With 790 primary care
providers and over 1 million patients, Catalyst Health Network in Plano offers
a counterweight to big hospitals.
By Mitchell Schnurman 6:00 AM on Feb 16, 2020
Major hospital
systems are often blamed for rising health care prices, and not just because
they treat the sickest patients.
As systems grow ever
larger, they gain more leverage with employers and insurers, allowing them to
raise prices and hold on to more health spending. Their growing market power —
and deep pockets — also put more pressure on doctors and independent practices.
Little wonder that
more physicians are working for hospitals and their affiliates, and for
insurers and private equity owners. In 2018, just under 40% of Texas physicians
were in independent practice, down from 60% in 2012.
That’s a troubling
trend because independent docs are generally a better bargain. They charge less
for similar services, have fewer avoidable hospitalizations and lower rates of
hospital readmissions.
Independent
physicians are pushing back, forming their own groups to negotiate insurance
contracts and improve coordination of care.
Catalyst Health Network,
based in Plano, includes 790 primary care providers with 310 offices and over 1
million patients. The nonprofit group, founded in 2015, is trying to build a
better model for value-based medicine — and it proudly stands as a
counterweight to the growing clout of large hospital systems.
“We were built for
that reason,” said Dr. Christopher Crow, president of Catalyst and
co-founder of Catalyst and its holding company, StratiFi Health. “We’re helping
communities thrive by keeping the independent practice of medicine alive and
well.”
There are other large
groups of independent doctors in the Dallas area, including Genesis Physicians Group and Premier Physician Group.
But Crow said Catalyst is one of the few in the nation to be doing this at such
scale and with primary care providers serving commercial customers, not just
Medicare.
On the contracts
side, he compared Catalyst’s role to the National Football League, in that the
league negotiates contracts with various broadcasters and shares the revenue
among the teams. Catalyst has value-based contracts with all the major insurers
in the region, and if providers save money by keeping people healthy, they
share in the savings.
Catalyst and United
Healthcare, for example, said they lowered health care costs in North Texas by
almost $40 million over the past three years — and providers got half of that,
Crow said.
Catalyst and United’s
accountable care organization helped thousands of members control chronic
diseases and get preventive cancer screenings, the companies said last week.
A number of factors
contributed to the health savings, including a double-digit decline in
out-of-network lab services and specialists, and a 6% increase in using
lower-cost outpatient surgical centers.
United shared
“actionable data” with Catalyst about patients’ underlying conditions, past
treatments, gaps in care and medications. That allowed a team of care
coordinators, including nurses, pharmacists and dietitians, to assist patients
and doctors in heading off problems.
Catalyst’s care team
is a key part of its business and health care proposition: “We already have a
lot of good independent physicians in North Texas,” Crow said. “They just need
to be resourced a little better.”
Dr. Darla Kincaid,
a pediatrician in Coppell, said she was drawn to Catalyst initially because of
its contracts and focus on primary care. But as a small practice — seven
doctors, a part-time psychiatrist and four advanced practitioners — it also
needed the tools and personnel to help care for patients.
Many have expensive
medications for asthma and other ailments, and the list of covered drugs
changes regularly. She said pharmacists at Catalyst provide a level of service
and follow-up that her practice couldn’t match.
“We wouldn’t be able
to staff up those extenders,” Kincaid said.
Catalyst has over 200
employees, up from 30 five years ago, Crow said. And many on the second floor
of the Plano headquarters are involved in caring for patients.
Last week, the team
was helping a diabetic who was getting serious about his treatment. The
pharmacist started by getting his medications in order, which included stopping
some auto-refills that had piled up.
Then the pharmacist
passed the patient to Tyrisha Mason, a registered nurse. The patient couldn’t
join a gym to start working out regularly, she said, but he had a couple of
10-pound barbells and a stairway in his home. She suggested he walk up and down
the stairs half a dozen times each day, carrying the barbells.
“Together, we set a
goal,” Mason said, “and we met him where he was.”
Ancy Purnell, a
registered dietitian, stepped in next. She and the patient reviewed his medical
history and discussed nutrition labels and portion sizes. She helped him
identify carbohydrates in particular foods and explained how they affected his
health..
“There’s a lot of
educating,” Purnell said. “I spend a lot of time on that.”
That kind of
follow-up has produced results, including over $55 million in savings in three
years, Catalyst said. Over 90% of targeted patients adhered to their medication
plan soon after the one-year mark. And high-intensity users had substantial
savings — roughly $600 a person per month in health costs, the company said.
Dr. Stephen Buksh,
an internist in Euless, said the Catalyst care team integrates right into his
practice. He reels off the names of nurses and others who contact patients on
his behalf and then update him.
“I could hire people
but it wouldn’t be nearly as robust,” Buksh said.
Crow, a family
physician for 13 years, co-founded Village Health Partners over a decade ago.
The Plano group was lauded for creating a medical village with easier access to
primary care docs, specialists and prescriptions. It has been an innovator in
value-based care, which seeks to improve outcomes and lower costs.
For seven years, Crow
has been building up StratiFi and Catalyst, believing the success of
independent primary care physicians was crucial to any progress in the
industry.
“Any moment they’re
not thinking about the business, they can actually focus on clinical care,”
Crow said. “And they don’t feel like they’re on an island.”
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