Private equity groups continue to invest in specialties such as radiology, anesthesia, emergency, dermatology and ophthalmology. The more doctors you add, the lower the operating costs.
“Where private capital roll-ups are starting to look attractive again is when they can bring cash to the table to fund some of those big expenses related to electronic medical administration and records,” Jennifer Breuer, a partner at Feagre Drinker Biddle & Reath, first said Modern Healthcare.
On the one hand, it is attractive for a private equity firm to invest and provide additional resources, said Dr. Peter Angood, CEO of the American Association for the Leadership of Physicians.
“On the other hand, productivity pressures are quite high,” he said. “If doctors are tired, they take some time and personal choice can be more valuable than more money.”
There has been some resistance to the private equity model from state medical associations, Scheffler said. “I suspect that some doctors, rather than being acquired by a private company, will ask you why they can’t group together some small practices and replicate the model to make some money for them,” he said.
Meanwhile, primary profit companies are also growing rapidly, often with the support of private equity, venture capital and insurers.
VillageMD is one of which aims to leverage team-based primary care, to improve patient outcomes and the overall patient experience while reducing costs. Optum, Humana and other UnitedHealth Group insurers have also invested heavily in coordinated primary care groups.
Paul Martino, co-founder and head of strategy at VillageMD, described it as a multiplayer business model, led by a doctor. When the company employs or affiliates with doctors, it keeps them in the community they serve with its full panel of patients, he said.
“Unlike our competitors who hang out and recruit a resident into a new community, we find doctors who are well known in their community. Doctors don’t like it when someone comes in and recruits their patients,” he said. said. “I checked last time, doctors don’t want to be hired by a payer who is just looking for their members – we’re not asking them to lose a subset of patients.”
VillageMD often welcomes doctors who are careful to take risks on their own, Martino said. He often takes doctors who were tired of the hospital’s focus on their specialty groups rather than clinical models, he said.
“We’re looking for medical leaders who believe value-based care is here to stay,” Martino said. “We’re not looking for 63-year-old doctors who want to gin up fees for service and retire.”
Many of the for-profit primary care practices use per capita payment models, the Medicare Part-Time Savings Program, and other risk-based arrangements. Atrium, Rissmiller said, can meet these incentives and support them with a well-known system that has a full-blown continuum of care.
Optum, the suppliers division of UnitedHealth Group, leads the market with its 56,000 employed employees. It is on track to grow by more than 10,000 doctors over the next year.
“We continue to evolve and employ physicians who are truly attracted to our value-based primary care model,” OptumHealth CEO Dr. Wyatt Decker said in a recent earnings call. “We eliminate much of the clerical burden in the practice of our doctors and advanced practitioners.
“Why has the system around us created an environment where the highest paid member of the team typically does data entry for two hours a day for hours caring for patients? It’s an absolutely absurd business model and doctors they hate it, ”he continued. “So there’s just a huge opportunity for us to get this right.”
Humana has developed its primary care offerings for commercially insured seniors. It has 171 CenterWell and Conviva structures and plans to double the number of CenterWell offices from 2020 to 2022.
“It’s good to see that primary care physicians have more choices than just selling their practices to a large integrated distribution network,” said Buckingham of Humana. “There is a renaissance around the role that a primary care physician plays in helping to slow the progression of diseases and in helping people take control of their own health.”
Buckingham emphasized its integrated model that offers seamless transmissions as patients move through the system. Doctors also have the opportunity to earn more money based on clinical outcomes and patient satisfaction, he said.
“We include social workers, behavioral health specialists, dispensaries and clinical pharmacists who can help manage what patients’ acute or chronic needs are, ”Buckingham said. “Our primary care physicians can spend time with a care coach to understand the lifestyle changes required or social work to help them address social determinants of need.”
When it comes to recruiting doctors and asking them to restrict their patient panel, Buckingham said they work closely with doctors to ensure their pre-65-year-old patients have a good landing position.
“There is usually a transition period of 60, 90 or 120 days to ensure that patients are transitioning appropriately,” he said.
As large insurers build their primary care teams, some startup insurance companies are turning to home health and virtual care.
The Federal Trade Commission is committed to resuming mergers between industries and increasing competition in unilateral markets. Federal regulators have sought vertical consolidation, with a focus on consolidating physicians throughout health care.
The agency voted in June to prioritize investigations on healthcare, technical and digital platforms for the next decade and authorized the use of citations to obtain information.
In January, the FTC asked six health insurers to claim data while studying the impact of doctors ’consolidation.
Regulators hope a renewed retrospective merger program may determine whether the agency’s threshold for bringing an enforcement action in a merger case has been too permissive.
“There is a concern for medical societies that there is a disappearance of the practice of medicine, especially in small groups,” said Scheffler of Berkeley. “All the small groups are getting bigger, and the affiliation will continue to be a massive trend.”