The industry’s shift to value-based care, coupled with an emphasis on efficiencies, has made it difficult for smaller practices to succeed alone. As a result, internal medicine and other primary care practices have joined forces in a range of practice models to maintain autonomy.
We spoke with Dr. Eric Harman, a family medicine practitioner at Mountain Region Family Medicine, about his practice’s success as a physician-led accountable care organization (ACO), as well as the challenges and benefits of operating as an independent practice.
Greenway: What can you tell us about the origins of your practice?
Dr. Harman: Mountain Region Family Medicine was formed in the late ‘90s by doctors who were not too happy about being hospital-employed physicians. They came together to practice medicine their own way and to share overhead and administrative duties. The practice started with six physicians and eventually grew to 15.
We started working on a multi-specialty independent physician association (IPA) in 1995. That was a bit hard to wrangle because the specialist contracts and the primary care contracts were so different, so it never took full form. Today we're a single-specialty practice — primary care — with one internist. The rest of us are family medicine physicians. We’re dedicated to remaining independent and have enjoyed running our practice that way.
Greenway: What led you and your partners to change your practice model to an ACO?
Harman: We've been involved in high-quality, low-cost medicine for a long time. We worked with a multi-specialty IPA for many years. Many of our partners had been involved in planning and working on quality issues as board members of our practice. When the idea for an ACO came up, some of the partners in our group and a couple of other primary care groups got together and said, “We think we can do this.”
We started a physician-led ACO in 2016, pulling together three practices — we eventually had more than 20,000 covered lives. We liked the concept of trying to reach the Triple Aim of improved patient experience, better cost, and higher-quality care — and we were successful. One year we were ranked in the top eight ACOs in the nation. We saw the value of being part of an ACO, which led to changes in our practice, such as working on improving population health, which is integral to what we do.
“Just because I don’t have a manager doesn’t mean I don’t have a boss. I have a couple thousand bosses … my patients. It’s the relationship with patients that is foremost, not my relationship with a manager.”
Dr. Eric Harman, family medicine practitioner at Mountain Region Family Medicine
Greenway: What challenges did you encounter in forming your ACO?
Harman: Getting our head around the data — trying to look at the health of our whole patient population and be able to report on our metrics.
Getting our partners on board with certain programs and discovering how to lower costs was also challenging. The partners got on board after some cajoling and after we told them they would be reimbursed for what they’ve been doing all these years — providing high-quality, low-cost care.
We also had to start disease management programs based around our highest-cost patients, which tend to be people with COPD-related illnesses.
Greenway: How is Greenway helping you thrive as independent physicians?
Harman: Greenway has been a great partner for us. It’s been a cost-effective solution that has allowed us to capture data and take action on information about our patients. Greenway has also helped us look at our population health issues in the way we needed to, so we could improve the health of our patients.
Greenway: Is it tougher to stay on top of changes in healthcare when you’re independent?
Harman: It can be. I think it’s more challenging for small practices with one or two providers. That doesn't mean you can’t overcome those challenges with the help of other services, but it’s nice to have more partners and bargaining power with insurers and different entities.
Greenway: What are the benefits of remaining independent?
Harman: We can be better advocates for our patients. I like being independent, and I think most doctors do. We went to medical school to deliver care the way we think it’s best delivered, to help the patients the best way we can. If you have partners, you learn from each other, and make your way together, trying to be the best servant of your patients that you can be.
With the new primary care payment models, we're getting compensated for providing quality care, so we’re more financially viable. If you're an employed physician, you're not as likely to be compensated as well for the extra work we are providing in primary care.
We have partners who have been with our practice for 25 years, and we see this as a sign that our independence has contributed to our practice stability. Many employed primary care physicians in our town have come and gone over the years. So if you want to remain in one place for a long time, it’s probably better to be independent.
Harman: It’s important because we have to know as much as we can about our patients to keep them healthy. It's a challenge because physicians use many different electronic medical records (EMRs). In our region we have a health information exchange (HIE) which has been moderately successful. We need to be able to hit the ground running and to be efficient in caring for patients, and better interoperability helps with this.
Greenway: What advice do you have for providers who may be considering a new practice model, such as an ACO or IPA?
Harman: Based on our experience with physician-run ACOs, we feel that's the best model. There are obviously some very successful hospital ACOs, but in general, the physician-led ACOs are probably more successful.
If you want to be in a physician-run ACO, look at the high-quality and low-cost physician groups in your area and talk with them about a partnership. We weren’t in the habit of partnering with other practices before we started our ACO, and now that’s something that has become important to us. We’ve made friends with some of our former rivals and have worked together on population health. That’s been an amazing change.
Greenway: What’s in store for your practice for the remainder of 2019?
Harman: We are trying to expand to have a bigger patient footprint, so that we can have more clout with contract negotiations in our region. There's been a big merger in our market, something that's happening across the country. To remain independent, you must have some size to your practice, or at least partner with other groups.
We also are entering into a clinically integrated network (CIN) with another big group that is also providing high-quality, low-cost care. We’ve had experience over the years with that concept and I think that puts us in a good position to move forward. It will give us a little bit more clout with negotiations.
Continual practice improvement is also an important goal for us. That’s why we’re also looking at adding a behavioral health program to hopefully reduce the need for emergency room visits, and thereby, hospitalizations. We have to meet the metrics of all the shared savings plans we have, but you know, then we want to look outside the box and say, "OK, you guys are making us do this, but what's the most clinically relevant things that we can do on our own to improve care and lower cost?"
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