Small physi­cian prac­tices can con­tinue to thrive through closer re­la­tion­ships with their pay­ers

Modern Healthcare - - COMMENT - By Car­a­line Coats In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? mod­ern­health­ View guide­lines at Send drafts to As­sis­tant Man­ag­ing Edi­tor David May dmay@mod­ern­health­ at

Physi­cians are leav­ing small prac­tices for larger groups at an un­prece­dented rate. Re­cent data show that be­tween 2013 and 2015, the per­cent­age of physi­cians work­ing in small prac­tices (those with nine physi­cians or fewer) dropped from 40.1% to 35.3%.

Mean­while, the per­cent­age of physi­cians work­ing in large prac­tices (of 100 physi­cians or more) in­creased from 29.6 to 35.1 %. %

While larger groups have more re­sources, in­clud­ing the ad­min­is­tra­tive in­fra­struc­ture, data re­port­ing and care co­or­di­na­tion ca­pa­bil­i­ties needed in a pay-for-per­for­mance set­ting, physi­cians who work in a small, in­de­pen­dent prac­tice still have ad­van­tages. They cer­tainly shouldn’t call it quits.

As Dr. Farzad Mostashari, for­mer na­tional co­or­di­na­tor for health in­for­ma­tion tech­nol­ogy, pointed out in an ar­ti­cle last year in the An­nals of Fam­ily Medicine, and as the Amer­i­can Academy of Fam­ily Physi­cians re­cently af­firmed, small prac­tices can flour­ish in the age of value-based care.

Physi­cians in these prac­tices tend to have close re­la­tion­ships with their pa­tients, al­low­ing for qual­ity face time. More en­gaged pa­tients can lead to bet­ter health out­comes. So in this sense, smaller prac­tices can have the “home field” ad­van­tage when it comes to de­liv­er­ing high-touch and per­son­al­ized care. In fact, many are well on their way to im­ple­ment­ing val­ue­based care on their own, with­out the sup­port of a large provider group.

A re­cent sur­vey con­ducted by the AAFP found that a third of fam­ily physi­cians are ac­tively pur­su­ing value-based pay­ment for their ser­vices. But the sur­vey also cor­rob­o­rated that they do face bar­ri­ers to im­ple­men­ta­tion. For many, it’s hard to gain ac­cess to enough data to get a clear view of the pop­u­la­tion they serve. Some can’t make the in­vest­ment in a big elec­tronic health record sys­tem and key staff like care co­or­di­na­tors and pop­u­la­tion health man­agers. Oth­ers sim­ply don’t have the time.

Given small prac­tices have a dis­tinct ad­van­tage to prac­tice care tied to qual­ity, they shouldn’t have to face these chal­lenges alone. And they shouldn’t be re­quired to merge with other prac­tices or health sys­tems, ei­ther. In­stead, I be­lieve there’s a real op­por­tu­nity for health plans to part­ner with small prac­tices and help them along the jour­ney to value-based care. Part of this means not en­forc­ing the same rigid value-based agree­ment for each small prac­tice with whom we part­ner. Dif­fer­ent prac­tices will be able to take on risk at dif­fer­ent in­ter­vals, and the health plan part­ner must be flex­i­ble and meet the prac­tice where they are. It’s also the re­spon­si­bil­ity of the health plan to pro­vide ed­u­ca­tion and op­er­a­tional sup­port to prac­tices to help them un­der­stand what it takes to move away from fee-for-ser­vice mod­els.

Im­ple­ment­ing a man­age­ment ser­vices or­ga­ni­za­tion, or MSO, con­vener model has, in my ex­pe­ri­ence, helped prac­tices re­main in­de­pen­dent while ac­cess­ing many of the re­sources avail­able to large provider groups. MSOs can as­sist with a wide range of op­er­a­tions, from care co­or­di­na­tion to billing and cod­ing, all of which are cru­cial to suc­cess un­der a val­ue­based model. Hu­mana’s MSO, Tran­scend, for ex­am­ple is well-po­si­tioned to serve as a con­vener for these types of prac­tices, of­fer­ing them the in­fra­struc­ture and ca­pa­bil­ity sup­port needed to be suc­cess­ful in a val­ue­based care model.

Last but not least, the in­dus­try needs to come to­gether to pro­vide payer-ag­nos­tic re­port­ing tools. Most small prac­tices don’t have the lux­ury of work­ing with only one health plan—in fact, many work with more than six dif­fer­ent in­sur­ers, which can all have dif­fer­ent qual­ity met­rics and data re­quire­ments. Stan­dard­iz­ing the way we mea­sure and track qual­ity will go a long way in re­duc­ing the bur­den for in­de­pen­dent physi­cians.

This won’t be a quick and easy tran­si­tion for most prac­tices, but with the right peo­ple, physi­cian part­ner­ships and tools, we can trans­form the way we care for our com­mu­ni­ties.

Physi­cians in these prac­tices tend to have close re­la­tion­ships with their pa­tients, al­low­ing for qual­ity face time.

Car­a­line Coats is a na­tional vice pres­i­dent in the Provider De­vel­op­ment Cen­ter of Ex­cel­lence at Hu­mana.

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