Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Value-Based Care Driving Independent Practices to Consultants

Rather than turn to hospitals for support, independent practices contracting with consultants to make the transition to value-based care.

Independent physician in value-based care

Source: Thinkstock

By Kyle Murphy, PhD

- Independent physicians and practices are turning to consultants to make the transition to value-based care and stay competitive in a shifting market.

The latest research from Black Book shows physician-led practices have turned the tide that over the last decade some these providers seeking hospital employment rather than remain independent, with the transition to value-based care serving as a catalyst.

In 2016, close to one-third of surveyed (32.6%) physicians reported being employed by a hospital or working for a practice with partial hospital ownership. One year later, that percentage shrunk by nearly five points (28%) as independent physicians and physician-led practices sought out external advisement on organizational, financial, and technical transformation.

“Population health and value based care models are driving more coordinated, integrated and consumer-centric physician organizations,” said Doug Brown, Founder of Black Book Research. “Physicians not affiliated with hospitals are recognizing there are long-term savings if they assume risk and manage population health in the same way as a hospital in an ACO.”

Results from a Q1/Q2 Black Book survey of 877 physician groups, practices and organizations indicate that more than two-thirds of group practices with ten or more physicians (68%) turned to consultants for guidance on financial and clinical transformation of their practices.

“Many physician organizations are not succeeding linearly through the transition towards alternative payment models and do not have well-defined plans to hit certain date-sensitive financial thresholds,” Brown continued, “hence the rise in demand for consultant firms with value-based care expertise in physician organizations.”

Specifically, the vast majority of independent physicians and practices (89%) are seeking expertise in both managing population health and revenue cycle.

  • 93% have no strategic plan activated for transforming population health management or value-based care solutions end-to-end to confront known deadlines because there are no internal experts identified;
  • Less than 7% of physician organizations surveyed have begun comprehensive value0based care software vendor selection activities and are considering consultants to assist them; and
  • 95% of group practice and large clinic Chief Information Officers state they do not have the information technology or staff in-house needed to transform value-based care end-to-end as their physician and or executive team envisions.

This increased demand comes with an increased sense of urgency. Eighty-eight percent of practice managers noted that their practices are not prepared for the impact value-based reimbursement will have on their entire organization.

“Real end-to-end value-based care transformations require complex technology optimization, strategic assessment of patient mix and payers, analytics, decision support tools, staff training, outsourcing and new software implementations,” added Brown.

According to Black Book, researchers used a score of key performance indicators (e.g., trust, reliability, transparency, and confidentiality; return-on-investment and quality of engagement deliverables; best-of-breed advisory technology) to evaluate healthcare advisory firms aiding independent physicians and practices make the move to value-based care. Cigna’s CareAllies scored first in nine of twenty total categories.

“Consultative approaches that emphasize physician engagement, culture change, actionable data and analytics are producing some very prepared and motivated physician organizations as they move from volume to value,” Brown explained.

While the industry-wide shift from fee-for-service to value-based reimbursement has not leveled the playing field for physicians and hospitals as far as market consolidation is concerned, it appears to be creating opportunities for independent physicians and practices to gain ground on their competition whose complex organizations made large-scale transformation difficult.

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