To control costs, integrate physicians, panel says

The best method to attract and keep consumers is to build access to points of care throughout the organization, from a hospital's retail clinic to physician offices, primary care and medical specialists, experts at HFMA 2015 ANI say.

ORLANDO -- To lessen financial risk in the switch from fee-for-service to being pay-for-value, providers need to track the cost of care through clinical integration, according to healthcare consultants who spoke during the Healthcare Financial Management Association 2015 Annual Institute conference on Monday.

“What is that cost of care? We need patients to stay in network,” said Daniel Marino, senior vice president of The Camden Group.

His own doctor lost his business recently when he had the flu, Marino said. Having been told he had to wait two hours to see someone, Marino went to a local retail clinic and got speedy results.

[Also: Live staff reports from the HFMA 2015 ANI]

The best method to attract and keep consumers is to build access to points of care throughout the organization, from a hospital’s retail clinic to physician offices, primary care and medical specialists.

Providers need to align physicians, hospitals, post-acute and ancillary providers with an organized system of clinical care, he said.

“The successful ones that are out there are building systems of care,” he said. “Technology and analytics, connected with care will reduce redundancy and drive down cost.”

To make up the difference in revenue as fewer people go to a hospital and reimbursement models change, providers must drive members into the organization.

“Access becomes critical,” Marino said. “Hospitals and physicians are starting to align. The next thing is to engage consumers. Link them into your network so they don’t want to leave.”

The best way to drive new membership is to collaborate product offerings with payers, he said.

[Also: Nonprofits must adapt]

If you have a contract to take care of a population, you’ll want to see that person who is currently not in the system, he said.

Physicians must lead the care coordination initiatives, according to William Faber of The Camden Group, by serving on the governing boards, setting the quality metrics and driving clinical protocols, he said.

“If we don’t start thinking about providing value, our competition is going to get us,” he said.

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Faber compared the new healthcare world to a “fast food culture” in which patients want convenience and quality.

Healthcare is among the last large sectors of the economy to get an integrated network, and to track its costs.

“How much does it cost to take care of the diabetic patient?” Faber said. “You probably don’t know.”

The up-front investment for clinical integration is $3 million to more than $20 million depending on infrastructure, according to the consultants.

The investment promotes greater access and care convenience to retain members, Marino said.

“It’s not just talk about clinical integration as you set it up, you have to talk about what’s next around value-based contracting,” Marino said. “If you do a better quality of care with a patient, you will reduce costs.”

Twitter: @SusanMorseHFN