Health Care and Small Business & Startups

Independent physicians form clinical network

Patient care and reducing burden on employers are at the heart of the decision.

February 20, 2015
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Independent physicians in West Michigan are building more clout.

West Michigan Physician Network, a physician-led organization serving independent providers, and Physicians’ Organization of Western Michigan, supporting independent physician practices since 1986, are in the process of forming a clinically integrated network to improve health care for patients in West Michigan and provide an opportunity to bring independent physicians together. As many as 800 physicians could be involved.

Dr. Kirk Agerson, family practice physician and medical director of the WMPN board, said the climate has changed as the nation and region moves toward shifts in medical care.

“Physicians, first of all, are independent thinkers, and independent physicians tend to be more of the cowboys,” said Agerson. “It is very important for our community to have independent physicians, and I think having a CIN is critical for the future of independent practice to continue to exist.”

A clinically integrated network is defined by the Federal Trade Commission and the U.S. Department of Justice as an organization with an ongoing program seeking to improve practices and create interdependence and collaboration among the physicians to control health care costs and ensure quality.

Dr. Jon Curry, urology specialist at Urologic Consultants PC and president of the WMPN board, said the CIN is in a state of formation and is an opportunity to bring independent physicians together to work collaboratively.

“It is a group of independent physicians sitting around the table trying to determine how to best structure a clinically integrated network for our area,” said Curry. “We would like to improve health care for our patients in West Michigan, improve quality, decrease cost of care and improve or continue to provide safe care in Grand Rapids and West Michigan.”

Initially planning on blending or merging the two independent organizations, Agerson said it quickly became apparent the two groups would need to develop a CIN. To form the network, which is anticipated to be completed in the next several months, WMPN and POWM are working with Hogan Marren Ltd., a Chicago-based law firm with experience in assisting clients to implement clinically integrated physician and hospital networks.

“We need to measure the quality and we need to look at what measurements we can improve on, and there are legal guidelines from the federal government that we must adhere to or follow, so that is what the consulting law firm in Chicago is helping with,” said Curry.

Becker’s Hospital Review, a health care industry trade publication, released a report in 2012 highlighting components of an effectively implemented CIN, including legal options, physician leadership, participation criteria, performance improvement, information technology framework and contracting options with payers and/or health systems.

Agerson said on a practical basis it means the shared patients across primary and specialty care will experience more efficient, quality care.

“There is a lot of duplication of testing — unnecessary testing — and lack of communication at times. What a CIN offers is the ability to give better patient care at a better cost structure, eliminating a lot of unnecessary testing and fostering better communication,” said Agerson.

Truven Health Analytics released a paper on the considerations for clinical integration in December 2011, which indicated incomplete patient knowledge due to lack of communication “has been associated with increased costs and poor outcomes” and an integrated technology platform supporting continuity of care is a key component.

A larger network also will allow larger representation when negotiating with payers, employers and health systems, according to Agerson.

“We decided we needed to have the two groups of physicians together to have greater numbers to better represent ourselves to payers such as Blue Cross Blue Shield and Priority Health and dealing with hospital systems,” said Agerson.

“I like to think of it as the quadruple aim … physician satisfaction is important, too. It protects ourselves as independent physicians and provides better quality and more efficient care for our community,” he added.

A West Michigan-based CIN is an opportunity to determine best care for patients, provide cost-effective care reducing burden on employers, and ultimately attract new businesses to the region, according to Curry.

“The idea of it is for physicians to monitor and track quality measures by accumulating information and data on how well we are taking care of our patients,” said Curry.

“I think in medicine, physicians over the last several decades have not done a good job of taking control of medicine and the care of our patients. We have allowed other businesses or companies associated with medicine to dictate a lot of what we do.”

Some of the challenges leading up to the formation process include overcoming the differences WMPN and POWM have had in the past and reconciling business practices. Although the integrated organization will include professional support from lawyers, consultants and accountants to help negotiate business operations, Agerson said it needs to be physician directed.

“It comes down to quality patient care. Medicine is pretty complex, and you just can’t look at it from a numbers standpoint, demographic standpoint; you have to look at it from a patient standpoint,” said Agerson. “We need to have the patient experience integral in the design of care protocols.”

With roughly 440 members involved in WMPN and approximately 500 with POWM, Agerson said the potential number of independent physicians participating in the CIN could be close to 800, taking into account an overlap of membership.

“There are some members that are not going to be interested in joining this, for different reasons. It is hard to say what the final number will be, but hopefully other physicians locally would want to join it,” said Agerson. “I don’t think it is in the best interest of our community to have all of our physicians employed by the systems. On the other hand, we need to work together with all of those systems, and that is going to certainly be a challenge.”

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