UPMC Pinnacle joins physicians for integrated network
A new organization formed by UPMC Pinnacle in partnership with independent physicians could help providers and networks adjust to changes in how payments are made by health insurers.
The organization, called Concert, is a clinically integrated network being developed by UPMC Pinnacle in collaboration with independent providers and providers employed by UPMC Pinnacle. Such networks, known as CINs, enable physicians to work together on lowering costs as part of the transition to payments based on the value of treatment and away from the old fee-for-service method.
"It encompasses collaboration between physicians and health systems, and in this particular case it’s between private practice physicians, hospital-based physicians and the health system," said Dr. R. Scott Owens, a provider with Urology of Central Pennsylvania in East Pennsboro Township and co-chair of the physician leadership council for Concert.
The 27-member council of physicians is expected to appoint candidates to Concert’s board of managers by the end of March.
Concert will also roll out a new IT system to its member practices meant to integrate communication between its members. The software is meant to help member practices improve health outcomes of the population overall, not just the patients of individual practices.
"In the current situation, we all work in our own box and take care of our patients. But we’re not really communicating through an IT structure so that there’s a common goal and a common approach to the entire patient population. The CIN is really held together by interconnectivity," said Dr. Craig Skurcenski, vice president of emergency medicine for UPMC Pinnacle and co-chair of the physician leadership council alongside Owens.
Bob Dondes, president of Concert and senior vice president at UPMC Pinnacle, stressed the role of the physician leadership council in choosing the direction Concert will take as it leaves its current development phase.
"What’s so incredible about this is that the physicians are taking ownership, they take leadership. They are the ones who are driving this," said Dondes.
Once it has measured improved health outcomes and shown reduced costs, Concert can then take that information to health insurers - including Medicare - and negotiate value-based payments. Concert can then collect those payments and distribute them to its member practices.
Such value-based payments are in addition to traditional fee-for-service payments and not yet meant to replace them, said Dondes.
"You could say they’re parallel or you could say supplemental or complimentary. They don’t replace [fee-for-service payments], they are typically additive," said Dondes.
The network's goal is to secure a partnership with one or more commercial insurance carriers by 2019.
A change for the industry
Value-based payments are often cited by policymakers as the future of the health care industry.
They were the major focus of remarks given by Secretary of Health and Human Services Alex Azar to the Federation of American Hospitals earlier this week.
"There is no turning back to an unsustainable system that pays for procedures rather than value. In fact, the only option is to charge forward — for HHS to take bolder action, and for providers and payers to join with us," said Azar.
Short of a complete overhaul of the health care system - such as Medicare-for-all - a transition to a value-based system may be "the last best good idea we have to play before something draconian comes along," said Dr. Jaan Sidorov, president and CEO of the Care Centered Collaborative, an organization within the Pennsylvania Medical Society that helps providers transition to value-based care.
Clinically integrated networks like Concert can help facilitate that transition, said Sidorov.
"It’s really designed to be win-win for everybody. If I provide increased quality and I drive increased efficiency, what the insurer sees is a lower health care costs trend and that releases the money from the insurer to compensate the physicians for what they’re doing," said Sidorov.
Sidorov said health networks like UPMC Pinnacle are eager to help facilitate the transition because of the benefits a value-based system could provide the health care market overall. As independent and employed doctors work to improve health outcomes among their patients, said Sidorov, large hospital networks like UPMC Pinnacle will see their own costs go down.
"If we can reduce hospitalizations and reduce emergency room visits, that’s real money in the health care system that will go back in a loop to keeping these atrocious health care costs from resulting in these bills that are unaffordable to individual patients as well as businesses," said Sidorov.