Selecting Physicians for Integrated Groups: A Strategic Approach

In the rush to integrate with managed care, healthcare providers are often overlooking the critical aspect of selecting the right physicians for their groups. Integration is not just about sharing common objectives, but also about balancing specialties and geographic distribution to meet the needs of the patient base. Without a strategic plan, efforts to integrate may end in disappointment and failure. A careful selection of the right partners is essential, considering factors such as physician-to-patient ratios, practice styles, and service mix.

Key Takeaways:

• A strategic plan is crucial for successful integration, including careful selection of the right partners based on specific criteria and provider components.
• Determining the fragile physician ratio is a complex process requiring skilled advisers, especially in the capitated environment where physicians assume increased risk.
• Balancing physician ratios and geographic distribution is vital for success, as it will have added appeal to managed care payers if physicians can conveniently service their enrollees.
• Selecting physicians with similar practice styles is essential to secure and retain desirable contracts, especially in a full-risk capitated model.
• Providing a broad range of services will have more appeal to managed care, especially in a full-risk capitated model, where physician groups will need to have a full range of traditional clinical services.
• Peer review and accountability are important factors in achieving long-term success for the group in managing the risk with capitation.
• Planning is just as important as legal and governance issues, and professionals should seek guidance from managed care consultants to develop a plan, secure the right partnership, and market the integrated group.

Statistics:

• The number of physicians needed in the specialty arena declines with the influx of managed care.
• Primary care physicians assume more responsibility and are in greater demand in a capitated environment.
• A fragile physician ratio is a complex process requiring skilled advisers.
• In a full-risk capitated model, physician groups need to contract with outside physicians for subspecialty clinical skills or have them in the group.
• A multispecialty group will engage in full-risk contracting and will want to have a full range of traditional clinical services.

Sources:

• Capko and Anwar, consultants with THE SAGE GROUP INC., a national consulting firm specializing in integrated health care development, managed care operations, marketing, and bottom-line practice management.