Provider services and solutions

Strategy and growth: Physician alignment and integration

The challenge

Better care for less cost. That mantra drives clinical and business decisions. It preoccupies providers and payers. And it’s moving healthcare toward a more integrated delivery system, with payers pushing physician/hospital integration and new payment models.

Payers have long sought to structure reimbursements to get physicians and hospitals to collaborate better. To efficiently deliver quality care. Comprehensive, patient-centered care. The Centers for Medicare and Medicaid Services (CMS) are leading the way. Their reimbursement policies are evolving from quality-based reporting, or pay-for-performance, to outcome-based reporting, or value-based pricing. CMS is now testing the effectiveness of bundled payments with its Acute Care Episode program. CMS believes that bundling payments to physicians and hospitals will reduce variation in cost and quality and encourage joint accountability for meeting quality and cost standards.

New reimbursement models pay more to providers who deliver continuous, equitable and comprehensive care to patients with chronic diseases. Payers hope to spend much less on acute care by spending a little more on preventive care, disease management and in-home treatment.

Physicians and hospitals with integrated practices can better serve their patients. By proactively aligning with new reimbursement models, they will ensure a stronger bottom line that will better serve their stakeholders.

How we can help you

• Physicians and hospitals can work together in many ways to integrate care delivery. Choose wisely for your organization, since some of these models are subject to complex and changing tax and reporting regulations.
  • We can assess physician/hospital alignment options, including employment, contracts, co-management companies, under-arrangement agreements and joint ventures. We can look at the regulatory implications of physician alignment models and recommend the option that is best for your organization.
• Your physician/hospital alignment model should deliver competitive advantage. It should enhance your mutual profitability.
  • We can analyze the advantages and disadvantages of each alignment option for compliance, efficiency and profitability. We can lead the development process for the model you choose and embed it into your operational and quality initiatives.

Common services include

• Planning for licensing, testing and accrediting inspections of new or renovated facilities
• Benchmarking your services and facilities against those of competitors
• Conducting a facility’s life-cycle cost analysis