Over the past three years, we have recommended to all of our clients that one of their main focuses should be the development of their primary care strategy. The reasoning is simple − in the current fee-for-service environment, primary care physicians own the referrals that will drive volume to specialists and to the hospital; however, in the future fee-for-value environment, primary care physicians will be best positioned to help manage population health, manage disease, and facilitate care coordination across providers.
While employment is the most prominent alignment solution for primary care physicians, it is just one of ten strategies discussed below that can be used with independent or employed primary care physicians. Developing a primary care plan around these strategies should result in solidified referral relationships, improved quality of care, improved readmission rates and cost of care, and more profitable volume for the hospital. Overall, these strategies will lay the groundwork for clinical integration, as the market evolution increases the role of PCPs in clinical management.
1. Recruitment Strategy. The first step in your primary care strategy should be the most straightforward one. Identify your primary care needs and recruit the appropriate number of physicians. This should take into account your primary care market share targets, the referral volume needed to support specialists and hospital services, and the geographic reach you are trying to attain, among other items.
2. Employment Strategy. In addition to employment of newly recruited physicians, an employment strategy that targets key independent practices should be developed. Ideal targets will be those practices that are vulnerable to being employed by competitors, those that have a positive payer mix, or those that are splitting volume between two or more hospitals.
3. Co-Management Strategy. While traditionally thought of as a specialist strategy, the co-management model has applications for working with primary care physicians to manage disease and reduce readmissions. With the rise of readmissions penalties from CMS in 2013 and beyond, giving PCPs incentive in this area will prove valuable.
4. Care Coordination and Management Strategy. To manage costs and readmissions, as well as improve quality, PCPs and specialists will have to work together to improve handoffs, share standardized information, and define the resources needed to keep patients healthy and prevent adverse events. A corollary Chronic Disease Management Strategy, in which primary care doctors would work with specialists to develop protocols and systems to manage patients with diseases such as diabetes, COPD, and heart failure, would make sense as well.
5. Care Model Development Strategy. To support care coordination and management, the primary care model will need to evolve. Engaging your primary care practices around the development of the Patient-Centered Medical Home model can generate greater alignment with the physicians while giving your hospital a resource to manage cost and disease. We see a number of clients working side-by-side on the development of protocols, standards, and a rollout process for reaching NCQA certification.
6. Hospital Primary Care Handoffs. With the rise of hospitalist programs, most primary care physicians no longer “darken the door” of hospitals. As a consequence, these PCPs are not interacting in a meaningful way with the groups of hospital-based physicians that they should be, namely hospitalists and emergency department physicians. By engaging key PCPs to work in an advisory group with hospitalists and emergency medicine physicians, they can collaborate to improve patient intake and service and define the ideal system for patient handoffs between groups.
7. Referral Management Strategy. One of the constant challenges for hospital executives in working with primary care physicians is referral management. It is frustrating to assemble a team of primary care and specialty care physicians in your market, only to see their business scatter to other hospitals or competing facilities. Primary care physicians can be engaged in a committee on this topic to answer at least these three questions: 1) What referrals are leaving the system most often and why? 2) What specialists/services do we feel most comfortable referring to? 3) If those are not part of our system, what would it take to improve our system’s services to get those referrals? This process could be supplemented by data showing which specialists provide the best care in terms of quality and cost in order to drive decision making.
8. Marketing Strategy. Many hospitals are too timid when it comes to marketing their on-staff physicians who are not employed. Within the context of a service line, there are many options for marketing physicians that will increase their ties to your organization, and in turn, solidify them as a member of your medical staff.
9. I.T. Strategy. A strategy around information technology can be approached two ways: 1) With many physicians still trying to get up on practice management (PM) systems and electronic medical record (EMR) systems, giving support to the practices in terms of financial and administrative resources (within legal limits) can tie the practice to your organization without the need for employment. 2) For many physicians, the operability of the I.T. systems, specifically the ability to view information from multiple locations and the speed/ease of access of that information, is a big selling point. If your EMR works better with the physician’s practice than the competitor’s does, that will go a long way to increasing loyalty to your organization.
When reviewing this list of what to include in your primary care strategy, the two key considerations are 1) which of these will add the most value in your market, and 2) what will be the most attractive to your primary care physicians. Healthcare Strategy Group can help you assess these questions, and begin engaging your primary care physicians in those areas.