Stephen DeBiasi has a unique role as Waltham, Mass.-based Northeast Orthopaedic Alliance’s first CEO, and he brings extensive leadership experience in orthopedics.
He has a background with Durham, N.C.-based EmergeOrtho and brings a strong foundation to NOA, a 100% physician-owned management services organization.
He spoke with Becker’s about his plan to strengthen culture and growth plans for the MSO.
Question: What are your three top goals in this role?
Stephen DeBiasi: We’re building the ship as we sail. It’s a one year old merger, so from my standpoint it would be easy for us to chase too many ideas and not really accomplish much at all. The three areas where I’ll initially focus are integrating some of our systems and processes that we need to streamline in order to administratively reduce the complexity and prepare us for the next three to five years. Second is fostering a shared culture of collaboration at all levels within the organization. Third is sustaining the independent clinical decision making of microcultures that exist at the divisional level.
The initial phase of creating the practice involved aggregating independent medical practices together. It was a “walk before you run” approach. I was brought in for the next phase, which is integrating the practice divisions to function more cohesively and efficiently at the local level as well as practice-wide.
Q: Can you dive more into the clinical decisionmaking and independence aspect? How will you approach maintaining physician independence while reconciling with the business needs?
SD: That’s first and foremost in the organization, and that was part of the creation of the organization. We were created as an aggregation and a divisional model where the local decision making can continue to the extent possible. I think that there are ways for us to continue to allow people to operate independently. There’s still local boards for the clinicians to make those decisions at a local level, and we have divisional leadership that’s focused on that.
Q: You’re working with a wide group of physicians and practices. What are some of the cultural and operational steps you take to create cohesion without erasing the individual identities that made each practice successful?
SD: It takes both time and intention. Overall, the collaboration among the leadership teams has been a tremendous advantage, one which will only increase as we move forward. It often looks like sharing best practices across divisions, which fosters a learning environment. However, we have not yet driven that collaboration deep into the organization. To do that, there are some technical collaboration resources we need to put in place. We also need to encourage those conversations. Sure, just like meeting someone for the first time, sometimes the initial interactions are a bit uncomfortable or forced, but over time they develop into close bonds. The individual identities of each practice will remain, but a new shared culture will also emerge organically as the teams work more closely together. We’re fortunate to have a group of physicians serving as board members who have developed strong, trusting relationships with one another. That will serve us well as we work through conflict and as we prioritize certain strategies.
Q: Are there any overlooked aspects when it comes to tackling these discussions about culture?
SD: I think it’s easy for physician groups to think that that culture is soft and not as well defined. Our strategy is we’re going to take advantage of opportunities as they present themselves and be intentional about that strategy and about encouraging collaboration and fostering communication.
Q: What are some of the biggest lessons you learned while working with EmergeOrtho? How will you carry those into this role?
SD: I learned quite a bit in my time with EmergeOrtho, and I think I appreciate now more, the cultural differences between each division and everybody’s readiness for change or even to listen to ideas that we may come up with. Timing is everything, and we land what I learned and relearned over and over again is how true the statement “progress at the pace of trust” is and how it is especially true in physician groups. The leadership team can only push so hard.
There are a few things I’m really proud of that we did with EmergeOrtho, and one was developing the next generation of medical practice leaders, both physicians and non-physicians. In a larger practice, we have the luxury of allowing people to specialize more, to explore their passions, or even to relocate to a different market and still stay with a company they know and trust. I feel certain that we’ll foster a similar culture within NOA. We’ll do that through engaging with employees, openly communicating our plans with our team, and providing opportunities to step up and volunteer on initiatives. In these first few weeks, I’ve been approached by several employees excited to share a new idea or suggestion for improvement.
Before, we weren’t perfect, but we made the hard decisions, for the long-term and moved forward. We would hash things out rather than kick the proverbial can down the road. If a decision turned out suboptimal, we’d quickly regroup and try something else. That iterative process served us well. I have no doubt; we’ll have that same mindset within NOA. It takes trust in others, low ego or pride of authorship, and a willingness to share openly – all things I’ve seen in our NOA leadership team already.
Q: Where do you see the most compelling growth opportunities from geographic expansion to new service lines and strategic partnerships?
SD: If you look at the individual practices that joined to create Northeast Orthopaedic Alliance, each brings slightly different services, affiliations and strategic partnerships. As we look for growth opportunities, I’d first like to see us expand what’s working across our entire footprint whether it’s certain ortho subspecialties, complementary MSK specialties, or ancillary services. Therapy, physiatry, rheumatology, and even clinical research, all come to mind. All of this, of course, is driven by community need and patient preference to have us provide their care. We have locations in multiple states, which naturally brings regulatory complications. And despite being right next door to each other, Massachusetts and New Hampshire could not be more different. In terms of geographic expansion, there are obviously some opportunities we’ll continue to explore. We’ve already tackled the complexity of having a significant presence in two states. Interest in our practice is stronger than we can realistically absorb, so we need to be very deliberate about adding existing practices into NOA. Maintaining and strengthening our strategic partnerships is critical to our success and the communities where we live and care for patients. This is especially true as we work on bundled payment models.
Q: Orthopedics has been a proving ground for bundled payments and episode-based models. How do you see value-based contracting evolving for large orthopedic groups? Where does NOA fit in the larger picture of value-based care?
SD: I’ve been out of orthopedics for a couple years, and it’s evolved a bit, so I’ll be leaning on my colleagues across the country who have more recent experience and expertise.
We see this as a great opportunity for the patients we serve and for the economic viability of private practice. I like to think of our practice as already providing care that is value-based – we’re just currently paid on a fee-for-service basis. We coordinate care with other provider organizations, consider the total cost of care, and we hold ourselves accountable for patient outcomes.
The scale and geographic coverage our group can provide, coupled with strategic partnerships with numerous ASCs, positions us well to execute on value-based contracting when we and a payer are ready. As a relatively new entity, we’ve got some work ahead in continuing to aggregate and analyze our data.
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