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Integrity ensures independents remain viable
Photo: Jeffrey Tucker
Adapting to the Affordable Care Act (better known as Obamacare) has been a challenge for everyone involved – patients, employers, insurers and healthcare providers. In the complicated world of medicine, the federal act has added new complexities into an already-complicated system.
The adjustment has been especially challenging for independent physicians and clinics, which operate leaner than integrated networks. Already grappling with a labyrinth of insurance, Medicare and Medicaid rules – they faced an even larger playbook as Obamacare unrolled.
“If we stopped and looked at the daunting tasks before us – the size of our competition and the immense amount of government regulation – I don’t know if we’d get out of bed in the morning. It’s almost overwhelming,” said Jeffrey L. Tucker, president and CEO of Duluth-based Integrity Health Network.
But leaping high hurdles is a passion at Integrity, which represents 200 physicians at 47 clinics and facilities in 23 communities spread between Minnesota and Wisconsin. In an industry where consolidation is the trend, Integrity provides tools that help independents remain their own boss.
“ ‘Interdependence to stay independent’ is a phrase we use to describe our mission,” explained Bruce Penner, Integrity’s director of quality. “A stand-alone physician doesn’t have the collegiality and connections with other physicians” that’s available at larger, integrated healthcare systems. “Our organization gives them a seat at the table and telephone numbers and relationships.”
Integrity was formed by the 2010 merger of Northstar Physicians, which represented independent primary care doctors, and Northland Medical Associates, which represented independent specialists.
“They were going down roughly the same paths but operated in isolated silos. It made sense to bring the two organizations together and get them talking,” Tucker explained. During the past four years, that relationship has blossomed and is evident in several new initiatives.
Opening a dialog between primary care physicians and specialists is an important step in the effort to reduce costs, Penner said.
“Some cases are being referred to specialists when they don’t need to be, and some tests conducted by primary care physicians weren’t needed,” he explained. “The primary care docs weren’t doing a bad thing, but in some cases, they were doing more than necessary.”
Integrity now is facilitating ongoing conversations between the groups.
“Our docs get together once every other month. We’ve developed a ‘quality proven medical directors group.’ A physician from each organization in our network is represented at the table,” either in person or by teleconferencing, Penner said. Together, they are reviewing care pathways used in the pre-referral world. Once agreement is reached, they issue guidelines.
“We have 26 of those on the table now and two await final approval. It’s all about efficiency – giving the patient the right thing at the right time in the right place and not wasting the patient’s time,” he said.
Each guideline is kept to one page. It is available in hard copy or as a searchable pdf that physicians can install on their cell phones, tablet devices or computer.
“Our docs wanted a quick, accurate look at care,” Penner said.
Integrity set the bar even higher by seeking Accountable Care Organization (ACO) status. The program, which addresses the cost and quality of care delivered to Medicare recipients, tends to restrict ACOs to large healthcare networks.
“ACOs require 5,000 Medicare enrollees, and it’s really unusual for a single clinic – even a large clinic – to have patient populations that large. But collectively, we’re able to negotiate as a group and come up with sufficient patient numbers,” said Integrity Chief Operating Officer Melissa Larson.
The challenge was to gain consensus among 47 independent member organizations.
“Fortunately, physicians and providers are very data driven, are very evidence based. If we can provide a solid foundation with evidence, in general they move in that direction,” Tucker said.
The ACO designation was granted on Jan. 1 and provides a key incentive for recipients. Those that provide high-quality care can share with the Medicare program any cost savings they achieve.
Integrity began analyzing Medicare claims data in mid-July. When meaningful data is distilled, it will be compared with national results. Eventually, the information can be used to identify how individual clinics and positions compare in terms of costs and quality of care.
Partnering with payers
When independent clinics negotiate contracts with private health insurers, they have little leverage on their own. Their bargaining power is much greater when they are represented by an independent practice association like Integrity, which negotiates with the clout of a large group.
Nonetheless, the Integrity network of independent care providers must be able to compete in terms of cost and quality against the mega-systems.
“Those who still use stodgy old models must either adapt or go away,” Tucker said. “We probably wouldn’t have emerged if this new era hadn’t come about.”
A welcomed element of the new model is a higher level of cooperation between healthcare providers and payers, Larson said. For example, they are sharing more cost data, which helps both sides better formulate ways to improve care and reduce costs.
“It’s a much more collaborative relationship,” she said.
The initiatives employed by Integrity are considered novel and have been featured in presentations Penner has made to the Institute for Clinical Systems Improvement (ICSI), a Minnesota group having national prestige, Tucker said. ICSI facilitates gatherings that include care systems statewide that gather to discuss quality and healthcare guidelines.
Penner said the effort has proven effective.
“Almost to a specific condition, we’re finding that when we enhance the quality and do the right thing, we’re going to save dollars,” he said.
The effort has been effective on a second level. Integrity has been receiving a growing number of calls from physicians at large systems who are inquiring about setting up independent practices. Although that had been the case in the past, it had declined during the past five years.
“We’ll see if that’s just an aberration or a trend,” Tucker said. “Competition is good. We provide a medium that provides a counter-lever in the marketplace to the rise of big systems.”Previous BusinessNorth Exclusives Articles:
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