1. Discuss Dr. Spears strengths and areas of opportunity with her leadership style?
2. What should Dr. Spears do to move forward and why?

Case One: Monmouth Regional Medical Group athenahealth Dr. Janice Spears sat at her desk, steeling her resolve for a meeting with Dr. Jack Kane, one of the more vocal, popular and unhappy primary care physicians in her group. Dr. Spears realized she'd overestimated her own popularity among the physicians. When she reviewed operations and strategies with her group she had focused on her ardent supporters, rather than on the small but influential group led by Kane, that quietly-and, at times, begrudgingly-went along with her decisions. As she organized her thoughts for the meeting, Spears reflected on her past 24 months as the CEO of Monmouth Regional Medical Group. When she first started, she was certain that the group's direction included building on its impressive history as the region's first multispecialty group practice and fastest growing medical organization in the area. But at the time of Spears' hiring, the group had been heading down a path of slow and steady financial decline. Adjusted for inflation, Monmouth's profit per physician had dropped each year the previous three years, driven by declining Medicare reimbursement, rising self-pay, deductibles, coinsurance, HSAs and so on. Spears had planned to turn the group around and ready it for the future. Donna Morin, her new CFO, examined the revenue stream and made some quick improvements. She re-contracted with two payers by leveraging the group's size and market clout to achieve small increases in revenue. Working with Spears, Morin had also designed a new physician compensation strategy. Spears implemented the new approach and managed the physicians' reactions, while Morin concentrated on understanding the group's overall cost structure and reducing cost through better staff alignment. The group had also implemented a new EHR, which initially met with some resistance. But with nine months of use under the group's belt, things were looking up. Some of these decisions were difficult and unpopular, but they had proven wise: The group's profit per physician had improved. Spears also reflected on a series of emerging revenue opportunities. While most reimbursement continued to be fee-for-service, and the group had qualified for Meaningful Use payments and recognized Pay-for-Performance incentives as a potential growing revenue source, it was unclear whether administering these programs could result in a positive return. Monmouth also looked for the financial upside that the new shared savings contracts could yield-but this would require some new capabilities and investment, as well as a further shift in how physicians tracked and engaged with patients. Spears and Morin were considering two risk-based payment programs, one around diabetes management and one for CHF patients. At the same time, some of the primary care groups wanted to pursue Medical Home certification and engage around Medical Home contracts. How these programs would work with the specialists, how the incentives would be defined and who would share in savings from reduced hospital, ED, imaging and other care, were all huge question marks. With a wave of changes already behind them, the overall mood at Monmouth was generally positive. The group had moved well beyond the apathy felt several years ago and was past the initial frustrations of its new EHR. Dr. Spears had sold her physicians and staff on the idea of "a new tomorrow," and most believed things would work out as she envisioned. But some physicians in the group were restless. They questioned Spears' leadership, feeling that she athenahealth.com 3