In 2019, Bryce Johnson, MD, and his colleagues from four California-based orthopedic practices knew they needed to be part of an integrated care delivery system to better navigate the evolving healthcare environment.
With their practices' long-term growth and independence uncertain, partners from Coastline Orthopaedic Associates in Fountain Valley, Los Alamitos Orthopedic Medical and Surgical Group, Platinum Orthopaedics in Fountain Valley and South County Orthopedic Specialists in Laguna Woods decided to join forces as OrthoWest. But they needed a partner to get them organized and aligned in their market, and support a path forward to optimize their new combined business.
Pictured Above: Dr. Dan Murrey, president, Optum Specialty Practices, Caitlin Zulla, CEO, Surgical Care Affiliates, Dr. Bryce Johnson, OrthoWest
Reflecting on the monumental task to bring the four practices together, Dr. Johnson, Chairman, OrthoWest recalled, "We wanted to merge our groups and maintain physician control with a shared vision for growth. There were many considerations and decisions to build a foundation for our long-term success. We knew that we would have to do it from the ground up and looked for a partner who could bring more market power, longevity and connectivity to patients in a larger integrated delivery system.”
Today, sitting at the table with OrthoWest is Optum Specialty Practices, SCA's physician solutions business, which helped to build that foundation starting in 2020. It included creating the new business structure, governance and contracting, as well as aggregation and integration with OSP platforms. Still in the early stages, OrthoWest now has access to deeper partnerships with local medical groups and is on the path to vertical business integration, clinical pathway alignment and practice optimization.
The challenges and needs of OrthoWest are not new to SCA. It's a story its leadership team have heard over and over again, accelerated by COVID-19.
"We know that physician leadership is required to control the total cost of care," said Dan Murrey, MD, SCA's CMO and OSP President. "Physicians know how to lower cost while improving quality but aren't put into a position to make the changes needed. We want to give them the agency and ability to do just that."
To facilitate that type of support for physician partners, SCA has evolved beyond its core ASC business to enhance sustainability of physician practices, invest in their future, and make connections to innovative and value-oriented primary care providers and payers. While shifting cases from higher cost settings to ASCs remains one of the biggest opportunities to reduce the total cost of care — there is so much more opportunity to enhance outcomes beyond affordability.
SCA's CEO Caitlin Zulla knew her company was well positioned to deliver.
"We asked ourselves 'How can we go beyond ASC partnerships to be an even bigger support to our physician partners?'" said Ms. Zulla.
One big need for specialists: introductions to primary care physicians. SCA joined UnitedHealth Group & Optum in early 2017, giving SCA-affiliated specialists an immediate pathway to meet the thousands of primary care physicians.
“Optum Care has the largest network in the U.S., with 56,000 physicians, serving 99 million people. The breadth of resources in Optum are a huge differentiator and benefit to our partners and patients," Zulla added.
Practice solutions through Optum Specialty Practices emerged as another big need for physician partners focused on optimizing practice fundamentals, driving growth, and moving specialists into value-based care agreements. The solutions range from capital access and support for back-office functions such as billing, credentialing, finance, HR, IT, supply chain, managed care contracting, but also negotiation and performance on risk-based agreements such as sub-delegation of capitation.
"We had each worked with Optum primary care and IPAs previously but knew we could perform better on risk agreements if we combined our resources and partnered with someone with the infrastructure and expertise to manage musculoskeletal risk more effectively," Dr. Johnson said. "OSP helped us construct our new entity and unify the practices. We now have established more advanced value-based care partnerships, built systems to manage utilization and affordability, and refer patients to the right provider."
Value-based payment innovation was already an area of strength and expertise for SCA. Today, 65 percent of SCA contracting facilities have at least one value-based contract in place and 40 percent have two or more. Adding to its capabilities, in February 2021 SCA acquired Global1 (G1). Through G1, SCA now can create new and enhanced bundles through its dynamic payment platform allowing it to act as both the payer and the provider, removing friction from the system. Their network of physicians and surgery centers receive the benefit of a single bundle that significantly reduces the cost for patients and payers while keep quality at the forefront.
Other needs were identified, such as value-oriented, high-quality anesthesiology groups. Earlier this year, SCA brought on Kathy Grichnik, MD, as its first chief of anesthesia services to solve this dilemma as a critical piece to the outpatient experience and the growing shift of higher acuity cases to ASCs. Anesthesia is a new capability to deliver consistent and exceptional care — from preoperative assessment, optimization and preparation to optimizing pain management through the recovery period — through unified protocols and quality standards.
"We want physicians to know we're invested in their professional and financial success as we strive to grow patient referrals and ensure quality outcomes so they can focus on the reason they decided to practice medicine in the first place — taking care of patients," Dr. Murrey said. "As physicians our patients entrust us with their well-being. SCA is putting our physician partners in a better position to deliver on that trust."