We all know that it's getting harder and harder for doctors to remain independent — with many ditching the solo life to become employed by a hospital. But one physician practice powerhouse is offering docs an alternative to hospital employment, and it could be setting up shop in your organization's market soon.
In the November issue of Hospitals & Health Networks, we took a closer look at a handful of successful physician-led accountable care organizations, and the lessons they might impart to hospitals in their own population health efforts. One such group is Privia Health, based in Arlington, Va. The technology firm and multispecialty medical group has demonstrated early success with its doctor-driven model focused on wellness and care coordination, including readmission rates that are 20 percent below market, and, reportedly, 1,000 percent revenue growth over the past 18 months.
Now, the physician group is aiming to expand outside the D.C. region, to such states as New York, Georgia, Florida and Texas, with a recent $400 million cash infusion from investors to pave its way. Privia is seeking independent doctors to join its model, offering the perks of being part of a larger network, while also keeping the autonomy that docs crave.
"The problem that we saw coming down the pike is that the small- to medium-sized practice model is going to be pretty much washed within the next two to four years," says Fred Taweel, M.D., a primary care physician with Privia. "That's because of the development of the Affordable Care Act and the ACO mentality that insurance companies and Medicare have. What we're doing with Privia Medical Group is more of a preemptive strike, and what's happening in this area now is physicians are starting to get that idea, and they're actually jockeying to be part of groups."
Andrew Aronson, M.D., chief medical officer of Privia, believes it's becoming unsustainable for docs to go it alone. So, the rapidly growing company appeals to physicians by offering them a chance to maintain their autonomy and independence in their day-to-day office practice, while adding the tools of a bigger network such as disease registries and other advanced data analytics. Privia seeks out doctors who have a solid reputation and puts them through a credentialing process before they join the fold.
While Privia often competes with hospitals and health systems when recruiting physicians to join its network, Aronson doesn't think hospital leaders should view the company as a threat. Rather, they should seek to form partnerships with similar physician-led ACOs in their own markets. In our November story, Privia CEO Jeff Butler said the group is seeking hospitals partners that strive to provide care in the right setting at the right cost.
"We're all trying to make the change together, and I think we should try to do so collaboratively rather than independently," Aronson says.
In a recent analysis of the different types of ACOs produced by Leavitt Partners, A Taxonomy of Accountable Care Organizations, the consulting firm found there are certain areas in which the doctor-led varieties excel. With their smaller size and less moving parts, physician groups are able to move into new models with much more agility, notes co-author and Senior Analyst Paul Gardner. Too, physician practices don't own any beds, and have a much better opportunity to break free from the mindset of treating the hospital as a revenue center, he adds.
However, ACOs championed by health systems have their own edges in the move toward accountable care, including greater capitalization and resources, and infrastructures that allow them to control more of the spectrum of care, from first visit to discharge. Gardner believes that hospitals and health systems should not get caught up in trying to emulate what the top physician-led ACOs are doing, rather, they should hone their core strengths, and seek out ways to partner and form agreements with these practices.
"Hospital-led ACOs shouldn't try to become physician-led ACOs. They should take advantage of the opportunities that they have, recognize what their strengths are and do what's best for them," Gardner says. "It's kind of like the analogy about an elephant trying to climb the tree. That's not what elephants do. They knock the tree over; monkeys climb trees. Recognize what your strengths are and what you can do well."