title: Evolution of physician-hospital alignment models: a case study of comanagement.
abstract: BACKGROUND
  Recently, quality, financial, and regulatory demands have driven physicians to seek alignment opportunities with hospitals. The motivation for alignment on the part of physicians and hospitals is now accelerating because the new paradigm under healthcare reform requires an increased focus on improving quality, cost, and efficiency.
  
  
  OBJECTIVE
  We (1) identify the key drivers for physician-hospital alignment models; (2) summarize comanagement as a physician-hospital alignment model; and (3) explore a detailed case study of comanagement as an option to better align physicians with hospital goals on quality, safety, and outcomes.
  
  
  METHODS
  A Medline abstract review was performed that identified 45 references that discuss options for physician-hospital alignment. None of the articles identified provide a detailed example of successful alignment structures. A detailed case study of a successful comanagement alignment program is reviewed.
  
  
  RESULTS
  The key drivers for alignment are inpatient growth rates, declining reimbursements, and the opportunity to improve quality, decrease costs, and increase efficiency. Two general strategies of alignment involve noneconomic and/or economic integration. In our example, comanagement with economic integration was chosen as the preferred structure for physician-hospital alignment.
  
  
  CONCLUSIONS
  The choice of structure will vary depending on the existing relationships and governance of the hospital and the physicians in the targeted area of focus. The measure of success in building physician-hospital alignment is measured in improvements in care for the patient, reduced cost of care delivery, and improved relations between physicians and hospital leadership.
authors.affiliation: Duke University Hospital, Durham, NC 27710, USA.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Sowers
authors.forename: Paul R
authors.initials: PR
authors.lastname: Newman
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Langdon
mesh_terms: D003299:Cooperative Behavior; D003365:Costs and Cost Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D017598:Efficiency, Organizational; D017048:Health Care Costs; D006739:Hospital Administration / Q000379:methods*; D018578:Hospital-Physician Relations; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D007349:Insurance, Health, Reimbursement; D017146:Models, Organizational; D015279:Organizational Culture; D011357:Product Line Management; D011787:Quality of Health Care