One of the truly pioneering patient care organizations in the United States is the Billings Clinic, which, though founded in 1917 as a medical group, in 1993 became an integrated delivery system, ,when the existing Billings Clinic, then composed of about 95 physicians, came together under that same name with what was then Deaconess Hospital, located across the street from the clinic in Billings, Montana.
Today, the Billings Clinic organization encompasses the 280-bed inpatient hospital, 11 critical-access hospitals in rural areas surrounding the city of Billings, as well as about five rural clinics in the region; and nearly 300 physicians. What’s more, the organization became nationally known when it joined the Medicare Physician Group Practice Demonstration Project, participating from April 2005 through 2010, along with nine other medical groups. As an important July 2011 report on the demonstration project noted, all ten of the medical groups involved made considerable progress in increasing the efficiency, effectiveness, and care quality of their management of patients with diabetes, congestive heart failure, and coronary artery disease, and in their preventive care efforts.
Indeed, much of what was learned in the PGP demonstration project, says Billings Clinic CEO Nicholas Wolter, M.D., became foundational for the Medicare Shared Savings Program, which Billings Clinic joined as an accountable care organization (ACO) in 2012.
So how did Billings Clinic become a national leader among medical groups? Ultimately, the answer is tied to vision, mission, and culture, says Dr. Wolter. He will be sharing some of his thoughts on those subjects when he gives a keynote address entitled, “Culture, Safety, and Quality: Strategies to Enable IT,” at the Health IT Summit in Seattle, to be held August 19-20 at the Seattle Marriott Waterfront. The Summit is sponsored by the Institute for Health Technology Transformation, or iHT2 (since December 2013, Healthcare Informatics has been in partnership with iHT2 through HCI’s parent company, the Vendome Group, LLC). For further information on the Summit, please click here.
Nicholas Wolter, M.D.
As he prepares to speak at the Summit on August 19, Dr. Wolter spoke with HCI Editor-in-Chief Mark Hagland about the ongoing journey of the Billings Clinic as a pioneering organization in U.S. healthcare, and how culture, vision, and mission have been decisive factors in its success so far. Below are excerpts from that interview.
How did Billings Clinic become such an innovative organization?
Well, the organization in its current form came to be in 1993 when Billings Clinic and a hospital right across the street, Deaconess Hospital, merged. We decided we didn’t want to duplicate services; and that merger led into a several-years-long dialogue about what form the organization should take. So we felt on the board and in the senior leadership that moving in the direction of a Mayo Clinic, Cleveland Clinic, a Virginia Mason Medical Center, would be the direction we wanted to follow. The group practice dated back to 1917. And when I came to the clinic in 1982, there were 55 physicians; and at the time of the merger, we had about 95 physicians in our self-governing organization. Now we’re at just under 300.
For a physician organization, that’s quite large, particularly in your region.
Yes, and the hospital is about 280 beds; we also manage 11 critical access hospitals, and have about five rural clinics in addition to the critical-access hospitals we manage. And as we got through the merger and developed one culture, and had a community board overseeing both the hospital and clinic, we also developed some internal structures, including the leadership council, which is comprised of seven physicians who meet with the senior leadership every month. We take budget requests there, IT requests, and discuss measurements of quality and performance there; the council is very much like an internal board.
In any case, by spending time on culture and by finding ways to be sure that the structure did involve physician leaders in the group practice, that set us up in a good way for the challenges of tackling quality and safety issues, as well as how health IT needs to be applied and embedded—as well as quality, too, because we’re doing a lot of Six Sigma work.
How did you and your colleagues create a physician-led culture of change and transformation?