In this second part of our expert forum series on Management Services Organizations (MSOs), we drill down on how MSOs help physicians strategically navigate through the tectonic shifts taking place in healthcare, which have significant implications for the long-term viability of the independent practice of medicine. MSOs provide improved visibility into quality metrics, physician performance, and patient health data, preparing practices to make the transition to value-based care.

athenaInsight spoke with leaders at four MSOs for this two-part series. Here, we look at how MSOs can improve practices' performance and ease the transition to value-based care. Read on for edited excerpts from our conversations. Please share observations in the comments section or on Twitter at @athena_Insight.

On performance

Goran Dragolovic, CEO of Women's Health USA: We are educating our partners 24/7 about seeing, thinking, and anticipating differently. We provide the capital and expertise necessary to identify, prioritize, and execute on all of the ways a practice can capture more value: how to get data, how to monetize that data, and how to realize all other new values. For example, keeping patients from going elsewhere for clinically relevant services like lab work, mammography, genetic testing. In many instances, we have already seen that providing these services would bring unique value if these could be captured on site.

Scott Disch, National Practice Director of Continuum Health: You can't think everyone will do well going into a contract, and there will be doctors who don't belong in these deals, so we're very focused on measuring performance and organizing physicians into groups that can be successful. We are hyper-selective about who comes into the group and on their performance when moving them into contracts. Finally, it's highly important to tie compensation models to performance in risk deals — not just in shared savings earnout, but in monthly paychecks.

Matt Eakins, M.D., COO of Unified Physician Management: Supplying insight for the physicians is what changes their practices and enables them to make the right clinical decisions. It's about actionable analytics. Fundamentally, doctors are scientists. When they have data to support a position, they can go out and say, “We need to change a policy." Or when they understand the cost structure of a lab test, they can change how they order it. They lead the problem-solving in our model.

Bret Jorgensen, CEO of MDVIP: Every one of our physicians has surveys delivered to their patients to look at satisfaction scores. Our staff delivers the results, along with benchmarking data so they can see how they are performing and where they can improve. Overall, our member satisfaction level is extremely high and our most recent Net Promoter Score (NPS) is 89.

On transitioning to value-based care payment models

Dragolovic: When we can identify where sources of waste are, pinpoint big variabilities in clinical processes and in decision-making, and quantify how these impact costs and clinical results, we can extrapolate for the larger population. We can apply it to an entire population to see the collective, total impact. Then we're talking value-based care.

Disch: Our approach includes a practice transformation team that goes in and sees how they're using their office team and tools. Then we layer in improvements month after month, bringing them into the medical home space, getting them ready for downside risk deals. And we have a new operating model tied to value-based care that uses different rewards. For example, one tool has our doctors choose a specific tiered provider when making referrals. It has staff follow up to ensure the patient gets good care and keeps it tight — so there aren't 10 unnecessary visits with the specialist. There's a lot of technological development in referral tools, since everyone struggles with referrals.

Eakins: We're 100% committed to moving toward alternative payment models to compete on cost and efficiency. We think this is the way for independent private practices to compete in women's health. We do this by being collaborative with payors and other providers. We all have perfectly aligned incentives to keep total care costs down while improving outcomes, and we approach it from that angle. We spend time with leadership boards of provider affiliates to educate them on value-based programs and spend time with payor groups to educate them on what is important to us. So much of the payor-provider conflict comes from negotiating, and we don't do that. We build relationships and go into it seeking to understand what everyone's motivations are.

Jorgensen: The goal is for MDVIP-affiliated patients to be hospitalized and readmitted less often, visit urgent care centers and emergency rooms less often, receive more preventive services, and have better control of chronic conditions than patients in traditional practices. We think our model helps manage all of this, and we've published data showing that MDVIP patients have decreased readmissions and ED visits — and better satisfaction.

On what the future may bring

Disch: Tech-wise, we're looking at online scheduling, remote monitoring, and virtual visits. Also, on a bigger level, large hospital groups are discussing divesting their medical groups and having MSOs help manage them. Most health systems can get the same loyalty from them but get them off their books, so they'd do that any day of the week. It will happen more and more.

Jorgensen: Our model can fill a growing demand for primary care, as health systems struggle to hire primary-care doctors. Affiliated physicians have time to provide immersive, dedicated care and proactively focus on patients' entire health trajectory.

Dragolovic: There's an enormous amount of talk about quality, but when you sit down with health leaders and ask them to give three or four metrics they currently deploy to clearly differentiate between high-performance and underperforming physicians, it doesn't exist. What's lacking is [an] agreement on what should be measured and which scores that could, without any ambiguity, define what counts as high-quality care. We have a national clinical advisory team beginning to develop our own metrics to inform our clinicians how they're doing, so they can better benchmark against peers in their market and nationally.

Erin Graham is a frequent contributor to athenahealth's Knowledge Hub.