New York Vendor Group, New Integrated Delivery Insurer Partner

Community Physicians and Metropolitan Doctors’ Health Plan have joined forces to create a new management services organization to outsource administrative operations to an independent multidisciplinary provider group while maintaining its independence.

The physician-owned medical group employs 420 physicians in 70 counties in and around Albany, New York, where both companies are headquartered. The not-for-profit insurance company serves 400,000 people in the 29 northern counties of the state in group, individual and state markets. The partnership is expected to close by the end of the year, subject to government regulatory approval, the companies said last week.

Community physicians who did not respond to interview requests will remain independent when the management services organization is established. The medical group will maintain its contracts with other payers and will outsource its revenue cycle, human resources and technology operations to the Metropolitan District Health Plan.

An increasing number of service providers are looking to integrate their transactions more closely with payers in order to take more of the risk to patients. According to the data, about 60% of healthcare systems plan to move to Medicare Advantage risk-based payment models in the next year, with at least 30% following the Community Care Phystors model and partnering with payers to ensure data integrity, accountability and technology capabilities, according to data survey results The Health Care Financial Management Association released this month.

Regional nonprofit insurance companies are involved in many of these ventures, said Capital District Physician’s Health Plan CEO Dr. John Bennett. Together, the partners will begin to develop risk-sharing agreements and integrate their functions into a single system.

“We want to make our patients healthier and we know this will lead to cost savings,” Bennett said. “But our intention is to allow doctors to be doctors, to allow them to practice and be with their patients.”

Fewer doctors than ever own their own practice, according to a recent study by Avalere Health. Many of the remaining independent physicians are looking for alternatives to corporate ownership, such as joining regional non-profit health plans or contracting with physician training startups like Agilon Health, which allow them to outsource the administration of their businesses, Rick Kees said. healthcare partner at the consulting firm RSM.

“Often times, if you ask doctors, they’ll say,“ I think the best option for us is to remain independent and provide the care that these patients have received before, without any problem, ”Kees said. “Now that there are tools, technologies and companies that can do this, it is generating more visible interest from those doctors.”

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