watch the video:

From the NEJM Catalyst event Leadership: Translating Challenge to Success at Mayo Clinic, June 2, 2016.

Call for submissions:

Now inviting expert articles, longform articles, and case studies for peer review

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Leadership
Comparison of EHR Use Measures by Physician Gender

Differences in Ambulatory EHR Use Patterns for Male vs. Female Physicians

UCSF Health found that women providers spent more time in the EHR and documented longer notes on a per-wRVU basis, possibly contributing to greater burnout.

Fiscus01_pullquote - humanizing physician performance review

Humanizing the Annual Physician Performance Review

Transforming the review process from a punitive, deflating experience to a valuable one that strengthens the relationship between physician and organization.

People Believe Strongly That Leadership Can Be Taught

Leadership Survey: Leadership Skills Are Teachable and Vital

Leadership is teachable, and leadership development and training are important, according to our survey on the topic. Yet the same survey reveals that more than half of respondents think their organizations’ efforts to develop and train leaders are lacking in quality and time commitment.

A Preliminary Model of Determinants and Consequences of Unhurried Conversations with Patients

Careful and Kind Care Requires Unhurried Conversations

Health care providers must have time to know their patients in “high definition” to best meet their needs.

From the Commonwealth to Obamacare: Reflections on 10+ Years of Expanding Health Insurance Coverage

The former Executive Director of the Commonwealth Health Insurance Connector — a model for the Affordable Care Act and other state marketplaces — reflects on what worked, what didn’t, and what could be done differently in both Massachusetts and at the federal level.

Time Spent Engaging Directly with 16 Camden RESET Participants or Coordinating Care on Their Behalf

“Putting All the Pieces Back”: Lessons from a Health Care–Led Jail Reentry Pilot

The Camden Coalition’s jail-based reentry program illuminated the necessity and challenges of engaging people with complex health and social needs and helping to transform the systems that serve them.

Sands01_pullquote clinical research partnership for learning health care

Real-World Advice for Generating Real-World Evidence

If envisioned and implemented properly, a partnership between clinical delivery systems and clinical research programs can get us closer to the goal of achieving learning within the care continuum and discovering evidence that is available when it is needed.

The Largest Share of Organizations Do Not Have a Formal Strategy for Clinician Engagement

Leadership Survey: Why Clinicians Are Not Engaged, and What Leaders Must Do About It

Clinician engagement is vital for improving clinical quality and patient satisfaction, as well as the job satisfaction of clinicians themselves. Yet nearly half of health care organizations are not very effective or not at all effective at clinician engagement.

Rowe01_pullquote - clinician well-being - fighting clinician burnout and creating culture of wellness takes all stakeholders

Defending the Term “Burnout”: A Useful Tool in the Quest to Ease Clinician Suffering

Health care leaders must take a preemptive approach to clinician well-being that is supported by all stakeholders and prioritized on an equal footing with essential clinical and financial measures.

Screenshot from the NewYork Quality Care Chronic Condition Dashboard

Success in a Hospital-Integrated Accountable Care Organization

How NewYork Quality Care achieved shared savings — by strengthening collaboration, enhancing care management with telehealth, and transparently sharing performance data.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Leading Teams

174 Articles

Humanizing the Annual Physician Performance Review

Transforming the review process from a punitive, deflating experience to a valuable one that strengthens…

Physician Burnout

54 Articles

Differences in Ambulatory EHR Use Patterns…

UCSF Health found that women providers spent more time in the EHR and documented longer…

Team Care

112 Articles

Humanizing the Annual Physician Performance Review

Transforming the review process from a punitive, deflating experience to a valuable one that strengthens…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now