With Medicare and other payers shifting to value-based-care business models, rural doctors face a fundamentally changing marketplace, a pair of rural healthcare leaders says.
Physician engagement is crucial to shifting to value-based healthcare in rural communities, says Kevin Halter, CEO of Ashland, KY-based Bon Secours Kentucky Health System, which features 215-bed Our Lady of Bellefonte Hospital.
"My biggest challenge is getting my physicians educated on the front end because they all see the wave coming. And that's true for any of the new initiatives—bundled payment and financial changes like& MACRA are in the journals, but it's not right in front of them as it is in places like Richmond, Virginia."
Bon Secours Kentucky Health System is part of the Marriottsville, MD-based Bon Secours Health System, which operates 19 acute-care hospitals in six states and has more than 25,000 employees.
Halfway across The Bluegrass State in Elizabethtown, Hardin Memorial Health features a 300-bed acute-care hospital. Hardin Memorial is affiliated with Louisville, KY-based Baptist Health, operator of eight acute-care hospitals with a total of 2,700 licensed beds.
Related: MACRA is a 'Trojan Horse' for Value-based Models
Primary-care physicians are crucial players in the shift to value-based care, says Hardin Memorial President and CEO Dennis Johnson.
"You don't have to employ every physician on the planet, but you do need to drive the primary care referrals... And if you have good primary care, you are going to be able to manage a population's health."
Halter and Johnson say there are several approaches that rural physicians and their practices can take to adopt value-based care models:
Engaging with Local Hospitals and Health Systems
The relationship between hospitals and physicians is critical to success in value-based care, Halter says.
"Hospitals have been in value-based purchasing for five-plus years, now it's going to go to physicians, and my physicians are just now starting to see it. The reason they are seeing it is I am putting it in front of them. We had a board retreat with about 40 physicians to start educating them."
Building Integrated Clinical Networks
Hospitals and health systems can build the infrastructure needed to support value-based care models, and they need to convey this advantage to potential physician partners, Halter says.
"This is coming, you need to get prepared, we are going to help you get prepared by putting in a clinically integrated network.' Now, we are helping them work through the change so they don't find relief in the channels outside the hospital."
Hospital-employed Physicians
Our Lady of Bellefonte has about 250 physicians on staff, with 30% of the staff hospital-employed. Employment status has had a significant impact on adoption of value-based care models among physicians at the hospital, Halter says.
"Employed docs get force-fed. They are in these programs. Bundled payments for instance, and MSSP ACO. We sign them up."
The Primacy of Primary Care
In 2011, Hardin Memorial and Baptist Health engaged the Healthcare Strategy Group, a provider of physician integration services, to help craft their strategic plan, Johnson says.
Identifying new primary-care partners was an essential element of the planning process. "HSG assisted both Baptist and Hardin on a primary-care strategy… to help identify those markets where we had an opportunity."
Primary-care practices can function successfully in both fee-for-service and value-based business models, he says. "Primary care is really a low-risk, high-return investment."
Christopher Cheney is the CMO editor at HealthLeaders.