Major hospital systems are often blamed for rising health care prices, and not just because they treat the sickest patients.
As systems grow ever larger, they gain more leverage with employers and insurers, allowing them to raise prices and hold on to more health spending. Their growing market power — and deep pockets — also put more pressure on doctors and independent practices.
Little wonder that more physicians are working for hospitals and their affiliates, and for insurers and private equity owners. In 2018, just under 40% of Texas physicians were in independent practice, down from 60% in 2012.
That’s a troubling trend because independent docs are generally a better bargain. They charge less for similar services, have fewer avoidable hospitalizations and lower rates of hospital readmissions.
Independent physicians are pushing back, forming their own groups to negotiate insurance contracts and improve coordination of care.
Catalyst Health Network, based in Plano, includes 790 primary care providers with 310 offices and over 1 million patients. The nonprofit group, founded in 2015, is trying to build a better model for value-based medicine — and it proudly stands as a counterweight to the growing clout of large hospital systems.
“We were built for that reason,” said Dr. Christopher Crow, president of Catalyst and co-founder of Catalyst and its holding company, StratiFi Health. “We’re helping communities thrive by keeping the independent practice of medicine alive and well.”
There are other large groups of independent doctors in the Dallas area, including Genesis Physicians Group and Premier Physician Group. But Crow said Catalyst is one of the few in the nation to be doing this at such scale and with primary care providers serving commercial customers, not just Medicare.
On the contracts side, he compared Catalyst’s role to the National Football League, in that the league negotiates contracts with various broadcasters and shares the revenue among the teams. Catalyst has value-based contracts with all the major insurers in the region, and if providers save money by keeping people healthy, they share in the savings.
Catalyst and United Healthcare, for example, said they lowered health care costs in North Texas by almost $40 million over the past three years — and providers got half of that, Crow said.
Catalyst and United’s accountable care organization helped thousands of members control chronic diseases and get preventive cancer screenings, the companies said last week.
A number of factors contributed to the health savings, including a double-digit decline in out-of-network lab services and specialists, and a 6% increase in using lower-cost outpatient surgical centers.
United shared “actionable data” with Catalyst about patients’ underlying conditions, past treatments, gaps in care and medications. That allowed a team of care coordinators, including nurses, pharmacists and dietitians, to assist patients and doctors in heading off problems.
Catalyst’s care team is a key part of its business and health care proposition: “We already have a lot of good independent physicians in North Texas,” Crow said. “They just need to be resourced a little better.”
Dr. Darla Kincaid, a pediatrician in Coppell, said she was drawn to Catalyst initially because of its contracts and focus on primary care. But as a small practice — seven doctors, a part-time psychiatrist and four advanced practitioners — it also needed the tools and personnel to help care for patients.
Many have expensive medications for asthma and other ailments, and the list of covered drugs changes regularly. She said pharmacists at Catalyst provide a level of service and follow-up that her practice couldn’t match.
“We wouldn’t be able to staff up those extenders,” Kincaid said.
Catalyst has over 200 employees, up from 30 five years ago, Crow said. And many on the second floor of the Plano headquarters are involved in caring for patients.
Last week, the team was helping a diabetic who was getting serious about his treatment. The pharmacist started by getting his medications in order, which included stopping some auto-refills that had piled up.
Then the pharmacist passed the patient to Tyrisha Mason, a registered nurse. The patient couldn’t join a gym to start working out regularly, she said, but he had a couple of 10-pound barbells and a stairway in his home. She suggested he walk up and down the stairs half a dozen times each day, carrying the barbells.
“Together, we set a goal,” Mason said, “and we met him where he was.”
Ancy Purnell, a registered dietitian, stepped in next. She and the patient reviewed his medical history and discussed nutrition labels and portion sizes. She helped him identify carbohydrates in particular foods and explained how they affected his health..
“There’s a lot of educating,” Purnell said. “I spend a lot of time on that.”
That kind of follow-up has produced results, including over $55 million in savings in three years, Catalyst said. Over 90% of targeted patients adhered to their medication plan soon after the one-year mark. And high-intensity users had substantial savings — roughly $600 a person per month in health costs, the company said.
Dr. Stephen Buksh, an internist in Euless, said the Catalyst care team integrates right into his practice. He reels off the names of nurses and others who contact patients on his behalf and then update him.
“I could hire people but it wouldn’t be nearly as robust,” Buksh said.
Crow, a family physician for 13 years, co-founded Village Health Partners over a decade ago. The Plano group was lauded for creating a medical village with easier access to primary care docs, specialists and prescriptions. It has been an innovator in value-based care, which seeks to improve outcomes and lower costs.
For seven years, Crow has been building up StratiFi and Catalyst, believing the success of independent primary care physicians was crucial to any progress in the industry.
“Any moment they’re not thinking about the business, they can actually focus on clinical care,” Crow said. “And they don’t feel like they’re on an island.”
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