Lancaster Physician Fall 2017 - 19
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Promise to Preserve Choice
In October of 2016, the Pennsylvania
Medical Society committed $15 million
out of its endowment to fund the Care
Centered Collaborative™. By unlocking
this capital, the Society unlocked considerable value by committing itself to
three goals:
INVEST IN PENNSYLVANIA
PHYSICIANS:
While the Society's endowment has
been expertly managed, deploying capital
in partnership with physicians as they
successfully manage their value-based
reimbursement arrangements will result in
other sustainable income streams. Patients
will also benefit from higher value care,
while physicians will be fairly compensated
for delivering higher quality at lower cost.
PROMOTE INDEPENDENT PHYSICIAN-OWNED PRACTICE:
As large integrated hospital-dominated
delivery systems continue to grow in
Pennsylvania, there is emerging evidence
that smaller physician-led practices-when
organized into regional associations- can
also provide high-value care. By investing
in a care model that has the advantages of
aggregation without the downsides of practice acquisition, patients will have another
option when they seek medical care.
INCREASE THE RELEVANCE OF
PHYSICIAN MEMBERSHIP IN THE
SOCIETY:
In addition to important activities
that include advocacy, education, and
professional development, the success of
the Collaborative will add to the Society's
reputation as an important factor in the
Commonwealth's health care marketplace.
The Collaborative's initiatives will also
further promote membership among all
Pennsylvania physicians who, until now,
haven't fully appreciated what the Society
can fully offer.
HOW DOES THIS WORK?
The Collaborative has two go-tomarket strategies:
Use its negotiating clout and the prospect of group purchasing to negotiate for
lowest-cost and highest-quality services
for Pennsylvania physicians. Until now,
these economies of scale have been out-ofreach for smaller physician practices. For
example, the Collaborative has secured
the personalized services of Mingle Analytics for MACRA-MIPS reporting at a
significantly discounted rate. In the last
quarter of 2017, additional services will
come on line, including claims submission,
eligibility, co-pay management, appeals,
referrals, human resource management,
and payroll.
Deploy its capital to partner with
physician organizations in value-based or
risk-based contracting. Tying physician
reimbursement to the achievement of population-wide quality goals or appropriately
reducing avoidable utilization requires
access to resources outside of the usual
15-minute office visit. These resources may
include, but are not limited to, community-based non-physician personnel who
can work with the patient outside of the
clinic, or access to real-time data feeds that
can target patients who are most vulnerable
to avoidable emergency room visits in the
coming month. While the up-front costs
are considerable, the downstream savings
are considerable. Patients will benefit from
lower health care costs, but there will also
be enough funding that can be shared with
physicians. In other words, they will finally
be compensated for the additional work
of providing high-value care.
ACTIVITIES TO DATE
While the Collaborative is only a year old,
it has a management team of seasoned health
care executives with expertise in health care
finance, business development, care management, and operations. They've engaged
with a wide range of business leaders, health
insurers, integrated delivery organizations,
and provider groups. They're finding:
Business leaders are being buffeted by
opaque pricing, increasing out-of-pocket
expenses, and rising premiums. They are
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