Rick MacCornack is CEO of Northwest Physicians Network, a Washington-based independent practice association and multispecialty provider network that has experienced record growth in the last 12 months.
NPN has seen an 80-percent increase in membership over the last year – a statistic that highlights the fact that independent physicians want to stay that way. What are the biggest obstacles private practices face when it comes to remaining independent?
The largest obstacle facing private practice today is the increasing administrative burden associated with so-called value-based payer contracts. Performing well on quality metrics, which are now required by all public and private payer contracts, is a challenge when the payment methodology is predominantly fee-for-service within PPO products. Patients are permitted to not have a primary provider, which flies in the face of a practice’s attempt to be actively “accountable” for an individual’s health. Technology cannot solve this issue. This is an adaptive, behavioral issue. Payment methods and consumer incentives are currently not in alignment with policy attempts to achieve the goal of population health.
How does NPN help them to overcome these challenges?
In the NPN network of 1,000 providers, there are 49 different EHR platforms in use. NPN staff supports the primary care providers by collecting and handling their clinical data for reporting and management purposes. This is done through remote access as well as in-clinic, manual abstraction of records. NPN supports a cloud-base registry, warehouse, and analytics platform, which serves as the aggregator and processing center for all reporting for each provider. Both clinical care gap reporting at the practice and patient level and managed care analytics (total cost of care and cost and utilization broken out by service category, per member per month) is provided to each clinician on a scheduled basis. Both sets of reports provide the clinic staff with a means of managing defined populations of patients. Reports to the provider are payer agnostic.
What role does healthcare technology play in this predicament?
Healthcare technology used by NPN is all cloud-based. NPN provides a comprehensive referral and care coordination platform to ease the administrative burden of referral processing, patient tracking, and care coordination. NPN also provides secure messaging via smartphone and desktop. And quality, utilization, and cost analytics are provided to all providers. The cost of providing these services is subsidized by NPN for all primary care providers, who are the least able to afford these technical services on their own.
What type of healthcare technology seems poised to best help private practices keep their doors open and patients satisfied?
All cloud-based solutions used by NPN have been developed and are provided by small startups who are experienced working in heterogeneous care delivery environments like IPAs. The private practice environment is a non-standard environment. True collaboration between vendor and the client in developing and delivering the service is required. NPN has even served as both an alpha and beta site for some of the technology services it uses.
How does NPN plan to help its network prepare for and work through MACRA? What resources do you feel practices are most in need of to make it through this transition?
MACRA adoption is a process of education and learning which track is most appropriate for each practice. One size doesn’t fit all. Across all tracks, data reporting by the practice and performance feedback to the practice are essential to participate under MACRA guidelines. NPN’s approach to supporting private practices under MACRA is to relieve the administrative burden of data collection from the EHR, uploading it into an analytics environment in combination with claims data, and returning results to practices on a scheduled basis for assessment and action. NPN staff serve to educate and support work flow changes in a practice to enable them to reach designated performance targets.
That said, until the payment system in the US is fully converted to “value-based” payment that is attached to administrative requirements that support performance- (cost and quality) based payment, it will be difficult for providers in any delivery system structure to consume practice-level data in a way that achieves better management of resources, one patient at a time. Population health is an unreachable goal when patients are not tied to a primary care provider who has the responsibility and the resources to manage each patient’s individual clinical needs over time.