Our mission is to enable independent physician practices in the Pacific Northwest to remain independent and thrive in the new healthcare environment. The vehicle for achieving that mission is a clinically integrated network of independent physician practices working under value-based contracts that reward practices for delivering high quality patient care in an efficient manner.
To be successful, Physician Care Alliance will:
- Engage participating physicians as leaders to drive development and operations
- Create a sustainable business and secure favorable, value-based, health plan contracts
- Provide the necessary support to transform participants’ practices to engage in population health management
- Deploy the necessary infrastructure, including proven analytics and patient engagement tools
- Demonstrate quality through participants’ achievement of specified standards
- Reduce the total cost of care for a defined population
- Improve overall patient experience of care
- Reduce the administrative burden for physician practice reporting
Healthcare systems across the country are evolving to realign cost, utilization, and quality incentives. The transformation in Washington State is impacting health plans, hospitals, physicians, and patients. Each stakeholder is adjusting to various changes related to the Affordable Care Act, ever-increasing costs, and growing employer and consumer demand.
Health insurers are increasingly negotiating value-based contracts that push more risk to providers. The new shared-savings or risk-based payment models frequently tie provider reimbursement levels to specific quality metrics in addition to total cost of care or cost trend reductions. These contracts come with a heavy burden on providers to compile data and produce reports to track and monitor performance.
With declining margins and high regulatory uncertainty, physicians are receptive candidates for buy-outs. For many independent physicians, employment is seen as a safe harbor to ride out the storm of healthcare reform. Hospitals and some practice management companies are seizing the opportunity to acquire practices and increase their market share.
In 2013, in order to address the market pressures that impact the long-term viability of independent, physician-owned practices, the Northwest Medical Group Alliance initiated a study to determine the feasibility of creating a physician-led Clinically Integrated Network (CIN). A CIN is “a health network working collaboratively, using proven protocols and measures, to improve patient care, decrease cost and demonstrate value to the market”.
The Alliance determined that The Polyclinic’s Physicians Care Network (PCN) provided the best foundation for the network since it had already built much of the clinical and operational functions, staff, expertise, and experience required for its Medicare Advantage business. The CIN could leverage PCN’s long history of high quality care management and have physicians enhance and customize it for a commercial population.
In 2014, PCN developed a business plan with funding and guidance from Physicians Insurance, a Seattle based, physician-owned mutual company providing medical professional liability insurance and related services. One of the largest health plans in the Pacific Northwest, Premera Blue Cross, also provided guidance and key insight to health plan objectives and requirements. In addition to the invaluable support from these two organizations, Physician Care Alliance leveraged industry consultants and legal counsel to ensure that physicians were at the forefront and the proposed legal structure was compliant with various regulatory requirements.
The business plan revealed the need for capital to support startup as well as ongoing operations until the entity had the necessary contracts and membership to be self-sustaining. Physician Care Alliance spent much of the year meeting with potential partners and evaluating potential arrangements.
In 2015, PCA was formed with significant investments from The Polyclinic, Physicians Insurance, and Premera Blue Cross. PCA secured its first value-based contract with Premera with unique provisions that aligned health plan objectives with PCA goals. Late in the year, The Polyclinic signed on as a participating group and Northwest Physician Network joined as PCA’s first participating network.
In 2016, PCA negotiated value-based contracts with Cigna and Aetna, which became effective on 1/1/2017. It also added four more participating groups – Edmonds Family Medicine, Sound Family Medicine, Western Washington Medical Group, and Woodcreek Pediatrics.
PCA also formed the physician-led committees and a Physician Leadership Council that will ensure physicians are driving quality programs, contracting decisions, and technology. PCA made a key technology infrastructure investment as it selected IBM Watson Health for population health management. It also hired a Medical Director, a Director of Practice Transformation, and several other key positions.
In 2017, Physician Care Alliance is looking forward to working with its participating groups to transform practices, meet or exceed quality program goals, and ultimately be successful under PCA’s value-based contracts.