There is a distinct value
proposition today for independent primary care doctors to become part of larger
practices. With the scale of a larger organization, it is far easier for
primary care physicians to enter into value-based contracts with payors,
allowing them to share in the value they create.
Small, independent practices
lack the size and scale needed to negotiate effective value-based
contracts with payors. By joining forces, primary care physicians can negotiate
contracts that allow them to benefit from the value created by improvements in
clinical quality and clinical efficiency. These value-based contracts are a
main reason behind primary care consolidation.
Value-based healthcare continues to gain momentum as an
economic model that focuses on patient outcomes, aligning providers to deliver
high-quality, lower-cost care. Value-based care differs from the traditional
fee-for-service, a model that compensates for quantity of healthcare and is not
necessarily aligned with quality of healthcare. Only a value-based model
compensates physicians for appropriate healthcare, delivering measurable
improvements in both clinical quality and the total cost of care.
Established practices with a
reputation for high quality are at the center of physician consolidation. An
example is Envision Medical Group, one of our providers in Michigan, which over the past few years has evolved from
multiple small independent practices to an integrated, physician-driven
healthcare enterprise.
As part of a larger group,
primary care practices gain economies in operating efficiencies. Large groups
can tackle technology implementation, such as changing electronic medical
records (EMR) platforms, far more easily than a small practice. Access to
management expertise, specialized consultant talent, and the ability to
withstand interruptions in cash flow allow large groups to invest in the
changes needed to meet a growing and evolving healthcare environment.
Scale and technological competency
are critical in managing large amounts of clinical data. It takes a significant
investment in talent and technology to gain the capabilities to take in data
from multiple and varied sources, normalize it, and produce actionable results.
Without data across the continuum of care, primary care physicians cannot
identify clinical patterns, apply risk stratification to patient populations,
and provide proactive clinical interventions. Uncovering emergency
department (ED) utilization trends, engaging in discharge plans for
hospitalized patients, and implementing aggressive transition care management
can all impact populations of patients.
Timely data in the hands of the
right providers can inform clinical conversations. Team huddles, evaluations of
clinical strengths and weaknesses and conversations with specialists and
ancillary service providers are more productive and better informed by good
data. In our Houston practice, the transition team meets regularly with
local hospitalists to share best practices and identify opportunities for
improvement, all informed by accurate and timely data.
Data drives the identification of
the most efficient and highest-quality specialty and ancillary networks. These
“narrow networks” are critical to delivering value based-results. Clive Fields,
co-founder and Chief Medical Officer of VillageMD, has observed, “Specialists
and ancillaries should earn our business the old-fashioned way, with quality,
access and communication.”
As the economic model of healthcare
continues to evolve, even greater emphasis will be placed on clinical outcomes.
No one is better suited to impact these results than primary care physicians.
Through value-based contracts, primary care physicians can drive improved
outcomes for their patients, the communities they work in, and their own
medical practices.
Paul
Marino is co-founder and Chief Strategy Officer at VillageMD. He recently spoke on a panel at Becker's
17th Annual Future of Spine + the Spine, Orthopedic and Pain Management-Driven
ASC Conference.
https://www.linkedin.com/pulse/how-primary-care-consolidation-helps-drive-paul-martino/
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