COVER STORY


emerging future? Among the key fac- tors involved in strategic planning right now: • The pace of consolidation across


all sectors in healthcare is continu- ing apace—among hospitals, medi- cal groups, and health plans—as the leaders of organizations of all types continue to seek market advantage. • Related to that trend, many patient


care organization leaders are looking nervously over their shoulders at the ongoing entry of disruptor organiza- tions, particularly such phenomena as medical “minute clinics” being estab- lished by such non-traditional entrants to the market as CVS/Aetna, Walgreens, Walmart, and other retail organizations. Should those minute clinics draw sig- nifi cant primary care traffi c away from primary care physician practices, one very signifi cant foundation of tradi- tional health system revenues could be diluted. • Even as all of this activity is going


on, federal healthcare offi cials continue to press provider leaders to move for- ward on the path of value-based con- tracting, with the Medicare program and the state Medicaid programs. Various types of provider organiza- tions will be particularly affected by that pressure, including children’s hos- pitals, which generally rely for the bulk of their reimbursement on the Medicaid program. Physician practices, too, have been buffeted, as the various alternative payment model (APM) programs under CMS, and the Medicare fee-for-service payment program, MIPS (Merit-based Incentive Payment Program); both sets of programs are seeing changes being made to the Quality Payment Program (QPP), whose patient out- comes measures strongly infl uence how Medicare-participating physicians are paid, whether they are receiving fee-for- service-based or APM-based payment. As the terms of the QPP continue to move forward in fl ux, physician group leaders are feeling particularly buffeted by the winds of change. • Yet it is also the leaders of multispe-


cialty physician groups who are moving forward the fastest to embrace value- based contracting, and especially risk- based contracting. In many cases, those medical groups, when independent from hospital-based health systems, are working directly with health plans, without hospital system involvement. • Above all, agree all those inter-


viewed for this article, a new style of leadership is clearly becoming nec- essary: one that is more agile, more connected to constant


fluctuations in conditions on the ground, and


better facilitated by both strategy and technology.


The road ahead: physician groups are innovating—quickly So, how leaders of different types of organizations are leading their col- leagues forward obviously depends on the specifi c type of organization they’re leading, and its specifi c circumstances. But leaders of the most advanced phy- sician groups are plunging ahead full force, and are making real strides. Among members of that segment


of medical groups, Kelly Robison, CEO, and Shannon Decker, Ph.D., vice president of clinical performance at the 1,500-physician-plus Brown & Toland Physicians multidisciplinary medical group in San Francisco, see physician groups leading the way to clinical and operational transformation in U.S. healthcare in the next several years. “I see a transformation of the medical model,” says Robinson. “Most medical groups are IPAs [independent practice associations]. And we’re seeing a trans- formation into more of a model in which physicians get more support from the organization through employment or practice support. In other words, there will be a shift toward greater integra- tion. Second, you’re seeing more risk across broader populations, and more total-cost-of-care-based risk. Third, there are more technology-enabled solutions to help physicians manage their practices, and more practice-based support.” And, says Decker, “COVID has provided the opportunity to get there even faster. People are looking for higher quality and more value. That’s the value-based model—and we’re pursuing that model.” A number of elements are underlying


the shift, Robison says. “I think that physicians by nature tend to be entre- preneurial, and I’ve been in healthcare for nearly three decades,” she empha- sizes. “Over the years, the management of healthcare has become so complex, and there’s been such a squeeze on reimbursement, and on top of that, there’s been so much consolidation that now, a physician’s range of choices is so different. So for those physicians who want to remain entrepreneurial, and who want to remain independent and not have their destiny controlled by a hospital-based system, they need some kind of help. And that’s where organizations like ours can help: we can support physicians in their practices, while allowing physicians to retain an entrepreneurial spirit.” “I’ve noticed an evolution,” Decker offers. “It’s important to recognize that


it’s a symbiotic relationship. And when we approach physicians, it’s not about telling them what to do; they already know what to do,” she emphasizes. Jeffrey LeBenger, M.D., CEO of


the 1,700-physician Summit Medical Group, based in Berkeley Heights, N.J., and which serves communities across northeastern New Jersey and in the New York City metro area, says, “Nationwide, I think that physicians are going to see major consolidation in the marketplace. Unfortunately,” he says, in the fee-for-service-based payment system, practicing physicians simply can no longer focus on increasing patient care volume, based on patient visits, even as they “really ramp up their volume to make ends meet. Their reim- bursement is low, their costs continue to go up, and the data analytics they need to run their practice, are unbelievably expensive. Hospital systems want to fi ll


Jeffrey LeBenger, M.D. beds, increase ancillary-based reim-


bursement, and want to consolidate. Only certain systems really integrate; most hospital systems just want to con- solidate,” he contends. LeBenger sees a clear alternative to


both hospital system-run operations and health plan-run operations. “Payers do try the clinic model and have been somewhat successful, but you are some- what beholden to shareholders. So we have an option here, and have pursued it—these physician-run practices.” The absolute key to success, he says, lies in creating and building clinically and operationally integrated physician group practices that are taking on risk- based and other value-based contracts, and moving forward to reduce costs and improve patient outcomes, engaging in intensive care management, supported by data analytics clinical performance management. Of course, physician group leaders


are pursuing a wide variety of specifi c strategies, with some participating in


NOVEMBER/DECEMBER 2020 | hcinnovationgroup.com 5


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