Interim CEO charts a new course for Yale's clinical practice

Michael Berman, MD, is restructuring YMG to make it a destination for care

Michael A. Berman, MD, interim CEO of Yale’s clinical practice, has already taken steps toward a more centralized way of doing business.

Michael Berman, MD, interim CEO, has been leading a restructuring of the clinical practice since last October, and took responsibility for day-to-day operations early this year.

As president and CEO of a consulting firm, Michael A. Berman Group, Inc., Dr. Berman has spent the last several years working with many major health care organizations. A pediatric cardiologist with a national reputation, he spent the early part of his career as chief of clinical pediatric cardiology for Yale School of Medicine and director of the cardiac catheterization laboratory at Yale-New Haven Hospital.

Dr. Berman later served as chairman of pediatrics and president of the faculty practice plan at the University of Maryland. He went on to New York, where he was responsible for the merger of The New York Hospital and The Presbyterian Hospital to form New York Presbyterian Hospital, where he served as executive vice president and director.

This summer, Dr. Berman made significant strides toward charting an exciting new course for Yale's clinical practice, which will soon have a new brand name: Yale Physicians, under the umbrella of Yale Medicine, along with the Yale Center for Clinical Investigation and possibly other clinical organizations.

He answered questions about the future of the practice.

What is your vision for Yale's clinical practice?

Our goal is to make Yale a destination for clinical care—a place where anyone would feel confident bringing their loved ones and where anyone who works in health care in Connecticut wants to work. That means we need to provide the highest quality of service in addition to being a leader in advancing medicine. We want to be better known—locally, regionally, nationally and internationally. Yale School of Medicine is already well known for its teaching and for having absolute cutting-edge research, but we are not known as well for clinical care, and that's what we want to change.

How is health care reform driving the clinical practice toward change?

It's pushing us to prepare for the challenges that lie ahead. It helps that we've had incredible growth: Our full-time clinical faculty has increased by more than 50 percent in the last decade, and clinical revenues have nearly doubled. We will continue to be a leader in caring for the sickest patients, but we also want to be known for preventive care. Providing this breadth of care has actually been a trend for many years, but now reform is forcing all physicians and health care centers to come together to manage all of these populations.

How will we accomplish this?

There are three drivers that I believe are critical in the current environment. Quality, including excellence in service, is the number one driver. Access is second, and that doesn't just mean making sure it's easy for patients to see our doctors, it also means communicating with our patients and our referring physicians. We are redesigning our website to create a useful portal that makes it easy to find a physician, a program or a clinical trial. Eventually, we want to build in functionality that allows a patient to make an appointment without having to go through 10 different steps. 

Thirdly, we must be financially sound. We know that we are soon going to be reimbursed less than we are now. So the question becomes how to do things efficiently in a streamlined way. This could be as simple as not scheduling all of our patients at 9 a.m., but spreading them out. The patient is at the center of everything we are trying to do or improve.

Do you see a new structure for the practice?

Right now we have 19 individual clinical departments, each going in their own direction without real accountability or real strategic planning. We need to restructure our practice to make it more centralized, transparent and unified. This doesn't mean the clinical practice will take over the departments. Our physicians must have a meaningful say in the direction we are going. Each one of our physicians knows more about his or her individual field than any administrator or leader. But care today is delivered across department lines, so we also need to have a more organized approach. Each of our departments must function as part of a larger whole, with no weak links.

We are looking at everything we can do to create a better operating environment. One thing we have done already was to put new metrics in place that people here are beginning to use, so that we can be strategic rather than anecdotal and reactive. If a doctor wants to open an office in Fairfield County, he or she can do it based on real data about the potential patient population there. We're making changes that couldn't be done individually, but when implemented collectively, will have a profound impact on the practice.

How do you see our relationship with YNHH evolving?

The school's partnership with Yale-New Haven Hospital (YNHH) is growing stronger. Much of our robust growth has been driven by joint initiatives and increased collaboration, and that includes the Epic electronic health record. We don't always have to be exactly on the same page right now, but we do need to be going in the same direction. Strategic planning and business practices for both organizations will become increasingly more aligned. For example, instead of having two calendars and two data efforts, we will be on the same calendar and use identical data sets as the hospital. These things take time, but over the next few years, you will notice a major shift toward a closer relationship with the hospital.

Can you tell us about your eight workgroups?

We established eight workgroups as an opportunity for engagement, as a way of empowering physicians and employees to work together to set goals and objectives. I felt strongly that if our chairs and leadership put their heads together they could make real changes. Chairs and physicians chose the topics, which include marketing and communications, practice standards and others. These groups met through the summer, and some of them are ready to report the results of their work. Our revenue cycle workgroup will keep going—we've already found $12 million to $15 million that we can recoup each year to pay for infrastructure. When we realize results like this and match this with results of similar initiatives at YNHH, I predict we will be a step closer toward having a more powerful medical center.

How was our new name chosen and how do we plan to market it?

When you travel, people talk about Harvard, Columbia, Johns Hopkins and Yale, and sometimes other centers. We want to highlight the Yale name because Yale is our strength. Yale Medicine encompasses everything that we have that goes into caring for patients. It may take some work on our part before people recognize the name Yale Physicians, but that is less important than the fact that what we are marketing are our physicians and specialties. Yale Physicians will be the glue that holds us together.

What qualities are we looking for in a leader and how close are we to hiring one?

We want a physician who is committed to academic medicine to serve as a full-time leader and steer our group toward a more centralized way of doing business. We're not going to be satisfied with someone just because they have an MBA. They must also have an appreciation for the research and teaching that make Yale unique. Preferably we'd like someone who has done this work before. Over the course of the next two months, we expect to have interviewed a total of five candidates, and we hope to make a decision soon.

Some people are describing all of this as a cultural change.

It's taken more than 200 years to create the Yale we know today. It's not going to change overnight. And we don't want to be the Mayo Clinic. We don't want to be the number one clinical care provider at the expense of our reputation for research. But it is time for a shift. If you have a workforce that believes this is the place to work and the best place to receive care, things will get better rapidly. Productivity improves, because we take away a lot of the noise, the duplication and triplication. People go home and say I did something useful today. If we put a new emphasis on all things clinical, it will change the culture.