MDNews - Greater Boston

SPECIAL FEATURE The Responsibility for Accountability WHAT BUSINESS CAN THRIVE IF ITS LEADERSHIP AND STRUCTURE ARE FRAGMENTED? YET ONE PHYSICIAN LEADER SAYS THAT'S EXACTLY WHAT THE HEALTHCARE SYSTEM IS — FRAGMENTED. AT A TIME WHEN THE AFFORDABLE CARE ACT IS SHINING LIGHT ON PHYSICIAN AND PATIENT ACCOUNTABILITY, HE SAYS AN INTEGRATED, MULTISPECIALTY, MEDICAL GROUPLED DELIVERY SYSTEM IS THE SOLUTION TO COORDINATED CARE. R a lecturer at the Stanford Graduate School of Business, Executive Director and Chief Executive Officer of The Permanente Medical Group, and Chair of the Council of Accountable Physician Practices (CAPP), says that's what CAPP, an affiliate of the American Medical Group Association, promotes — advancing the development of accountable physician practices and organized delivery systems. At Stanford, Dr. Pearl has explored countless case studies of successful businesses, and he says none of them operates the way the majority of healthcare organizations do. "I can't think of a single business that would structure itself so it's not integrated," Dr. Pearl says. "The healthcare system is left over from the past, and that's why it's under the microscope. It has to evolve toward integration. Health care is changing dramatically for physicians who started practices in the 20th century. We're now in the second decade of the 21st century, and the change that has happened in other industries — retail, finance, travel — is starting to happen in medical practice." OBERT PEARL, MD, The Physician, the Patient or Both? Health care is also under the microscope as the rise of the accountable care organization (ACO) begs the question of with whom the burden of healthcare accountability rests. "It's clear that ACOs won't succeed unless they apply efforts toward 10 | Greater Boston MD NEWS I MDNEWS.COM [fostering] the accountable patient as well as the accountable provider," says Martin Gabica, MD, Chief Medical Officer of Healthwise, a nonprofit patient education organization. "ACOs need to target interventions to different situations, and that requires resources from primary care, patient education, psychology and social intervention. You have to have a multiphasic approach based on the individual's needs." Dr. Pearl lays the responsibility for accountability on patients, physicians and one more stakeholder — government. "It definitely rests with physicians," he says. "Why? Because they have a unique set of knowledge. They went to med school. They did residencies. And they are accorded a level of respect by patients that they have to continue to earn. I take accountability for my patients' health not just when they come see me, not just when I can generate a bill for an encounter in my office. I take that accountability all the time. In fact, if I do my job well, they don't have to come to

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