Fallon Clinic in Worcester, Mass., is breaking a longstanding exclusive relationship with its sister, Fallon Community Health Plan, and signing managed care contracts with the health plan's competitors.
Today, the 240-physician clinic announced its first contract with Wellesley, Mass.-based Harvard Pilgrim Health Care, effective Jan. 1. And a contract with Blue Cross Blue Shield of Massachusetts became effective Sept. 1, the clinic reports.
While the Fallon clinic and health plan share some board members and are located in the same city, they are otherwise completely separate entities, says Craig Samitt, M.D., chief operating officer of Fallon Clinic.
But until this fall, Samitt says, the clinic had a virtually exclusive managed care relationship with the health plan, although it always treated outside fee-for-service patients.
This "single-payer" relationship limited access to only 20% of the market, and "if you have access to 20% of the market, you can't grow," Samitt says in an interview with Modern Physician.
When employers changed health plans, he says, patients often had to leave Fallon.
"It was very disruptive to patients and doctors," Samitt says. "They were very dissatisfied, and it certainly doesn't do much for quality and efficiency."
But now that the health plan has fully recovered from financial problems that were besetting all Massachusetts health plans in the late 1990s, the exclusive relationship can be loosened, he says.
In addition to opening up managed care relationships, Samitt says the clinic has contracted for a electronic medical record system from Epic Systems Corp., in Madison, Wis., and is undergoing a "strategic transformation" emphasizing customer service.
"We want to be the Ritz-Carlton of healthcare," Samitt says.
He says Fallon Clinic now has a policy to hire doctors and staff who are "patient-oriented" and is planning an "advanced access" program under which patients can get same-day appointments for routine physicals.