LCHM Fall 2017 - 25

L C M E D S O C .O R G

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.

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 for an
unnecessary emergency room visit 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.

 Provider organizations made up of
independent physicians are not only
surprisingly common in the Pennsylvania
marketplace, but they are growing in size
and sophistication. This is leading to an
increasing appetite to develop "clinically
integrated networks" (CINs) that can work
with health insurers to develop their own
specialized payment contracts that grow value
and de-emphasize volume-driven payments.
As an aside, because CINs may have greater
control over the healthcare premium, health
insurer payment denials over irritants such as
the "Modifier 25" can be eliminated. What's
more, CINs may assume responsibility for
credentialing on a delegated basis, which
could also eliminate the requirement of
"maintenance of certification."

In addition to important activities that
Across the Spring and Summer, the Colinclude advocacy, education and professional laborative has met with and listened closely
development, the success of the Collaborative to physicians in practice, health insurers,
will add to the Society's reputation as an integrated delivery organizations and leaders
important factor in the Commonwealth's of provider organizations. Findings to date:
healthcare marketplace. The Collaborative's
initiatives will also promote membership Business leaders are being buffeted by
among its physicians who, until now, hav- opaque pricing, increasing out-of-pocket
en't fully appreciated what the Society can expenses and rising premiums. They are
fully offer.
vitally interested in having physicians be a
positive force for good and avoiding what
many consider as the worse possible outcome
of all: a single payer system;
Use its negotiating clout and the pros- Health insurers are more willing to WHAT DOES THIS MEAN FOR
pect of group purchasing to negotiate for engage in transformative reimbursement PHYSICIANS?
lowest-cost and highest-quality services models that not only compensate physiAs the rapid pace of healthcare accelerates,
for Pennsylvania physicians. Until now, cians for the increased work associated physician leadership is more important than
these economies of scale have been out-of- with high value care, but in risk-transfer ever. We estimate that there are more than
reach for smaller physician practices. For arrangements that profitably put the 10,000 independently practicing physicians
example, the Collaborative has secured the providers' "skin in the game." They un- in the Commonwealth, and that they can
personalized services of Mingle Analytics for derstand that not all insurance risk can be continue to offer an important care option
MACRA-MIPS reporting at a significantly managed by physicians, but are willing to to Pennsylvania's patients, are key to the
discounted rate. In the coming quarter of talk about limited risk-sharing arrangements success of integrated delivery systems
2017, additional services will come on line, that are win-win;
and are an area of opportunity for health
including claims submission, eligibility, coinsurers. As a result, we are "bullish" on
pay management, appeals, referrals, human Integrated delivery organizations are independent physicians and look forward
resource management and payroll.
reaching the limits of hiring physicians to partnering with them in any way we
and are increasingly turning to affili- can. We would be happy to talk further
Deploy capital to help support physician ated arrangements with independently with you. You can reach me at jsidorov@
organizations in value-based or risk-based practicing physicians in their service or through our website at
contracting. Tying physician reimbursement area. They are vitally interested in having
to the achievement of population-wide a sustainable "neighborhood" of economquality goals or appropriately reducing ically sustainable practices that can serve
avoidable utilization requires access to their patient population and welcome the
resources outside of the usual 15-minute support of the Collaborative;
office visit. These resources may include,
but are not limited to, community-based
FALL 2017 | Lehigh County Health & Medicine 25


Table of Contents for the Digital Edition of LCHM Fall 2017

LCHM Fall 2017 - 1
LCHM Fall 2017 - 2
LCHM Fall 2017 - 3
LCHM Fall 2017 - 4
LCHM Fall 2017 - 5
LCHM Fall 2017 - 6
LCHM Fall 2017 - 7
LCHM Fall 2017 - 8
LCHM Fall 2017 - 9
LCHM Fall 2017 - 10
LCHM Fall 2017 - 11
LCHM Fall 2017 - 12
LCHM Fall 2017 - 13
LCHM Fall 2017 - 14
LCHM Fall 2017 - 15
LCHM Fall 2017 - 16
LCHM Fall 2017 - 17
LCHM Fall 2017 - 18
LCHM Fall 2017 - 19
LCHM Fall 2017 - 20
LCHM Fall 2017 - 21
LCHM Fall 2017 - 22
LCHM Fall 2017 - 23
LCHM Fall 2017 - 24
LCHM Fall 2017 - 25
LCHM Fall 2017 - 26
LCHM Fall 2017 - 27
LCHM Fall 2017 - 28
LCHM Fall 2017 - 29
LCHM Fall 2017 - 30
LCHM Fall 2017 - 31
LCHM Fall 2017 - 32