Dave Spalding is COO of TMA PracticeEdge.
Tell me about yourself and the company.
TMA PracticeEdge, LLC, is a new services company developed by the Texas Medical Association to bring physicians the technology and expertise they need to take advantage of new healthcare payment models. It provides Texas physicians real options to design their own future. Today, we offer physicians a complete tool kit to help them form clinically integrated networks, manage population health, and operate value-based care models. We also provide consulting services in support of practice transformation. We will be seeking to expand our service solution set very quickly.
I am a healthcare executive with experience starting up new, high-growth healthcare services companies. Some of the recent companies I have helped get off the ground successfully include a new management services organization, a no-fee Health Savings Account bank and a five-star Medicare Part D Administrator.
Why did TMA decide the time was right to introduce PracticeEdge? What were you hearing from TMA members that led to its development?
Faced with the rapidly evolving healthcare environment and growing concern from the membership, the TMA leadership and board established a physician-led task force to research the concept of creating a physician services organization. After about two years of design and development work, the company was formally launched in February 2015.
Have any other state medical associations launched similar ventures? If so, did you reach out to them as PracticeEdge was coming together?
My understanding is TMA is the first medical association to launch a venture of this kind.
Why did TMA decide to partner with BCBS in this venture?
BCBSTX shares the TMA PracticeEdge goal of supporting and growing physician-led ACOs in our communities throughout Texas. When they initially expressed an interest in working together jointly on that goal, we welcomed their input and ideas. Ultimately, we were able to develop a mutually beneficial joint venture structure with BCBSTX bringing to the table innovative ideas, strategic capital, and flexible value-based contracting models for physicians.
Are PracticeEdge services only available to TMA members? How does your business model work?
Our services are targeted to our membership base, which is natural given the strength of our brand with independent physicians. We had a strong desire to get to market as rapidly as possible; therefore, we are utilizing a service provider to help us deliver our services. The firm we chose was Innovista Health Solutions, a leading physician-centric provider of population health, network development, and care management. Innovista already has over 120,000 lives under management in ACOs in Texas and Illinois. They bring competency and expertise to our clients, and they are very complementary to our trusted brand.
How many clients do you currently have? Are you seeing a particular type of physician practice express the most interest?
We have already landed three new ACOs for January 2016, and our pipeline is expanding as the word gets out about our services. Interestingly, we are working in a large urban setting, a middle market, and a rural market. We could not be more pleased with the reception we have received from physician leaders.
How do you envision helping them your clients better utilize healthcare IT as part of their overall ACO strategy?
Probably the biggest single IT-driven advantage we can bring to an ACO is access to best-in-class population health management technology. That access comes at a scalable cost, and it levels the playing field for independent physicians looking to compete against larger healthcare provider systems.
What types of ACO models will PracticeEdge steer its clients towards? Pioneer, Next-Generation, eventually commercial?
Every client is different, and we consult with them to assess their specific needs; however, it is safe to say we see real interest already in commercial ACOs as well as Medicare Advantage. Also in Texas, physician ACOs have been successful in working with the CMS Medicare Shared Savings Program ACO model.
Will you eventually offer your services outside of Texas, competing with companies like Aledade?
Our affiliation with our medical association makes us unique in some regards. We plan to grow our business around our membership and that strong historical connection. There is a lot of competition already in our space, and we think that is great for physicians, as competition drives market innovation.
Given that reimbursement models for telemedicine are shifting, do you anticipate your clients incorporating telemedicine services into their practices at a faster rate than previously?
We don’t see anything on the horizon that indicates telemedicine is going to expand in our region. Healthcare is local, and so far, retail telemedicine has not seen great uptake here.
Where are the majority of your clients with Meaningful Use? Are they feeling burdened or empowered by the criteria? How are you helping them to clear any IT hurdles they may be facing?
Physicians are feeling extremely burdened by the Meaningful Use criteria and are dropping out of the program. The unintended consequence is that it will further impact access for Medicare patients as the Medicare penalties increase. The program in its current form is unsustainable. As for helping them clear IT hurdles, the main approach we are taking is to work closely with a couple of EHR vendors that have been vetted by TMA physicians. Once these relationships are finalized, TMA PracticeEdge can help these practices optimize use of their EHRs, not only for Meaningful Use, but for other value-based programs as well.
Do you have any final thoughts?
We are really encouraged by what we are seeing in Texas and nationally with physician-led ACOs. Our estimate is that about 70 percent of the shared savings generated under the CMS MSSP ACOs has been delivered by physician-led ACOs versus a hospital-based ACO. We know from experience that when physicians step up and lead the charge into value-based care and population health, they can produce sustainable results including higher quality healthcare delivery at a lower cost.