Today’s healthcare system is undergoing a complicated transformation, a regulatory restructuring of care coordination and payment reimbursement from fee-for-service (FFS) to value-based care. Payment models and care delivery systems are evolving, and independent physicians are being forced to reexamine their roles and sustainability in this modern approach to health care. With the help of Independent Physician Associations (IPAs), physicians are experiencing the numerical strength, collaborative support, and quality success needed to compete and thrive in today’s value-based care environment.
Independent Physician Associations (IPAs) are physician-led entity groups, made up of solo or small-group primary care and specialty physicians, who are usually tied to a specific geographic location. IPAs are designed to negotiate on behalf of their participating independent physicians, concerning the acquisition of new patients and patient reimbursements. IPAs contract with insurance companies, health management organizations (HMOs), accountable care organizations (ACOs), and even hospitals regarding modified fee-for-service or capitation payments. The healthcare landscape is seeing an exponential increase in influential mergers and acquisitions, and the creation of these powerful networks places a tremendous burden on independent physician practices to compete, forcing them to consider employment with larger organizations, or even selling their medical practices altogether. An IPA entity group can represent tens or thousands of assembled physicians, giving them the numerical strength to collectively bargain and to strategically develop larger, more competitive and appealing third-party contracts. This collective strength helps independent physicians to expand their patient base by supporting multiple payer health plans, allowing them to compete in today’s healthcare environment while maintaining physician autonomy.
An IPA entity group can represent tens or thousands of assembled physicians, giving them the numerical strength to collectively bargain and to strategically develop larger, more competitive and appealing third-party contracts. This collective strength helps independent physicians to expand their patient base by supporting multiple payer health plans, allowing them to compete in today’s healthcare environment while maintaining physician autonomy.
IPAs deliver support to primary care physicians and specialists by allowing them to take part in a structured, collaborative approach to healthcare where physicians share resources, data, analytics, insights, financial risk, and overhead costs associated with value-based care models. Complexities in MACRA requirements, specifically under the Quality Payment Program (QPP), have created regulatory frameworks that require education, training, and preparation, and that demand large financial investments in clinical improvements, information technology, and administration. At the same time, physicians must stay focused on being cost-effective while successfully achieving performance-based, quality measures. Chris Dawe, vice president of Evolent Health, a technology firm that helps providers adopt value-based payment models, explains, “It is really hard to stay independent in a world moving to risk. Becoming part of a network of colleagues where you have the scale necessary to efficiently manage a population at risk and to share the expenses…it’s an appealing pathway.” By joining an IPA collaborative model, IPA member physicians can share with and be supported by their peers in organization, innovation, administration, management, and technology, as they focus on quality improvement and cost-efficiency. IPAs help independent physicians to stay competitive by coordinating resources and by offering support in areas critical to success in the value-based care environment.
Through the collaboration and support they provide, IPAs help to align physicians to achieve more comprehensive, cost-effective, quality care. Independent physicians and specialists provide optimal patient care, in part, because they can communicate more efficiently and effectively with each other and their patients. Many IPAs offer third-party information technology platforms that provide interoperability with Electronic Health Record (EHR) systems, allowing physicians to review lab results, medical services and pharmacy claims, hospital readmissions, care transitions, and immediate care needs.
Independent Physician Associations give individual physicians and specialists the opportunity to participate in a team approach to healthcare, while maintaining their independent status.
In addition, IPA management infrastructures allow physicians to focus more on providing care, rather than being burdened with aspects of payroll, benefits and claims management, compliance, marketing, and so forth. Kelly Ann Pappa, RN, explains that “many providers feel overwhelmed by the myriad of administrative regulations and reporting criteria that they must meet in order to receive just compensation for the quality of care that they deliver.” She continues, explaining that “IPAs may offer the opportunity to participate in quality programs that reward improved outcomes that are often not otherwise available to the independent or solo practitioner.” Independent Physician Associations empower physicians and specialists to successfully provide high-quality, patient-centered care, and to be financially rewarded for doing so.
Independent Physician Associations give individual physicians and specialists the opportunity to participate in a team approach to healthcare, while maintaining their independent status. IPAs help physicians to grow their practices and to remain competitive by offering more contract bargaining power, by coordinating physician resources, by providing management and technology support, and by helping physicians to successfully collaborate to improve patient experiences, improve population health, reduce costs, and deliver high-quality value-based care.
North Texas Clinically Integrated Network, Inc. (TXCIN) is a non-profit ACO that began in late 2014. A small group of independent physicians aligned to initiate clinical integration and value-based contracting. Partnering with RevelationMD and its state-of-the art information platform, TXCIN has become the largest independent network of physicians in North Texas.
Castellucci, Maria. “Independence-minded Physicians Turn to ACOs.” Modern Healthcare. February 3, 2018. http://www.modernhealthcare.com/article/20180203/NEWS/180209972
Woodcock, Elizabeth and Casey Crotty. “IPAs: Joining Forces to Retain Independence.” Medical Economics. April 1, 2015. http://medicaleconomics.modernmedicine.com/medical-economics/news/ipas-joining-forces-retain-independence?page=full