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Integrating cultural competence into primary care is essential for addressing the unique needs of diverse populations, especially in underserved communities.



A deep dive into the intersection between primary and culturally competent care 

Being sensitive to the needs of patients from diverse backgrounds produces better health outcomes

The benefits of providing culturally competent care

Value-based payment: An introduction to a study

Value-based payment: Sources and a summary

Value-based payment: Will it cover the cost of doing business?

Value-based payment: Or is it fee-for-service? Or both?

Value-based payment: Not all insurers are on board

Value-based payment: Health systems don’t support doctors

Value-based payment models: Workforce shortages are a problem

Value-based payment models: Problematic performance measures 

Value-based payment models: Too much documentation

Value-based payment models: Potential solutions, part 1

Value-based payment models: Potential solutions, part 2

Value-based payment models that focus on patient health sound like a great idea.

So why don’t more physicians use those programs instead of fee-for-service 

 that remain a substantial part of the health care economy?

 were not participating in value-based payment models. Researchers from Mathematica wanted to find out why, so they went to the source: a dozen primary care physicians, primary care management experts and focus groups with 17 frontline physicians and other clinicians. None of them had any prior participation in value-based payment models.

Their responses were compiled for the study, 

“Why Primary Care Practitioners Aren’t Joining Value-Based Payment Models: Reasons and Potential Solutions,”

In this video series, co-author Ann S. O’Malley, MD, MPH, discusses the findings. Lessons from 14 years of value-based payment models could shape how physicians adopt them in the future – and ultimately improve patient health.

Co-authors are Rumin Sarwar, MSPH, Cindy Alvarez, MPH, and Eugene C. Rich, MD, of Mathematica.

Value-based payment models, designed to enhance patient health, are not widely adopted by primary care physicians, who predominantly use fee-for-service models. A study by Mathematica, involving primary care physicians and management experts, explored the reasons behind this reluctance. The study, published by The Commonwealth Fund, highlights insights from 14 years of value-based payment models and suggests potential solutions for increased adoption. The findings, discussed by co-author Ann S. O’Malley, MD, MPH, aim to guide future implementation and improve patient outcomes.

Researchers asked doctors why they continue with fee-for-service payment. There are many reasons, as a study co-author explains.

Topics

Why more physicians don’t participate in value-based payment models

Private equity in health care: Measuring quality of care

Does lower cost of patient care lead to a drop in quality? Not necessarily – and in fact care might be better. 

 Board Chair and President Paul Berggreen, MD, discusses the findings of a study that compared cost and quality across physician employment models, including doctors in independent practice supported financially with private equity investment.

The relationship between the cost of patient care and quality is not directly proportional, as lower costs do not inherently lead to diminished care quality. In some cases, care quality may even improve. A study examined various physician employment models, including independent practices backed by private equity, to assess cost and quality metrics. The findings suggest that independent practices with private equity support can maintain or enhance care quality while managing costs effectively, challenging the assumption that higher costs are synonymous with better care.

The leader of the American Independent Medical Practice Association discusses the state of private equity investment in health care.

Private equity in health care: Developing the base of a study

Doctors around the country found there was little, if any, change in their patient care when they worked with private equity investors in their practice management services organizations. AIMPA wanted to turn that anecdotal evidence into actual data. 

 Board Chair and President Paul Berggreen, MD, describes the origins of the organization’s study.

AIMPA sought to quantify the impact of private equity involvement in practice management services on patient care, following anecdotal reports of minimal change. Dr. Paul Berggreen, AIMPA Board Chair and President, elaborated on the study's inception. The study aimed to provide empirical data to support or refute the anecdotal evidence, offering a clearer understanding of private equity's role in healthcare practices. This initiative reflects a broader interest in assessing the influence of financial stakeholders on clinical outcomes and operational efficiency within medical practices.

Private equity in health care: Physicians provide the lowest-cost care

 commissioned a formal study of health care cost across models of different physician employment, including unaffiliated practices with private equity investment. AIMPA Board Chair and President Paul Berggreen, MD explains results. Spoiler alert: Physicians with financial support to operate independently can provide care at a lower cost than hospitals and health systems.

A 2024 study by AIMPA examined healthcare costs across various physician employment models, including private equity-backed unaffiliated practices. The findings, as explained by AIMPA Board Chair and President Paul Berggreen, MD, reveal that physicians who receive financial support to maintain independent operations can deliver care at a lower cost compared to hospitals and health systems. This suggests that independent practices, when financially supported, may offer a more cost-effective alternative in the healthcare landscape, challenging the traditional dominance of larger healthcare institutions.

Private equity in health care: Four models of physician employment

Consider four categories of physician employment: What is happening in private practices affiliated or not with private equity investors, large corporate employers and hospitals? 

 Board Chair and President Paul Berggreen, MD, explains the methodology to examine cost and quality when physicians in unaffiliated private practice move to another practice model.

Physician employment is evolving across four main categories: unaffiliated private practices, private equity-affiliated practices, large corporate employers, and hospitals. The transition of physicians from unaffiliated private practices to other models is analyzed through a methodology focusing on cost and quality. This approach helps in understanding the implications of such transitions on healthcare delivery. The insights provided by AIMPA Board Chair and President Paul Berggreen, MD, shed light on the dynamics and outcomes associated with these employment shifts, emphasizing the importance of evaluating both financial and quality metrics.

Private equity in health care: an introduction

Private equity in health care: ‘A different animal’

Private equity in health care: Developing a study

Private equity in health care: Picking medical specialties to study

Private equity in health care: Cost, quality and regulation

Private equity in health care: ‘Don’t regulate us out of existence’

Private equity in health care: Fix the Medicare Physician Fee Schedule

Private equity in health care: More ways to strengthen independent practice

It’s time for doctors, patients and policymakers to rethink some perceptions about private equity investment in health care, according to the 

American Independent Medical Practice Association

In 2024, AIMPA commissioned consultant Avalere to study Medicare fee-for-service data about 

the effects of private equity investment in medical practices

 across five specialties: cardiology, gastroenterology, medical oncology, orthopedics, and urology.

There are some striking results, said Paul Berggreen, MD, AIMPA board chair and president. To start, 

 (PE) affiliated management services organizations (MSOs) have done a really good job controlling costs, promoting quality, and remaining independent, he said.

 are dwarfed by hospitals and corporate practice settings. Yet they have generated a huge amount of public attention – including legislative efforts to bar PE investment.

“I don’t completely understand the momentum in the national conversation saying that this is not a good model,” Berggreen said. “We have proven now with objective data that it is a really good model, and we also feel strongly that competition in the marketplace is a good thing.

“What we’re asking people in the legislatures, around the statehouses and on Capitol Hill: Don’t regulate us out of existence,” he said. “We feel that we are a very important segment of the health care ecosystem.”

In this video series, Berggreen discusses AIMPA, the study, and how private equity-affiliated MSOs can help independent practitioners. The full study, “Medicare Service Use and Expenditures Across Physician Practice Affiliation Models,” remains 

The American Independent Medical Practice Association (AIMPA) advocates for a reevaluation of perceptions regarding private equity (PE) investment in healthcare. A study by Avalere, commissioned by AIMPA, analyzed Medicare fee-for-service data across five specialties, revealing that PE-affiliated management services organizations (MSOs) effectively control costs, promote quality, and maintain physician independence. Despite being smaller than hospitals and corporate practices, PE-affiliated practices face legislative scrutiny. AIMPA emphasizes the importance of competition and urges policymakers not to overregulate this segment of the healthcare ecosystem.

There are different types of PE involvement in health care, and not all are bad, says group of independent practitioners.

Khaliq Siddiq, M.D.

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