As new models for dealing with the rising costs of health care emerge, new types of leaders are taking over, with skilled nurses rising to the top.


The national conversation about health care reform focuses relentlessly on cost reduction. While bending the cost curve is extremely important, improving quality is also essential -- but sometimes downplayed -- in today's reform equation. Grappling with quality challenges has attracted a new breed of health care leaders: physician and nurse executives.

Higher quality leads to better outcomes and reduced costs, according to the experts. That's why many organizations are forming Accountable Care Organizations (ACOs), integrated networks of hospitals, clinics, physicians, and other providers held accountable for the quality and cost of care for a specific patient population, such as Medicare beneficiaries. ACOs provide incentives by offering bonuses when providers meet quality standards and keep costs down. For example, providers get paid more for keeping their patients healthy and out of the hospital -- just the opposite of the traditional fee-for-service payment system.

The ACO initiative officially launched this year. Hospitals, physician groups, and payors are scrambling to create their own clinical integrated structures, poised to take advantage of early bonus payments or potential rate increases driven by quality over volume considerations. The Centers for Medicare and Medicaid Services (CMS) estimate that ACOs could save Medicare up to $940 million in the first four years, based on participation levels and successful implementation. However, ACO-style health care remains untested.

As new care models emerge, new types of leader are taking the helm: physician and nurse executives. There has been a major uptick in the number of requests for physicians and nurses who are prepared to lead health systems, academic medical centers, community hospitals, and managed care organizations. According to the executive search database at Witt/Kieffer, there are already 64 physician CEOs leading U.S. health care systems with thousands more in the talent pipeline. They are exchanging their lab coats for a seat in the C-suite, taking advantage of opportunities to lead during the post-reform era.

These new leaders are arriving with strong clinical backgrounds and nuanced perspectives on patient care as well as physician behaviors. They are charged with the enormous task of preparing health care organizations to thrive in this age of quality and cost accountability. Most importantly, based on their clinical credentials and patient care experience, they bring the voice of actual caregivers to the executive offices and board tables where strategic decisions are made.

Among physician executives new titles are emerging, such as chief quality officer and chief clinical integration officer, signifying a strategic move to remake the organization's capacity for seamless delivery of care. Physician executives are tasked with bringing the medical staff and the executive team into full alignment. Physician executives understand how providers think and can encourage the consistent use of best practices throughout the medical staff. To be successful, health care organizations can no longer afford to use the "us" (practitioners) against "them" (administrators) paradigm. They need a combined talent approach that puts the best minds on the field, advancing quality, safety, and cost goals together.

According to Dr. John B. Chessare, president and CEO of the Greater Baltimore Medical Center: "Alignment of the physicians is the first step. Getting them to work together toward a unified goal of doing right by the patient -- and doing well financially -- will be the real trick. Our only hope in making this new world work is to keep calling out the problems in the present system that every patient -- especially those with chronic diseases -- must navigate every day."

So where are these new executives coming from? Their career routes are varied, from private practice and medical affairs offices to nursing leaders who worked their way up the organizational chart. Many of them returned to school to earn MBAs and degrees in finance so they can bring sharpened business skills to their new positions. They speak both clinical and financial languages to help the organization achieve full accountability in quality and safety. In addition to their patient care credentials, today's physician and nurse executives must be fluent in pro forma development, business plans, cost containment, staff productivity, and data mining.

The stakes are high. Beginning in 2013, hospitals' reimbursement for care will be based on documented performance. Health care organizations not meeting national clinical and patient satisfaction benchmarks are likely to see huge declines in Medicare revenue under the new federal Value-based Purchasing Program. Reimbursements to high-performing hospitals will be larger than those to lower performers as CMS uses financial incentives to drive improvements in quality, patient satisfaction, and cost efficiency.

On a personal level, consumers are feeling the impact of these changes. For example, they are now invited to participate in "medical homes" where the physician, hospital, ambulatory services, and other professionals are connected to patients in a less fragmented and more results-focused way. The medical home delivers coordinated care backed by best practices, not test volumes. In turn, patients are expected to actively engage in their own care plans, making lifestyle changes and monitoring their wellness. Nurse navigators have emerged to help patients implement healthy behaviors and remain compliant with medications and therapies.

Distinct models may evolve over time, but these transformations are increasingly directed by physician and nurse executives for better outcomes at a lower cost. That's the new face of health care.

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