Getting Started

10 “musts” for expanding capacity

The following steps will help mobilize your community for the greater good of providing health care to all, including the most vulnerable among us:

  1. Identify patients, hospitals, and physicians. For most organizations, these three elements are the starting points within your community.
  2. Engage a recognized, energized and passionate champion. A highly respected, long-term leader of your cause is critical to carry the torch in your community. A physician champion is even better as he/she can speak to other physicians as peers. 
  3. Write the mission statement based on what you wish to accomplish. For example, consider your future health partners’ mutual area(s) of interest with you. For Doctors Care, partnering with South Denver hospitals and the Arapahoe Medical Society solidified our initial geographic boundaries
  4. Recognize the critical success factor(s). Primary care without specialty care does not provide comprehensive accessible care. For us, initial inclusion of specialty care was a “must have.” Another critical success factor is hospital partnership – local hospitals have to be on board for patients in need of care beyond the doctor’s office. Hospital engagement gives physicians a place to perform surgeries and utilize both inpatient and outpatient services. 
  5. Bring together ancillary services. After identifying the drivers, create partnerships with laboratories, pharmacies, radiologists and anesthesiologists. Later, these will be crucial selling points to getting others involved. 
  6. Initiate a relationship with your local medical society. It has the physical and virtual addresses of physicians, it has board members who are engaged, and it can get the word out quickly. The medical society can offer membership discounts to physicians who join your cause. In return, you can offer them recognition in everything you do to help them grow their membership base. 
  7. Develop patient screening procedures. Who qualifies for the program? Where do they live and what is their financial situation? What is the timeline? What documents are needed by the patient? At Doctors Care, financial criteria are designed to include people whose income is too high to qualify for Medicaid but still live in poverty. A sliding-fee scale is used to determine the patient’s payment percentage responsibility based on financial assets and liabilities.
  8. Use the four P’s of marketing (price, product, place and promotion) rather than rely on the softer sell of public relations.  The accessibility and delivery of health care services (the product) must appeal as worth the exchange of its price. From physicians, you are asking for something in which they will receive abundant value:
    • They will have access to the services of other providers with different specialties, as well as ancillary services for uninsured patients already in their practice. 
    • These patients often transition to private insurance and generally choose to stay with their assigned health care providers. 
    • Physicians have the ultimate say in the number of patients they choose to manage through this program. 
    • Next, the place of care needs to occur where it is easiest for the provider - at their practice or hospital. 
    • And as for promotion, find a volunteer graphic designer to brand your identity. 
    • A final “P” is never underestimate the value of peer pressure.  
  9. Identify key volunteer leadership. Find a service group to adopt your cause. Make physician assignments and help patients navigate the system. Appoint a board of directors based on position, not necessarily interest alone. For example, the executive leadership of Doctors Care’s hospital partners serve on our board. And while these individuals are passionate about improving our community, they are also interested in keeping tabs on what competing hospitals and providers are doing. After all, competition is motivating, even when it comes to charitable care. And with the executive leadership on the board of your organization, the hospital staff will follow. 
  10. Know precisely what you are asking for. You, the champion and volunteer leadership will need to know how to ask for what you need from others to mobilize a larger base. Be specific about what you will achieve together and what their role will be.  For example, hospitals must provide lab, imaging and pharmacy services from the start.

Key Principles

  • Assume everyone is “in.” The founding committee and physician champion of Doctors Care wrote letters to all physicians of the Arapahoe Medical Society in 1988. The letter explained the concept and informed them that they were grandfathered into Doctors Care’s physician network. If they did not want to participate, they were required to opt-out. 
  • Remove the burden of care from community primary care providers. By starting up simultaneously with both primary and specialty care, it is clear that care is shared among providers and specialties.
  • If everyone does a little, no one will have to do a lot. No one physician should be overloaded with the responsibility. Every level of participation by physicians is allowed, but everyone has to do something.
  • Physicians are paid by the patient, not by the organization. Patients pay a percentage of charges to the physician based on the sliding-fee scale. The selling point is that paid services are more highly valued than those which are free. Therefore, patients will be more engaged in their own care.  

Organizational Lessons Learned

In every organizational model, there is room for improvement – and if we had to do it all over again, here is what we would change: 
  • Start with “Yes!” Never let objections get in the way. This includes your own objections, as well as those of others. 
  • Celebrate seemingly small changes. Impacting the life of one person at a time is an enormous achievement.
  • You will always need more space than you anticipated. While Doctors Care has expanded multiple times, it quickly filled its capacity with new staff and new programs each time.
  • Always say “thank you."

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