Independent practices are uniting for scale and leverage during contract negotiations, but that may not be the best strategy for sustained success over the next decade.
In the value-based healthcare ecosystem, the currency will be data, and organizations with the best information will be more likely to thrive, said Maulik Bhalani, MD, owner and founder of Florida Pain Medicine in West Chapel, during a June 16 panel discussion at Becker's 18th Annual Spine, Orthopedic and Pain Management-Driven ASC + Future of Spine Virtual Conference.
"The selling and mining of data is really going to be the future of medicine," said Dr. Bhalani. "What is your complication rate? How fast can you see patients? What are your readmission rates? How many of your patients are having less epidurals over a certain time? If you've done a Vertiflex procedure or a spinal cord stimulator, did they actually save themselves from 100 back surgeries happening in the future?"
It becomes easier to collect data and gain insights when the entire continuum of care is in one organization. Large orthopedic groups with imaging, physical therapy, a surgery center and other ancillary lines have an advantage because the data is readily available, and everyone has the same information. There is also power in numbers as more physicians join together.
In Elmhurst, Ill., DuPage Medical Group is executing on the vision of a data-driven healthcare organization. The independent practice has more than 800 physicians and treats more than a million patients, giving it a powerful voice in the local healthcare landscape. The practice aims to use its data to take on risk in future contracts, which will require additional technology acquisition and data analytics capabilities.
"As we look at ways to really create value-based care, we're going to have to take into consideration all this technology so when someone comes in with back pain we ask: Do we do an injection? Do we do physical therapy? Do we do a minimally invasive surgical procedure?" Anthony Romeo, MD, executive vice president of the Musculoskeletal Institute of DuPage Medical Group, said during the panel discussion. "Well, the truth of the matter is, we have to be better with data and data analytics because we're not going to be able to do those things and afford it."
Dr. Romeo said his group is becoming more vertically integrated, creating data dashboards and analyzing outcomes so every physician can identify the best value for the outcomes and costs of treatment for patients with a specific diagnosis.
"At some point what we're going to do is we're going to take risk, and we're going to control the revenue from the insurance and then use that and population-based care to manage a group of individuals," Dr. Romeo said. "We can't be focused on fee-for-service or we will not be able to provide the best level of care."
DuPage Medical Group's strategy is in contrast with that of physician groups that add members and ancillary services for pure leverage in payer contract negotiations without the focus on data and value-based care performance.
"The insurance companies are going to be tighter and tighter on these groups because they're bigger. No matter how big the orthopedic groups get, they're not going to be bigger than the insurance companies," Dr. Romeo said. "They're already starting to steer cases to [lower cost] sites of service, and a number of other things, so it's going to be an interesting battlefield as we go forward."