Making value-based care work for smaller practices

Physician practices are facing an uphill battle in their quest to remain independent, particularly as the sector moves toward value-based care. Not only are they under siege from national competitors, they are also faced with declining reimbursement rates, intense regulations, greater administrative demands, increasing compliance costs and changing payment models.

These challenges have resulted in many physician practices shuttering or being acquired by larger organizations. In just one year, hospitals acquired 5,000 independent practices and physicians employed by hospitals grew by 14,000. And over the past four years, the percentage of hospital-employed physicians grew by more than 63%, increasing in almost every six-month period evaluated.              

Despite these numbers, some physician practices have found a formula for remaining independent and thriving in the new value-based care environment. Family Medicine Partners of Santa Fe, N.M., is one example of independent providers bucking the trend. Despite the regularity at which practices are being gobbled up by hospital chains and larger consortiums, Julia Martinez, MD, and Patrick Samora, MD, decided to undertake the alternative, breaking away from a larger practice to form their own office. With experience at community health centers, critical access hospitals and large, multi-specialty practices, the doctors wanted to focus on providing a personal touch to their patients – many of whom had followed them to their various practices. As the industry was shifting to a quality-based payment model, they seized on the opportunity to forge their own path.

Martinez and Samora had specific goals for their new practice: creating an environment where physicians were not over or underworked, ensuring that all patients get standard care with respect to all preventive services, meeting chronic care needs and treating acute illnesses.

Overall, the key to building a successful, enduring independent practice is to put the right processes and tools in place from the start. This includes:  

·      Setting goals and getting buy in from the entire practice: Everyone, from the doctors and nurses to the front office and billing staff, must work toward the same goals. To achieve value-based care means providing proactive care and greater responsiveness to patient needs. Some practices may also choose to focus on specific conditions impacting their communities, such as diabetes, obesity and substance abuse, or specialize in working with the aging population.

·      Understanding the rules and your practice's responsibilities: To be successful, it’s imperative for practices to make the move from the more traditional fee-based model to a value-based approach, despite the learning curve. The Department of Health and Human Services offers training on the Quality Payment Program for practices with 15 or fewer clinicians. And, the American Medical Association and other organizations provide free, credible resources for training your staff and keeping up-to-date with changing rules.

·      Leveraging technology to enhance patient care and engagement while also easing compliance: Technology can be the great equalizer for physician practices that have limited staff and time. Reimbursable time spent one-on-one with patients requires even more work to ensure the visit is meaningful and profitable. Electronic health records and solutions for care coordination, population health and medical practice management can assist with administrative tasks, facilitate reporting and increase patient engagement. These solutions can also be used for compiling and analyzing demographic data; verifying insurance information and eligibility; reviewing records; ordering referrals, tests and prescriptions; and communicating with patients via phone, email, text or a patient portal.

·      Integrating systems – While employing various technologies can help with different aspects of the practice, true benefits will not be realized until they are all tightly integrated. When considering new solutions to support patient engagement or practice management, be sure that all new tools will integrate with existing workflows and solutions, and work to minimize the burdens on the staff and practice overall.

Independent practices, like ones formed by Martinez and Samora, do not have to be victims to the megamergers and consolidation trends that have proliferated during the transition to value-based care. By clearly defining the business model, understanding how to maximize reimbursements for proactive and preventative care, and employing technology to support the overall mission, physician practices can thrive and deliver on the true promise of value-based care.

Zachary Blunt, senior manager of population health at Greenway Health, focuses on population health and patient engagement tools. He is passionate about enabling physician practices to make data driven decisions and improve patient behavior toward overall health goals. He has worked in the healthcare industry for more than nine years and has been a member of the Greenway team for six years.