Building a Market to Achieve a Vision: Part One

Part One: The Role of Strategic Planning in Patient Care and Physician Engagement

Ths is the first of a two-part series describing how Geisinger Health System links strategic planning with physician recruitment and practice development to build sustainable, community-based healthcare services.

A patient should receive the highestquality care possible. For this to happen, the right scope of clinical services must first be established, and these services are predicated on current and forecasted market volumes and a corresponding business imperative. This is the fundamental rationale behind strategic planning: to understand, develop, and determine geographic placement of the optimum level of services in pursuit of the best possible patient care.

The economic downturn of the past several years forced numerous providers to enact sweeping cuts, which in some cases extended to strategic planning. However, regardless of market conditions, the accelerating evolution of disease management, coupled with healthcare reform changes that will increasingly link outcomes with reimbursement and financial performance, make now the time to reinvest and re-focus on the art and science of strategic planning. These efforts will enable healthcare organizations to better position themselves for success in such an increasingly challenging environment.

Geisinger Health System (GHS) in Danville, Pennsylvania is a physician-led, integrated health services organization that serves 2.3 million residents throughout central and northeastern Pennsylvania. GHS is nationally known for numerous innovations, including evidencebased bundled care (ProvenCare™) and an advanced medical home model that aligns physician incentives with patient outcomes (ProvenHealth Navigator™). Through these and other innovations, GHS’s strategic planning process sets the stage for resource optimization, incentive alignment, and market growth, thereby improving care within our service area.

Strategic Planning Components

There are three basic components to GHS’s strategic planning model. The first, which is led by our chief executive officer, is an enterprise-wide discovery process of discussions with physicians, administrators, and staff that leads to identification and definition of strategic themes and priorities.

The second element of our planning model is a robust market assessment. The strategy and business development team (SBD) surveys, quantifies, and trends specific (external) environmental indicators to identify geographies and corresponding services that optimize GHS’s market position and mission. The assessment also lays the foundation for identifying how best to engage with referring physicians, as well as determining what clinical service opportunities warrant the recruitment and deployment of new, employed medical staff. Further, the market assessment provides direction on how and where to establish and build relationships with other community providers (GHS may be an integrated system but recognizes that it cannot be all things to all people). In order to meet a key system goal of keeping care close to home for patients, the organization has developed a series of hospital-to-hospital relationships, including telemedicine programming and deployment of GHS-employed specialists to do procedures in other institutions.

The combination of strategic priorities and market assessment provides the foundation for the third component of GHS’s strategic planning process: development of a long-range framework by each clinical service line and operating unit that establishes specific tactics, goals, accountabilities, and budget for meeting the system’s four strategic priorities:

  1. Focusing on Quality:
    As momentum builds through healthcare reform to link payment with outcomes, GHS is engineering new, value-based care models. From a strategic planning perspective, development of unique approaches to clinical service delivery is required. This requirement creates additional planning imperatives specific to physician recruitment and clinician utilization, including greater deployment of advanced practitioners to allow physicians to focus on patient engagement and complex clinical decision making.

  2. Driving Innovation:
    GHS is steadfast in its mission to serve the best interests of patients, which includes keeping care close to where they live. Through planning and collaboration with community-based providers, the organization is developing new strategies to optimize care delivery in rural areas, including using telemedicine for quicker and more-efficient specialty access and closing "care gaps" to ensure patients receive optimum care post-discharge, including a variety of health maintenance and patient communication and education activities. In addition, new models of clinical service placement (urgent care centers, community practice sites, and eVisits) are in development.

  3. Managing Growth:
    Keeping care close to home for patients requires an “intelligent growth” strategy, part of which means relationships with community providers. This element of mutual benefit helps offer the best clinical services possible within a defined market (ensuring community needs are met and both GHS and other community providers amicably co-exist). It also creates an environment where new GHS specialists can achieve a quicker “ramp up” by virtue of solid, existing relationships with non-GHS referring physicians.

  4. Building a Legacy:
    From 2009 through 2011, GHS has added 119 physician FTEs. Although the market assessment portion of the planning process provides quantitative justification for hiring new physicians by specialty, the deployment of so many additional physicians requires strategic focus on developing physician leaders, in order to maintain our physician-led, patient-centric culture. In addition, one of our strategic priorities is professional development, which has contributed to new clinical programs that optimize physician skills and passions. Recent examples include development of a brain tumor institute and creation of an epilepsy monitoring unit that links to GHS’s nationally known program for surgical treatment of intractable epilepsy.

Strategic Planning Cycle

The planning process at GHS takes place within one, two, and five-year cycles:

  • Annual Planning:
    Each year, SBD performs an environmental scan of the market. Additional planning activities include completion of a capacity assessment for each acute facility, a system leadership retreat to review performance and strategic priorities, operating and capital budgets, and service line operating plans. Performance reviews specific to the operating plans include monthly service line meetings, and quarterly progress updates (that cover the year’s goals per each of the system’s strategic priorities). This enables ongoing performance assessment and plan adjustments.

  • Two-Year Planning:
    Every other year, SBD completes an in-depth market assessment for each major service line. Additional activities include a review and update of all major service line long-range plans, as well as the system’s financial model.

  • Five-Year Planning:
    In addition to the robust planning activities that take place every two years, on a five-year basis GHS reviews its overall system vision and strategic priorities, which tie into the long-range financial and capital models.

Linking Plans to Performance

To mitigate implementation challenges and shifting market conditions, GHS employs a series of key performance measures and tools to monitor progress and help achieve budget targets. These include “care gap and referral reports” and “new physician ramp-up reviews” to identify opportunities for improving specialty care access in areas where gaps exist (thereby strengthening alignment with community providers) while accelerating development of specific Geisinger practices. These tools also reflect a philosophy that physician productivity and professional fulfillment are linked to delivering the best possible care within our service area, in conjunction with our provider partners.

Lessons and Takeaways

Years of planning and assessing feedback from our community partners have yielded several key lessons:

  • Focusing on the patient is always the best strategy. GHS's planning process and its results over the past several years have validated the notion that improving patient care also drives better financial performance.

  • It is in the best interests of both the patient and the bottom line to employ strategies that increase engagement and collaboration between referring (non-GHS) and employed (GHS) physicians. This creates an environment for optimum patient care and comprehensive yet mutually beneficial market coverage.

  • Link robust market assessments to distilled market intelligence. SBD's assessments and environmental scans synthesize a significant level of demographic, discharge volume, and market trend data into key decision points and recommendations that, in turn, enable senior leadership to make the best-informed decisions possible.

  • Be prepared for some “head scratchers.” The external environment is changing, creating both opportunities and challenges. Change requires analysis and leadership dialogue but also “filtering” and prioritization. Navigation from a world of volume to one of value requires the ability to say “no” to some projects, while realigning resources to experiment on others.

  • Make the most of physicians while also deploying advanced practitioners. GHS invests a significant amount on recruitment, development, and efficient deployment of our employed medical staff. The return is tremendous in terms of community impact, research, and volume. Deploying specific tactics to offload certain tasks from physicians also ensures those physicians are focused on complex decision making and patient relationships, which is central to our vision and ability to serve the care needs of central and northeastern Pennsylvania.

  • Invest in relationships with community providers. Keeping patients close to their homes requires building relationships with other, non-GHS hospitals. These community hospitals benefit by keeping more of their patients and reducing transfers, except for patients who need treatment in one of GHS’s high-level facilities.

A sound strategic planning process is a prerequisite for success. Although change is a constant in health care, the next several years will be as tumultuous as any in memory. In order to maintain performance within the traditional, volume-based environment while migrating to a new world of value-based care, organizations must budget and allocate the resources necessary to deploy an effective market assessment and strategic planning process.

In the future, meeting patient needs will require new care models that align clinical services, quality, and outcomes with financial performance. The organizations that succeed will initiate their journey through a robust planning process. These organizations will enjoy greater engagement and collaboration with referring and employed physicians and partnerships with other providers for optimum patient care delivery.

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