Physicians organizing for payment reform
I'm only aware of on successful example of providers contracting with plans in a outcomes-based payment model in Alaska. For the most part, fee for service is alive and well. But a new organization, Pinnacle Integrated Medicine, is looking to expand value based contracting in Anchorage. It's a combined effort of Medical Park Family Practice, Alaska Center for Pediatrics, Alaska Women’s Health and Alaska Urology, as well as providers in Idaho and Washington State.
We asked Pinnacle's CEO about the company's plans and vision. The bottom line: " We know that fee for service isn’t going anywhere soon, especially in Alaska, but there are now incentives for providing value that don’t involve risk."
The organization is building buzz for itself, particularly in Alaska which does not have a strong history of any contracting, including even fee for service contracts.
The organization is led by CEO Jason Haugen. We got him to answer a few questions about Pinnacle, his vision for the company and the value proposition for the health care system.
DJ Wilson: Tell me about the vision for Pinnacle Integrated Medicine. What is Pinnacle being established to be able to do? What’s your purpose? How does the construct of being clinically integrated help that?
Jason Haugen: Pinnacle’s vision is to bring forth a physician owned and led clinically integrated network to keep quality high and control costs across the continuum of care.
When physicians come together for a common cause the change is lasting. This collaboration is happening on a number of fronts. For starters, the backbone of our model is to bring independent groups and systems together clinically through an inter-operable system linking disparate EMRs.
Maintaining cultural and financial independence for groups is important to ensure groups remain flexible and autonomous but it is the clinical integration across the continuum of care that allows us to roll out a patient centered medical home model that keeps quality high while controlling costs.
Equally important to this model is to ensure that the health of independent groups is maintained. Pinnacle has established tools and partnerships to support the independent physician model. Pinnacle owns a professional employment organization and has its own qualified registry to offer to its participants.
DJ: You’ve gotten some early interest from physician groups, I understand, many of whom are investors. Can you tell me which clinics are engaged with you, either as dues payers or as investors?
JH: Some of the physician participants have been involved in the development of Pinnacle’s solution since it was just an idea three years ago, so it was natural that this model progressed into one where physician ownership was central to our model. While there are efforts in other states, we believe all healthcare is local and so our initiatives in Anchorage are driven by a physician led board.
Our board consists of physician owners and directors from Medical Park Family Practice, Alaska Center for Pediatrics, Alaska Women’s Health and Alaska Urology. Pinnacle has physician owners across seven medical groups of different specialties from three states.
Developing our solution over the course of the last three years has allowed us to learn a lot from the success and failures of other models. For one, we’ve learned that physician led networks are performing better than hospital networks.
One of the reasons is that physician groups are nimble and can work in a number of different value based models. Physician led groups also achieve savings differently than hospitals by taking care of patients upfront. That isn’t to say hospitals aren’t important to this model, they are. Their value proposition is just different as they manage patients once admitted.
Also, there is a roadmap to follow now that didn’t exist three years ago making participation easy without risk of losing money or violating laws. We know that fee for service isn’t going anywhere soon, especially in Alaska, but there are now incentives for providing value that don’t involve risk.
DJ: One of Alaska’s primary challenges is related to cost. The cost of care in Alaska is as high as anywhere in the nation. How does Pinnacle and its member physicians help address that problem?
JH: Alaska Center for Pediatrics (ACP), one of our founding groups, has been successfully operating in a Patient Centered Medical Home environment for a number of years. They are one of the only NCQA Level IIII PCMH in the state of Alaska.
We are committed to replicating ACP’s model in the groups participating as well as ensuring the groups receive economic incentives for doing the right thing.
An interoperable system is certainly necessary to make this happen but even more importantly is that physicians are supported by a team and model that will allow them to get the right patient care at the right time.
This will impact costs by reducing ER visits and waste as well as keeping care local while providing high quality timely care. One of our key initiatives is moving participants towards Patient Centered Medical Home or Patient Centered Specialty Practice Recognition, or at least introducing them to the fundamentals of these models, this year.