Jeff Tillery: We took the tack to say that we didn’t believe we had bad clinicians. We believed we had bad processes. And so, if we saw outlying performance, it wasn’t about being a bad clinician — doc, APP, nurse, et cetera. It was about what’s different in the environment of that care than in a different environment, and why one practice gets it right, and another does not. That opens yourself up to this continuous performance improvement cycle and a sharing of information that brings your clinicians together.
Matthew Weinstock: That was Dr. Jeff Tillery talking about the importance of fixing flawed processes when looking for ways to redesign care models and improve performance.
Tillery is a family medicine physician by training, but he also served as an executive for a large health system medical group in Illinois before retiring in 2024. With decades of clinical and administrative experience, he now works with health systems and medical groups across the country as they consolidate.
In this episode of the Oliver Wyman Health Podcast, Tillery and Oliver Wyman’s Dan Shellenbarger discuss what it takes to be successful when integrating a medical group into a larger health system. Because of his background, Tillery is able to share perspectives from both the clinician and health system executive sides.
The Oliver Wyman Health Podcast is brought to you by the global management consulting firm Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com.
And now, let’s pick things up with Tillery detailing his background.
Jeff: I’m a family physician by training, of a generation in which I was a family physician who did the full spectrum of care — from delivering babies to office practice, inpatient care, ICU care, nursing home care, et cetera. So, I guess I’ve been around long enough to see a lot of change in the healthcare scene.
I trained here in Illinois and then in the Navy, and I was able to practice at various sites around the world. I came back to Illinois and was in private practice for several years, and then joined a healthcare system during the Clinton administration, when vertical integration was under way.
I was part of that healthcare system’s growth of our medical group, and I watched it grow and mature over the years as well. I ultimately moved into administration, became a chief transformation officer, worked with Dan on some efforts around care model redesign, and ended my career with that health system as the president and CEO of our medical group.
Dan Shellenbarger: That’s great, Jeff. In that time, you saw a lot of change, as you said — from independent practice and being a family doctor delivering babies and providing inpatient care, things that have long since changed, to keep it simple.
During that same period, like many of your peers, you also joined a health system as a provider. That consolidation trend has probably accelerated over the time horizon you just described, to the point where more than 50% of previously independent practices have ended up with health systems, much like the journey you described.
How has that consolidation changed medical practice, caring for patients, and the profession of being a physician?
Jeff: It has changed a lot over those years. In the early days, the target was acquiring and integrating primary care because that was where patients were attributed. Hospitals and healthcare systems were interested in primary care to gain access to the population.
Over time, that began to translate into specialty care, especially as payment models changed and margins started to erode.
With the integration and acquisition of practices, however, there have also been changes, such as a reduction in autonomy in practice. I think it has eroded the sense of ownership inside a practice in some ways.
At the same time, it has introduced access to much-needed technologies. Whether it’s the electronic health record, specialty services, equipment, or other resources, there is stability there, as well as an income that can be counted on.
In the old days, it was perhaps more important to look at whether your schedule was full and how long your waiting list was. The longer your waiting list, the more it suggests that you were in demand, that you were a good doctor, and that things were going well.
Now, we’ve seen that change. The health system is interested in access to care, which means how quickly you can get people in.
All of those dynamics have been in play over the years. They have caused tension, I would say, but there is also stability.
Dan: Given all of that, the root question, I’m sure, is: Where do we go from here?
As you said, we have all sorts of issues and challenges with access. We have reimbursement pressures. The world is changing with respect to insurance coverage. Technology is changing. Now we have AI.
There is no shortage of things continuing to put pressure on care models and the way we think about the practice of medicine.
As you think about all of that — and recognizing that there has always been some undercurrent of change — is now different or is now the same?
Jeff: I think that, at heart, any healthcare professional — physician, advanced practice clinician, nurse — enters this career wanting to do good for people.
Obviously, the environment has changed a lot. But I think the way out, in some regard, is to come back to the core, which is: What is the best way to do good for your community, for the people you serve, and for the population at large?
I think that is when you begin to blend access to the critical resources that a health system can bring to bear with driving value for patients. Value means quality, access, experience, and mindfulness of cost, while empowering those professionals to advance the highest-quality care they can.
Dan: How does that work for providers? How have you seen that play out for your peers when you were still practicing and part of the system?
There are obvious associations we can draw between volume and income, and between volume, workload, and burnout. You spoke about the value of being able to manage across those things.
Talk to us a little about what you see as fulfilling for providers in this day and age, and how some of those things that seem at odds with one another may not be as incompatible as we think — or how they can create a more sustainable and professionally rewarding career.
Jeff: I think the value of being part of something bigger is that it introduces transparency.
While transparency can be viewed as somebody watching you — Big Brother watching — I think what it really allows is the knowledge and awareness that there can be a better way.
It challenges all of us to do better and to drive better outcomes. It also allows for the sharing of the best processes or the best paths to reach those outcomes.
I remember that, in private practice, colleagues — and perhaps myself — lived somewhat in a bubble. You could get into habits, good or bad, and you didn’t know better. You would read the literature and certainly aspire to clinical best practice. However, there were other demands that could prohibit that.
Being part of a larger system allows that transparency to help drive outcomes to a greater level. It gives you access to data that perhaps you would not have had otherwise.
It also gives you a little bit of a spirit of competition. You don’t want to be on the left-hand side of the curve, the outlier in the lowest 25th percentile. Clinicians are inherently competitive by nature. That is part of how they reached the roles they are in today.
There are good parts about being part of something bigger, like a health system, if you build the operating structure appropriately, support clinicians in their needs, and allow them to drive the necessary clinical outcomes.
Dan: That transition to a more transparent paradigm is really important.
Wearing your system-leader hat, how would you advise other systems to go through that transition, knowing that if things have not previously been transparent — if people have been in the bubble, as you described — that first wave of transparency can produce anxiety?
Jeff: Sure. You can move toward greater individual transparency along a progression.
You might start by unblinding data within a practice group, or perhaps blending the outcomes within one group and comparing group to group.
That begins the path toward understanding that there is variation in clinical practice and variation in outcomes. It does not mean there is one singular right or wrong way to do something, by any means. But it invites conversation and exploration of a path to improvement.
As you continue down that path, it opens the door to a much deeper array of individual performance transparency, whether that is clinical performance or practice-level performance involving productivity, panel size, how many resources you have, or other measures.
Those are critical factors, especially as we move deeper into value-based care and risk-based care. They are critical elements to get right for both a health system and a medical group.
Dan: There is often anxiety on the part of leadership that, if they begin to impose change, some of the doctors won’t want to come along and will pick up their toys and leave.
I’m sure there were people who were actively interested and energized by moving down this path, and others who had questions or suspicions.
What are your observations about what it takes to move everybody forward, and what did you realize about how different people perceived that transition?
Jeff: You’re right that health system leadership can become very nervous because they believe they will lose their clinician base.
However, I think that if you begin with a partnership and explain why this is important, it helps. People already have a lot of this data anyway. You are not really hiding as much as you think you are.
If you can use the data in a meaningful way to make improvements and drive group performance together, rather than using it to penalize people, that is going to be crucial.
We took the tack that we did not believe we had bad clinicians. We believed we had bad processes.
If we saw outlying performance, it wasn’t about someone being a bad clinician — doctor, APP, nurse, et cetera. It was about what was different in the environment of that care compared with another environment, and why one practice was getting it right while another was not.
That opens you up to a continuous performance-improvement cycle and a sharing of information that brings clinicians together.
One of my biggest concerns right now is that clinicians are being isolated from each other. We have become very transactional in care. We have created conditions involving isolation of care and multiple handoffs.
I believe there is value in bringing clinicians together, whether it is around defining clinical guidelines, determining how we practice, or reviewing outcomes and how we achieved them.
I think that is another condition of sustainability for medical groups and healthcare systems.
Dan: If you compare the culture from, say, 10 or 15 years ago with the culture when you stepped out of medical group leadership, you obviously went through a transformation that moved in many of the directions you’re describing.
What are the top two or three ways you would say the culture changed within the medical group?
You just alluded to one: becoming more of a team-oriented and transparent environment. In what other ways did the culture shift within your group?
Jeff: I think a big part of it was being personally accountable.
Anyone in the system who saw something took the time and made the effort to be personally accountable and ensure that the right things were done.
Some of that comes down to culture. It gets to the root of the culture of the organization in which you work.
That takes a lot of time and effort, but it is invaluable in driving the best care, creating the best experience, and developing a sense of esprit de corps within the organization and the group — having pride in what you do.
Again, I think that is a retention element for the organization as a whole.
The other important point is that you have to do this as a partnership. That means you have to get to know one another within the organization, and you have to understand people’s goals and aspirations.
You cannot know the goals and aspirations of every person. That is impossible. But at a broad level, you can understand what people aspire to do in both their personal and clinical careers, as well as what they want to achieve collectively as a group.
You then set those goals and challenge people to drive toward them. And, of course, you have to celebrate successes along the way.
Dan: Your comments about culture are very interesting.
How would you advise other systems to measure it? There are engagement scores and things of that nature, but I suspect you would make the case for assessing culture through a variety of observations and measures.
Jeff: People hear the word “culture” and think of this soft, squishy, ill-defined metric or value.
Certainly, you can try to create more objective measures. You can use physician engagement scores or other measures that give you an objective number.
Those are important, and I would not say to ignore them. But there are many other elements that point to a thriving culture.
What is your retention rate? How many people show up in your group? And when I say “show up,” I don’t just mean attending a meeting. I mean, showing up to actually contribute.
I would turn the question around and direct it not only toward the group, but also toward leadership: Have you created a culture in which you invite people to give honest feedback?
That is another crucial element.
When you begin pulling all of these components together — leadership creating the right environment for people to succeed, clinicians wanting to advance into successive leadership roles so they can continue the work, and the organization achieving strong clinical outcomes — you begin to see the culture.
Clinical outcomes are a big part of your culture because it is difficult to achieve great outcomes if you do not have a strong culture.
Dan: When you think about previously independent groups coming together to form what we have so much of today — health system-based medical groups — there is also a transition.
As an independent provider, you are running an independent business, so you focus on productivity and the almighty work RVU.
When you come into a health system, productivity remains important. But as you’ve described throughout this conversation, there are many other things that require attention.
What measures did you pay attention to, and what was that evolution like as you moved from very clear productivity measures to something more diverse and all-encompassing?
Jeff: At the individual level, it is very easy to measure work RVUs, and they can certainly be a double-edged sword.
They can be a sign that people work hard. On the other hand, they do not assure that you are doing the right work or that the right people are doing the right work.
Should an advanced practice clinician or a nurse be doing some of the work? Sometimes, I have seen physicians capture that work because it is easy work to use.
You have to align your incentives, measures, and actual data sets in a way that allows your team to practice and work together most effectively.
It is also very important to have a cross-section of the group come together and help set the goals and outcome metrics.
Certainly, if you have depth in data analytics and predictive analytics, that helps immensely. It brings people together and challenges them to reach a much higher level.
I was very fortunate that, in the organization I was part of, one of the critical success factors was our access to data and analytics. It allowed everyone to come together, and we set system-wide goals against which we measured ourselves.
But it takes years to get there. It is an evolution over time.
You cannot start there with a disparate group of recently acquired individual practices. You have to work toward developing the culture, trust, and transparency. Then, you set the goals together and progressively work to advance and raise those goals over time.
Dan: As you think about leadership within that community over the period in which you went through this transition, what did you see your leaders doing differently from the beginning to the end?
Jeff: Health system leaders might once have had an attitude of, “We employ them. We own them.”
All I can say is that this is the worst attitude to have.
I saw that change over time. The mindset moved from employment and ownership to partnership: How are we collectively going to drive this?
Some of that happened through service-line development, clinical guideline development, quality feedback, performance transparency, and other efforts.
I think that was probably one of the biggest transformations I saw over that period, and it paid dividends in supporting the entire clinical enterprise.
Dan: The coming together has to happen, right?
That was the whole point of beginning this conversation with consolidation: How do the parts come together to create something of greater value?
That is a somewhat poetic way to bookend this conversation — considering how the two sides come together to create greater value for their communities.
Jeff, thank you. This has been terrific. I really appreciate your time and wisdom. Thank you for sharing with us.
Jeff: It has been a pleasure. I hope to do it again.
Matthew: Thank you for listening to the Oliver Wyman Health Podcast. This podcast is brought to you by the global management consulting firm Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com.
This transcript was edited for clarity.
