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Large Independent Primary Care Medical Groups.

TitleLarge Independent Primary Care Medical Groups.
Publication TypeJournal Article
Year of Publication2016
AuthorsCasalino LP, Chen MA, C Staub T, Press MJ, Mendelsohn JL, Lynch JT, Miranda Y
JournalAnn Fam Med
Volume14
Issue1
Pagination16-25
Date Published2016 Jan-Feb
ISSN1544-1717
KeywordsArizona, Attitude of Health Personnel, Colorado, Connecticut, Group Practice, Health Care Costs, Humans, Michigan, Ohio, Physicians, Primary Care, Primary Health Care, Professional Autonomy, Quality Improvement, United States, Value-Based Purchasing
Abstract

PURPOSE: In the turbulent US health care environment, many primary care physicians seek hospital employment. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. We wanted to describe these groups, their advantages, and their challenges.

METHODS: We identified 21 groups and studied 5 that varied in size and location. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers-leaders of a health plan, hospital, and specialty medical group that shared patients with the group. We triangulated responses from group leaders, group physicians, and external observers to identify key themes.

RESULTS: The groups' physicians work in small practices, with the group providing economies of scale necessary to develop laboratory and imaging services, health information technology, and quality improvement infrastructure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Unlike hospital-employed and multispecialty groups, independent primary care groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Each group was positively regarded by external observers. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale.

CONCLUSIONS: Large, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting.

DOI10.1370/afm.1890
Alternate JournalAnn Fam Med
PubMed ID26755779
PubMed Central IDPMC4709151
Category: 
Faculty Publication