Post-acute care networks grow amid concerns from independent doctors

Health system executives will be focusing their attention on post-acute care networks over the next three years, according to Premier, Inc.’s spring 2016 Economic Outlook Survey.

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About 95% of executives in the survey said they expected to spend significant time growing, managing and refining these networks, according to Premier, a Charlotte-based medical improvement alliance. The survey was conducted online in winter 2016, and included 82 health system leaders.

The growth of post-acute care networks is the result of a seismic shift from fee-for-service payments to population health management and value-based payments requiring care across the medical spectrum. These networks have fueled innovation, but have also raised issues about physician independence.

Marni Jameson, executive director of the Association of Independent Doctors, said consolidation of practices into networks is troubling for many doctors who value independence. Jameson, a former medical journalist who holds a master’s degree in writing from Vermont College, heads an organization that represents about 1,000 independent doctors in 14 states.

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Jameson said making medical care less fragmented doesn’t always make it more efficient, but it does allow more control, something that’s attractive to government and insurers. “They want to make it simpler,”’ she said.

Jameson cited a recent study by the Health Care Cost Institute that shows substantially higher costs for chemotherapy when oncologists consolidate their practices.

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“It’s just typical of government,” she said. “They have the best intentions, but businessmen are often smarter and just do a work-around.”

Members of her organization are concerned that they will have to sacrifice their independence to participate in systems that don’t always reflect their values and don’t produce better medicine, she said.

Meanwhile, Houston-based Memorial Hermann Physician Network has worked for more than a decade creating a network of independent physicians and providers. This has produced one of the largest and most innovative clinically integrated physician organizations in Texas and the nation.

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Shawn P. Griffin, MD, chief quality and informatics officer for Memorial Hermann, said his group has succeeded by getting independent doctors involved early in management decisions, instead of creating a system and then recruiting or hiring physicians who will “buy into it.”

 â€œThe devil’s in the details,’’ said Griffin, a family practitioner who spent more than a decade caring for patients, mostly in small practices in Missouri, before moving into management.

Institutions must seek partners who are like-minded so that goals and incentives can be aligned, Griffin said. “If you’re in an environment where some of your providers are fee-for-service and others are value-based contracts, you actually may have conflicting goals.”

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Houston has always been home to many small practices, and Memorial Hermann respected that, he said.

“Memorial Hermann has been most successful at working with independent providers, both independent facilities and independent physicians,” Griffin said. “When you look at our ACO, 90% of our physicians who make up our ACO are not employed by our health system. Two-thirds of our primary care physicians are independent providers.”

But what about all those electronic health record systems and non-standardized quality measures that makes such a network clunky? “You have to focus on the information that matters, and recognize that seamless is a wonderful goal, but meaningful is more important,” he said.

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Memorial Hermann has managed to share the critical information needed to enable doctors to manage populations, Griffin said. “All of us want more, but all of us are used to working with what we got.”

He emphasized that it’s absolutely critical to get participating physicians involved very early in the creation of a post-acute care network, and keep them involved with finding solutions to problems.

“Physicians are trained problem solvers,’’ Griffin said. “You’re talking about people who spent a decade of their lives being trained to analyze and solve problems. You don’t want to put them on the sidelines and only bring them in after you’ve constructed your solution because they will deconstruct your solution.”

Like many doctors, Griffin has his concerns about all the changes occurring in medicine.

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“When you start talking about caring for populations, very few physicians have training for that,” he said. “Very few physicians have the information for that. And very few of them have a system to support that.”

So his organization’s goal is to develop tools so doctors can concentrate on care instead of tracking dozens of quality measures from several insurance companies.

“Doctors went into medicine to care for people, and they’re going to keep caring for people,” Griffin said. “Sometimes it’s going to mean long hours and learning new things. They are committed to doing that. But we also shouldn’t ask them to just bear with inferior tools and practices simply because that’s all we have.”
 

References

Premier Inc.’s Spring 2016 Economic Outlook:

https://www.premierinc.com/wp-content/uploads/2016/04/EOSpring16Survey_HandoutFNL-1.pdf

Health Care Cost Institute’s “The impact of provider consolidation on outpatient prescription drug-based cancer care”

http://www.healthcostinstitute.org/files/HCCI-Issue-Brief-Impact-of-Provider-Consolidation.pdf