GRAND RAPIDS — Two organizations that represent independent physicians in West Michigan could morph into a single new group they formed last year to give greater voice to doctors who operate their own medical practices.
Dr. Khan Nedd, interim CEO of Answer Health LLC, hopes that the Physicians’ Organization of West Michigan and the West Michigan Physician Network could reach agreement this fall to merge into Answer Health at the beginning of 2017.
The two organizations created and financially backed Answer Health, a clinical integration organization that aims to unite independent doctors in the region. Folding the two groups into Answer Health would give it greater depth and strength in numbers in an era when health systems are directly employing more doctors.
“Our vision is we need to continue to build the strength of independent physicians,” Nedd said. “We are looking at how we can position ourselves for the future as independent doctors.”
That push comes from the emergence in recent years of risk-based, or value-based, contracting where payments from health insurers are pegged to quality, cost of care and patient satisfaction. The resulting greater risk for care providers with the payment system has contributed to more doctors opting for an employment model and going to work for a health system medical group, rather than running their own independent practices.
A 2015 study by the American Medical Association showed that a majority of physicians in the U.S., 56.8 percent, still worked in practices wholly owned by doctors, although that’s down from 60.1 percent in 2012.
In the same period, the number of physicians who worked directly for a hospital, or in a medical practice that had some hospital ownership, increased from 29 percent to 32.8 percent.
The push to an employment model gives health systems increasing influence over the marketplace and patient referral patterns, Nedd said. Answer Health’s goal is to partner with health systems such as Spectrum Health, Mercy Health and Metro Health in Grand Rapids to have a voice and a role in the market’s overall health care system.
“They need to see us as a partner, just as any of those pieces,” he said. “We’re not talking up or down to each other. We’re talking across from each other. We want to be a real partner in how we deliver health care in West Michigan.”
Independent doctors are facing the same kind of pressures as employed physicians and large integrated medical practices, said Anthony Colarossi, a health care consulting partner at Plante Moran PLLC.
The move to risk-based contracting and the growth in the number of employed physicians have forced independent doctors to become a “little more creative” in their approach as those pressures intensify, Colarossi said.
“Four, five years into value-based care and value-based purchasing, they are feeling a little bit left out and that they don’t have a seat at the table,” Colarossi said.
Unlike a large medical practice, independent doctors generally lack the structure and capacity to gather and analyze large amounts of data to identify health trends within the broader population they serve, he said. The same goes for being able to demonstrate that they meet the cost and quality standards of health insurers in an era of value-based care.
“They need to figure out how they’re actually going to prove themselves in the risk-based model going forward,” Colarossi said. “That’s going to entail not only quality metrics, but over time, there’s going to be more and more overall cost-of-care metrics that are included in value-based care.”
Setting up that infrastructure is costly, and aggregating together in a collaborative such as Answer Health can help with the analytics needed to prove their case, he said.
Yet a collaborative still faces an “uphill battle” for reasons that include fewer medical school graduates who are interested having their own practices, and the emergence of narrow care networks created by health plans that generally contract exclusively with a single health system and its physicians, Colarossi said.
“The narrow networking is going to exclude them more and more,” he said. “Through the narrow network product offerings out there, they’re being restricted and eliminated from the pool of patients.
“It’s not going to be an easy mechanism for them.”
An estimated 1,000 independent physicians practice in an area of West Michigan including Kent, Ottawa, Montcalm and Mecosta counties, Nedd said. Nearly 300 primary care doctors and specialists have signed up since March to join Answer Health, which provides a conduit for the clinical integration of the partnering physicians as well as to health insurers for risk-based contracting and partnerships with area health systems.
Nedd believes independent doctors in the region can and do perform better on quality and cost measures and that Answer Health is working to create the systems needed to operate in a value-based health care arena.
“It is clear to AH physician leadership that the real promise of Answer Health will be realized only by independent practices working together to achieve our goals,” Khan wrote in a May progress report to independent doctors and practice leaders. “At the network level, we will guide investments in clinical systems and staffing to support your practice, facilitate meetings to refine standards of care for participants, and provide performance data to identify improvement opportunities.”
One of the organization’s first endeavors was the formation this summer of a telemedicine service.
A partnership between Answer Health and Emergency Care Specialists P.C. in Grand Rapids, Answer Health Care On Demand provides independent doctors a 24-hour urgent care telemedicine service that they may otherwise not have the ability to offer.
The organization plans to expand Answer Health Care On Demand to include primary care, behavioral health, specialty care and wellness programming.
Emergency Care Specialists already was working on the telemedicine service when Answer Health approached it about a partnership, Nedd said.
“We felt that was a low-hanging fruit and an easy option that we wanted to do,” he said.