By Blaine Lindsey, Executive Director, Aledade, Inc. | The DPC Journal | Special Contributor
APRIL 2016 – For primary care physicians, the last two decades have brought a never-ending (and mostly unpleasant) series of regulatory, reimbursement, and technological changes that have increased frustration and overhead to a point where many independently owned practices are faced with the ultimate question: Can I survive – let alone thrive – in a landscape increasingly tilted towards consolidation, specialists, and large health systems?
The short answer is YES! I unequivocally believe that empowered, independent primary care practices are key to creating a healthcare delivery system that achieves the triple-aim: better for patients in delivering the highest-quality care; better for society by bringing down skyrocketing costs; and better for physicians by giving them the space to practice medicine in the way they want.
That’s why I’ve worked throughout my career to find and support viable practice models that allow independent physicians to retake control of their patients’ health, and that rewards them for the critical role they play within the system.
One of the best models is independent primary care physician-owned Accountable Care Organizations (ACOs). And that’s why I’ve joined Aledade as ACO Executive Director where I’m focused on creating innovative partnerships with independent primary care physicians to provide everything they need to enter into, and succeed in, ACOS and other value-based reimbursement structures. First, the basics: ACOs are groups of health care providers, who come together voluntarily to give coordinated high-quality care to their patients. In an ACO, primary care physicians continue to receive payments for their services – but they also receive a share of any savings from avoiding unnecessary ER visits, hospitalizations, and procedures. ACOs reward doctors for quality, not quantity – for better outcomes, not more tests.
ACOs work because they are built around the same core principle as the physicians who join them – ensuring that patients get the right high-quality care at the right time. Like Direct Primary Care and Concierge medicine, ACOs provide an opportunity for doctors to succeed by focusing on prevention and keeping patients healthy.
While some ACOs/Managed Care Arrangements had issues during their developmental phase years ago, value based reimbursement has come a long way since then. And, these physician-owned ACOs are specifically designed to make sure that much of those savings go back to the primary care practices whose work made it possible.
Aledade takes this physician focus one step further, as it is not owned or managed by any hospital or health care plan. The Aledade model provides a low-risk way for doctors to form ACOs with no upfront cost, and the company immediately invests in practices who join an ACO. Practices get assistance from the practice transformation team – supplemented with local partners – to adjust to the value-based payment system, as well as access to Aledade’s technology and policy experts. We equip practices with cutting-edge technology and analytics to help physicians make the most of EHRs, population health data, and patient claims.
I understand that, in a vacuum, converting to Direct Pay (Concierge Medicine, DPC, etc.) appears to be the silver bullet for most struggles that primary care physicians face. However, my experience in Direct Pay medicine has made it clear to me that outside of that vacuum, Direct Pay is only part of the solution for the way better primary care will be practiced in the future.
There are other ways to remain an independent physician that take into account the reality of those physicians who cannot or do not wish to convert to Direct Pay today.
For this reason, ACOs present an important option for many primary care physicians. While they are not the same as a full shift to Direct Pay, ACOs empower independent physicians to take control of their practice and patients’ health. ACOs solve many of the regulatory and reimbursement problems that have driven so many physicians to consider Direct Primary Care and Concierge Medicine, while also allowing practices to fully serve their patient populations and remain independent within the system.
In the next article I will make a case for why physicians considering Direct Pay medicine, but who are not quite ready to take the leap, can benefit greatly from joining with other independent practices to enter into ACOs and other value-based contracts. I look forward to a robust discussion!
Blaine W. Lindsey, JD, MPH