Healthcare's New Connector: The Chief Integration Officer (INFOGRAPH)

REPORTING STRUCTURE AND STAFF

In many cases the chief of integration reports to the health system CEO, says Berra, as Fenn does at Baptist Health. Knight, on the other hand, reports to Palmetto Health’s CMO, who reports to the CEO. As executive director of PQHC, he also reports to the board, which reports to the system board of Palmetto Health.

Berra says that many times this role is staffed with a “skeleton crew” of a few direct reports, and many dotted line or indirect reports, which requires the chief integration officer to have good persuasion skills to address concerns on various organizational levels.
“[One of my] goals would be to further develop the culture of these organizations,” says Knight. “I’ve always said you can talk about economic integration, you can talk about clinical integration, but cultural integration trumps all of those things. Like minded physicians develop in a culture that fosters behaviors and vision that we’re looking at together, otherwise we’re not going to be successful. It’s a big change for a lot of physicians.”

Knight has three direct reports that include the vice president of clinical integration, the vice president business operations, and the vice president of clinical affairs for the employed physician network.

Fenn agrees that the integration officer must earn and build trust within the organization to align various physician groups across the healthcare system. “Our employed doctors should be our largest supporters when it comes to why the independent medical staff would want to work collaboratively with the hospital system team,” he says. “If the employed doctors weren’t able to effectively communicate that they thought it was a good idea, then no one else in the medical staff would do it. We spent a good year and a half repositioning and refortifying the relationship with our employed doctors before we started in on the alliance.”

Fenn has 10 direct reports that include the CMO, CIO, the president of medical group; and leaders in managed care contracting, graduate medical education, outpatient services, and quality/case management.

PROFESSIONAL BACKGROUND

Berra says that in interviews she did with about 30 executives with integration-related job titles, many had a relatively long tenure at the organization, worked on both the provider and the payer side of healthcare, had clinical credentials (oftentimes as a nurse leader), and had experience with care management and clinical IT roll-outs.

“You’re definitely looking for someone who has a lot of experience working on administrative teams and administrative initiatives,” says Berra. “There are a lot of nursing positions that have a significant administrative and leadership component to them, so potentially that is why this person is getting pulled. I think it depends on the organization and where this position is living.”

The person in the chief integration role must understand the clinical and business side of healthcare, and Fenn believes that a physician with an MBA would be a good fit. “Some experience in working closely with physicians and organizing the delivery systems of care that achieve real clinical results, but in a way that’s collaborative with the hospital and physician staff,” says Fenn. “I spend a lot of time building consensus with hospital teams and physician teams, and helping lead them to come up with the right answer.”

Knight agrees that the position requires solid clinical background. He is not sure a formal business degree is needed, but rather an understanding of the economics of healthcare and a strong management skill set to get physicians “to march in the same direction.”

FINANCIAL AND CULTURE CHALLENGES

Executives with direct responsibility for transitioning health systems into a risk-based world face some significant challenges, notes Berra. She adds that these leaders are faced with an overwhelming number of projects to complete in a short time frame, and therefore, have to prioritize. “The setting up of this care management platform so that it does the basics of care management, which would [create] some sort of risk segmentation capability and ability to reach out proactively to higher-risk patients and get them into care coordination [programs],” she adds.

Additionally, Berra says that because the chief integration officer and its team is so new, budgetary input, or even having a dedicated budget, is not always clear. Fenn agrees saying that most health systems in the country don’t have the financial wherewithal to pay for the tremendous cost of clinical alignment that necessitates EHRs, health information exchange technology, patient kiosks, and more.

“It’s going to take some ingenuity in the way we construct these contracts with payers and employers that they step up and pay for the infrastructure that could save healthcare dollars and provide a better healthcare product for the patient,” adds Fenn.

Knight says his biggest challenge is to help create that cultural shift for providers in today’s mixed reimbursement environment. “Hospitals and physicians are both providers of healthcare, and I don’t think we need to be in an antagonistic relationship,” says Knight. “I think we should work together, and it will not only help quality of care, but bring down some of the costs [as well].”