Physician Driven Organization

Physician Driven Organizations

We are seeing evidence in many areas that the economics of medicine combined with new rules and regulations for both physicians and third party purchasers are leading to the formation of new and successful physician driven enterprises.

These enterprises can withstand the test of time and market pressures even after all the reform legislation is enacted because physicians are anticipating regulations and are now building their practices around patient need and the new reimbursement opportunities emerging in most markets.

In some cases, this can be a simple network of 10 or 15 individual physicians who want to receive better contracts from managed care and share overhead so the regulations and reporting do not overwhelm the practices. Many of these Management Services Organizations (MSOs) are owned by the physician partners and keep the actual practices separate while reducing overhead.

Sometimes these are formed when larger networks have stalled out of their growth patterns and are starting to lose members because third parties are capturing them as part of narrow networks. Forming a high performance physician network to better structure arrangements with third parties and set in place a framework for network growth can be a solution.

This trend will continue while insurers begin to buy practices and physicians suddenly see new options to strategically leverage their expertise and clinical knowledge and demand market share at a favorable price with a condition to share in any savings they create for the third party. This means asserting ownership over a broader scale organization, but it does not mean giving up all independence.

Value Driven enterprises such as High Performance Networks and Group Practices Without Walls fit well into the future of payer and government reimbursement but need some planning and assistance in guiding the efforts of resources such as lawyers, accountants and IT professionals.

Physicians would have a hard time building a house without an architect and a general contractor and this kind of building process is no different. A well run physician organization, be it a small group, large network or joint venture, all require the skills of an experienced consulting and project management process to make judicious use of time and money.

Pendulum Health has over 40 years of experience in designing and building such enterprises. We can assist existing enterprises who want to grow into larger networks, ACOs and/or physician driven health plans, a strategy that, once again, fits the direction the private pay and now the Medicare and Medicaid payers are going.