WellSpan Health, a $2 billion integrated, physician-led health system headquartered in York, Pa., uses a variety of organizational structures to solve the “participatory governance challenge” for their employed physicians. WellSpan’s genesis as an integrated delivery system began in 1993 when a founding group of physicians came to the health system suggesting that a medical group be organized as part of an effort to build an integrated hospital-physician delivery system. At the time, there were still a number of hospitalists and emergency department physicians employed directly by the hospital, and the standard practice of the day would have been to have the system’s hospitals simply add the physicians to their staffs. The founding physicians, however, insisted that a separate medical group be formed under WellSpan’s corporate umbrella, because they did not want to work directly for the hospitals.
Now, some 25 years later, all employed physicians are part of the medical group, which comprises more than half of WellSpan Health’s overall clinical staff of nearly 1,300 physicians. The remaining medical staff is in independent community practice. The medical group’s president is a senior vice president of the health system, reporting to the executive vice president of clinical practice, who also is a physician. And there is a chief medical officer—also a health system vice president—who reports to the medical group’s president.
The medical group and the various clinical service lines are organized as a separate division on a par with the hospital divisions. The WellSpan Medical Group board is split roughly 50-50 between administration and physicians, with a few lay community leaders. The chairman of the medical group board is always a physician, which is seen as an important “symbolic” appointment, so physicians will never feel they are being bossed by nonphysicians. WellSpan Health’s president and CEO also is a physician, as are the executive vice president of clinical services and many of the various service-line executives reporting to him who are responsible for clinical services across the six hospitals, ambulatory and retail services, and post-acute care divisions.
