After decades of physician integration and alignment consulting, one thing I can say with complete certainty is that when faced with a choice between a single and a multispecialty group with which to contract, the multispecialty group, if properly formed and organized, will ALWAYS win out in the eyes of a payer. Here’s why:
With one signature the payer gets more contracting done in a single-signature contract
Meh, so what else is new? Actually, the numbers make a different. Figure that every contract negotiated has a cost. The more the plan eliminates in contracting overhead and maintenance of the contracts, the more money drops to bottom line for their shareholders. But that’s not even in the top 5 reasons for challenges
Multispecialty “group-think” is a necessity to manage health delivery and care across a continuum.
Trusted colleagues that know one another and how they use local technology and clinical resources within the community is a key component to success under healthcare reform. Many physicians know that there will always be significant income disparities between specialists and primary care physicians. These can be mitigated (but not erased completely) with creative ways to divide the economic pie. That is easier said than done, in reality. The “buy in” from all concerned is the first hurdle to be overcome. Specialists often, (but not always) have higher overheads and therefore will be unwilling to give up too many berries from that pie for the good of the order.
Successful “group think” comes from leadership within the organization
This is something that some people possess innately, and most others require training. While the training may be readily available (call us, we offer it) the precious commodity will be the ability to take time out to attend the training. In addition, the culture of accountability must be developed and fostered. This doesn’t take just a bunch of cool software, it takes implementation of a “system” to operate, monitor and measure continuous improvement, identify best practices that have relevancy to the group in question. Why make a best practice that you order an MRI at such and thus point if there isn’t a MRI within a 65 mile drive of the community? Integrating different business cultures and clinical resources is not a cookie cutter exercise. It takes time, money (to pay the coach) commitment, and staff (for day-to-day operations) in order to make it work. I believe that the time element is going to be the most critical as more and more patients are covered for the first time and they bring in their reams of Google searches to discuss the pent up concerns and diagnoses, and treatment interventions that have been delayed for months or years.
The right ratio of clinicians to patients
How many doctors does it take to turn on a light bulb? What size population is required to produce meaningful outcomes and statistics? Where do the ideas and creativity come from and how do they happen? The Medicare Shared Savings provision of the ACA proposes a minimum Medicare population of 5,000, but this number may be too small. A population of 25,000 is closer to reality, especially if capitation is being paid or relied upon to run the day-to-day overheads of the group. Without that cash infusion, I fear that many shared savings ACOs won’t make ends meet for the initial 3-year stint. Even then, if the capitation and/or payment amounts are too thin to adequately cover the number of physicians in the group, the reimbursement won’t be “meaningful enough” to change behavior.
