Medical Group Challenges

The demands have never been greater

CHALLENGES ARE OPPORTUNITIES FOR BETTER

Virtually all medical groups find themselves facing unprecedented challenges. We believe that the challenges present new opportunities to achieve better.

Medical group leaders today must focus on five key challenges:

1.

The challenge to improve financial performance of your medical group

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2.

The challenge to evolve to value-based payment, especially as you struggle with volume-based performance

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3.

The under-recognized challenge to improve chronic disease outcomes

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4.

The challenge to bring your medical group from a confederation to a high-performing organization

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5.

The challenge to lead and drive change, which requires a leadership team that is on top of its game.

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The incentive to act is increasingly urgent. MediSync leads and manages very successful groups and we have a variety of sophisticated methods to move your group from Point A to Better.

01

FINANCIAL PERFORMANCE

Challenging and getting more so

The dollar your medical group earns today is worth far less than the dollar you were paid five, ten or seventeen years ago. At the same time, the costs of running your group are inflating – higher employee salary and benefit costs, higher compensation for doctors, inflating rent, supplies and all the usual expenditures. While paid less in constant dollars, your group is asked to accomplish more today – more wellness/prevention, better chronic outcomes, more Meaningful Use,and more accountability. And your organization is asked to invest in your ACO and other value preparations, often without revenues to match.

Delivering more for less is the key to medical group success

Moremedical group challenges

The team at MediSync understands the stress. We’ve successfully managed large, high-performing medical groups since 1997. In that process, we’ve watched group costs rise at a rate far outpacing the concurrent rise in revenues. That’s left many medical groups squeezed, and it’s not showing signs of getting better as value-based pricing takes hold.

Let us show you:

  • How we are paying the doctors consistently at or above market rates with no subsidies
  • How we create value-based medicine agreements that make millions for our group partners
  • How we have achieved the best chronic disease management outcomes in the US

It isn't easy, but it IS possible.

Dealing With Real Income Erosion

Your rates are increasing at a much slower rate than your overhead is inflating. Every year that a doctor sees the same number of patients and has the same support structure, the doctor loses more money.

As leaders and managers of real-world medical groups, we’ve found that we needed to deeply rethink the entire group venture. If we kept doing what we’ve always done, we would have failed.

Our first step was to discover that we were not realizing all the revenue that we rightfully earned. At the same time, we found that our physicians wasted time on actions that were not contributing to either better care or better financial performance.

medical group challenges
medical group challenges
Case Study of Large Medical Group's E&M CodeRight Experience

In a case study co-sponsored by AMGA, MediSync’s E&M CodeRight solution delivered an incremental $14,400 per physician per year. For a 50 physician practice over a reethyea-r period, this could result in an additional $2.7M in practice profitability!



Source: Medicare rates used for the analysis. Commercial pay rates may provide different results.

These strategies didn’t solve the entire problem, but they sure helped. Then, we added whole new ways to rethink how our groups can accomplish far more revenue and drive out every unnecessary cost possible.

Talk to us about what we’ve found and learned. Join us in the collaborative to learn and do more that is meaningfully different.

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02

VALUE

Value is a new game

We are being disrupted. Disruption is when your old business model doesn’t work anymore because of legislative changes, pressures from customers, or pressures from new competition – especially competition that changes how the game is played.

Value is part of the disruption. We have extensive systems to manage volume, but few to manage value. The challenges - of maintaining success in a declining real revenue fee business and investing in an uncertain future value business - are enormous.

MediSync offers clear thought on value.

We’re wildly in favor of planning. This disruption is the biggest change to occur during your career. This is our “D-Day.” If the switch from volume to value doesn’t require planning, then nothing does.

More medical group challenges

MediSync’s partner medical groups have earned tens of millions of dollars in value revenues – even from Medicaid – and we’ve got the best chronic disease outcomes in the nation.

Talk to us. Join us in leading medical group transformation that delivers better healthcare.

Value is Dangerous and It Is Tough

Value is new and the industry is in a steep learning curve. Pitfalls in the insurers’ early value contracts are designed to take advantage of the disequilibrium. Value requires medical group paradigms to fundamentally change. Our doctors, managers, and administrators feel overwhelmed and burned out. Increasingly, our patients require more care due to the prevalence of multiple chronic diseases. We don't know the direction, rate, and pace of change. Even as our organizations are experiencing severe financial stress, at the same time, value requires investment.

medical group challenges
medical group challenges
How Do We Win in Value?

Groups that make $ in value-based contracts make sure they do the following:

  • Formally document planning and scenarios before entering into value-based contracts
  • Proactively understand the types of value-based contracts and how to engage with payers
  • Know their metrics so they can perform and deliver consistent improvement

Each group must customize their planning and execution based on their market environment and their willingness to change.

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03

CHRONIC DISEASE OUTCOMES

Chronic outcomes are key to future group success

The most important and most difficult hurdle to winning in value is successfully controlling chronic diseases among your patient panels. You need the best chronic outcomes in your state or region.

For medical groups who are required to report outcomes, process measures are being replaced by actual outcomes measures. Today, reporting blood pressure and A1c success rates is common. In the future, outcomes reports will expand to more of the top 12 chronic diseases.

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The best research shows that 75% of US healthcare spending is attributable to the chronic diseases. It is not possible to succeed in reducing the total cost of care if your group cannot get the blood pressures, lipids, blood sugars, asthmatic episodes, heart failure and COPD exacerbations under control.

When it comes to to chronic outcomes, getting behind your competition is a losing proposition.

Top 12 Chronic Diseases

  • Hypertension
  • Diabetes Management / A1C
  • Lipids
  • Obesity
  • CAD and PVD
  • Chronic Kidney Disease
  • Asthma
  • Chronic Heart Failure
  • Osteoporosis
  • Osteoarthritis
  • COPD
  • Anxiety / Depression
Chronic Disease

dd asta ucm Youcrehrsson ichc rodinsicea se is an across-the-board win. Simultaneously, your medical group can:

  • Achieve the best outcomes in your state or region
  • Lower the total cost of care significantly, positioning your group for value
  • Provide better care for your patient population, potentially delaying or preventing major health events
medical group challenges

PriMed Physicians Achievements

Research Shows

Research shows that 75% of US healthcare spending is related to chronic disease. It is not possible to succeed in value if your group cannot achieve improvements in blood pressure, lipids, blood sugars, asthmatic episodes, heart failure, and COPD exacerbations. These are the patients for whom you can decrease spend; these are costs that are significantly preventable.

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04

PATIENT SATISFACTION & MARKET SHARE

It is time to up your patient satisfaction game

In American capitalism it is totally acceptable to take another organization’s customers and revenues. The winners are those who make life better for their customers in meaningful ways, and the losers are those who saw no need to change. We predict a lot more disruption in healthcare. Patients will switch from their old providers to new for a variety of reasons. Gaining versus losing patients is the differentiator that really matters.

Growing Your Patient Base
  • Market penetration is critical to revenue, and revenue is critical to financial performance and stability.
  • While many costs are fixed, patient revenues are the variable driver of your financial performance.
  • Patient population is critical to scale and to your access to capital.
  • Size generates clout with insurers.
  • Size builds actuarial stability into any value agreements you enter.
  • Satisfied patients are more likely to be engaged patients, enabling more successful outcomes.
medical group challenges
medical group challenges
Increasing Patient Satisfaction Is Vital

Patients today are increasingly fickle and have higher expectations than ever before. This makes competition between groups and systems fiercer.

We are beginning to see a different type of competition. Companies want to approach employers directly or engage certain patients - especially those with high-dollar health spending - via new technologies and delivery models. This trend will increase rapidly over the next decade.

Patients have more choices than ever before and patient satisfaction is THE critical business health variable.

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05

MEDICAL GROUP CULTURE

The key to all other challenges

When medicine was simpler, when there were no quality metrics, no value agreements, and earnings were based on volume, organizational coherence did not matter so much. Building culture and establishing an effective, high-performing team that works within and across specialties is absolutely critical to improving your group’s ability to make better happen.

The Past

Many medical groups operate as confederations. Within and across specialties, physicians practice separately. Most docs have at least some of their own personal staff and all have their own special recipes for practicing medicine.

But in today’s world, group culture often equates to call coverage and using consulting physicians within the group. As group revenues and market share become driven by total cost-of-care, patient experience, and published quality metrics, the old models fail.

medical group challenges

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Turn Challenges into Opportunities for Better!

Virtually all medical groups face unprecedented challenges in today’s healthcare environment. MediSync can help make your situation better through solution options that address your top challenges.