Partners Health Alliance is a newly formed, 700-strong, clinically integrated network of physicians that is touting itself as the solution for independent and small group physicians facing financial pressures in the state as a shift to value-based reimbursement grows.
The alliance will be a one-stop business service shop for independent physicians and physician groups by providing administrative support, sharing data and best practices, and acting as a singular force to gain leverage at the negotiating table with insurers.
Its stated goal is “to help independent physicians and physician groups work together as a united front, PHA will help members take better advantage of value-based contracts with government and commercial payers, including Horizon Blue Cross Blue Shield New Jersey, Aetna, Cigna/QualCare, and the Centers for Medicare & Medicaid Services.”
It’s a unique option that is already garnering a strong response from interested parties, according to CEO Richard Larison.
On one hand, there are hospitals employing or buying physician groups, multispecialty groups like Summit Medical Group — the largest in the state thus far — and, on the other hand, organizations like Advocare and Continuum (the latter of which purchased a controlling interest in Partners in Care earlier this year) who provide administrative support to physicians.
PHA aims to provide all the benefits of a back-end service as well as employment model — but without taking away the independence of physicians and small groups.
Don McDaniel, CEO of Continuum, said that, while PIC will continue offering the care management services it has always offered, Continuum is the source of the back-end practice management services it is known for.
And because of the way the alliance and Continuum’s relationship has been structured, there was very little startup cost required.
Larison believes it is going to be a lucrative endeavor based on the current response.
He said there is no shortage of individual physicians in the state and estimates the alliance will have 2,000 physicians on board by the end of the year.
"One thing we noticed in the marketplace in New Jersey is there is still a large number of independent physicians. That is, those that have chosen not go into an employment model,” he said.
The alliance is also targeting independent hospital physician groups as clients.
PHA will help physicians transition to value-based care by, ironically, offering services for a fee.
Physicians can choose from a menu of options that range from total administrative support to just one or two specific areas.
"What we really want to do is have the small, independent practices remain independent," he said.
"But in order for them to be able survive this marketplace, we have to have some way for them to aggregate ... to ensure they have access to the insurance products and covered lives."
The “clinically integrated network of clinically integrated networks” is currently in Central Jersey, but Larison said there is interest from all over the state.
“Partners Health Alliance provides an alternative for physicians who wish to remain independent rather than become employed,” said Dr. John DeTullio, CentraState Healthcare Partners president. “This clinically integrated network will provide value-based care — high-quality care at an acceptable cost. PHA will offer care coordination and data analytics that small practices simply cannot perform on their own due to the administrative burden involved.”
McDaniel said the key is it’s a physician-governed organization.
“We have physician partners who really are going to be driving the decision-making process,” he said. “There is plenty of money in the system, but the money is being spent the wrong way.
We really need to meet the structural needs of these groups.”