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How the Dynamics of Physician Alignment Are Changing

Michael Zeis, for HealthLeaders Media, September 13, 2013

"Healthcare reform provides a huge impetus for looking at other models," Stoyanoff says. "When you're implementing population health management or an ACO, you have to have physicians working with you. Physicians are not going to want to be part of every ACO on the planet. They'll start to pick and choose, and you want them to pick you."

Independents remain viable

Although much has been made of a physician hiring frenzy, survey responses show that independent physicians have critical mass and do not appear to be threatened in the near term. "A lot of the physicians still prefer not to be employed," says Stoyanoff. "Even though the numbers of physicians we're all employing are growing, there are still a lot of entrepreneurial physicians out there."

As Stoyanoff suggests, survey results do show expected increases in employed physicians and decreases in independents. The average percent increase in employed physicians in the three-year time frame is 40%. Over the same time period, the average percent decrease in independent physicians is expected to be 29%.

But with the average number of employed physicians standing at 246 per respondent compared to 693 per respondent for independents, the latter will be in the majority three years hence, despite the expected decrease. "I've doubled the number of employed physicians," Stoyanoff says, "but that's still only 10% of what we have. There still are a lot of independent physicians out there."

A learning process

When respondents talk about current and near-term initiatives, the talk is about collaboration and risk-sharing. Today, 41% of respondents are involved in an ACO, up from 26% in last year's survey. Within three years, 55% will be pursuing or involved in an ACO.

Stoyanoff acknowledges that, for Methodist Health System, learning is an important benefit to be derived from making such steps.

"A lot of healthcare institutions are wondering about learning to manage patients along the continuum of care," she says. "We are focusing primarily on the development of our ACO, which started a year ago. And we are in a Medicare Shared Savings Program, so we're learning how to manage lives from a global perspective."

Other collaborative care models are gaining traction, according to survey respondents. More than half of respondents (52%) are now undertaking initiatives related to a patient-centered medical home, up from 39% a year ago, and 58% expect to be there within three years. Similar growth is seen for the population health model, which was a current initiative of just 25% last year, now stands at 33% of respondents, and will reach 51% within three years.

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