Physicians are leaving small practices for larger groups at an unprecedented rate. Recent data show that between 2013 and 2015, the percentage of physicians working in small practices (those with nine physicians or fewer) dropped from 40.1% to 35.3%.
Meanwhile, the percentage of physicians working in large practices (of 100 physicians or more) increased from 29.6% to 35.1%.
While larger groups have more resources, including the administrative infrastructure, data reporting and care coordination capabilities needed in a pay-for-performance setting, physicians who work in a small, independent practice still have advantages. They certainly shouldn't call it quits.
As Dr. Farzad Mostashari, former national coordinator for health information technology, pointed out in an article last year in the Annals of Family Medicine, and as the American Academy of Family Physicians recently affirmed, small practices can flourish in the age of value-based care.
Physicians in these practices tend to have close relationships with their patients, allowing for quality face time. More engaged patients can lead to better health outcomes. So in this sense, smaller practices can have the “home field” advantage when it comes to delivering high-touch and personalized care. In fact, many are well on their way to implementing value-based care on their own, without the support of a large provider group.
A recent survey conducted by the AAFP found that a third of family physicians are actively pursuing value-based payment for their services. But the survey also corroborated that they do face barriers to implementation. For many, it's hard to gain access to enough data to get a clear view of the population they serve. Some can't make the investment in a big electronic health record system and key staff like care coordinators and population health managers. Others simply don't have the time.
Given small practices have a distinct advantage to practice care tied to quality, they shouldn't have to face these challenges alone. And they shouldn't be required to merge with other practices or health systems, either. Instead, I believe there's a real opportunity for health plans to partner with small practices and help them along the journey to value-based care.
Part of this means not enforcing the same rigid value-based agreement for each small practice with whom we partner. Different practices will be able to take on risk at different intervals, and the health plan partner must be flexible and meet the practice where they are. It's also the responsibility of the health plan to provide education and operational support to practices to help them understand what it takes to move away from fee-for-service models.
Implementing a management services organization, or MSO, convener model has, in my experience, helped practices remain independent while accessing many of the resources available to large provider groups. MSOs can assist with a wide range of operations, from care coordination to billing and coding, all of which are crucial to success under a value-based model. Humana's MSO, Transcend, for example is well-positioned to serve as a convener for these types of practices, offering them the infrastructure and capability support needed to be successful in a value-based care model.
Last but not least, the industry needs to come together to provide payer-agnostic reporting tools. Most small practices don't have the luxury of working with only one health plan—in fact, many work with more than six different insurers, which can all have different quality metrics and data requirements. Standardizing the way we measure and track quality will go a long way in reducing the burden for independent physicians.
This won't be a quick and easy transition for most practices, but with the right people, physician partnerships and tools, we can transform the way we care for our communities
