Premier Independent Physicians (PIP) CEO Dr. Haris Naseem is building a network of physicians that is upending the business of healthcare by growing the value-based care contracts that already exist in the Medicare world. The COVID-19 pandemic has brought light to new payment models and telehealth options that could change the future of medicine forever.
While coronavirus created a number of problems, the innovations to solve those issues would in normal circumstances have taken 10 years to implement. The pandemic allowed that same advancement to happen in a matter of weeks, Naseem says.
Naseem is a specialist in cardiac electrophysiology, but has a passion for the business of healthcare in addition to his work as a physician. When he moved from academic medicine at UT Southwestern into the world of private practice, he found misplaced incentives and misguided goals. “We make it about the business of medicine instead of the care of patients,” he says. “If you care about patients, the money will follow.”
PIP includes over 300 physicians in North Texas, and the network gives them the claims data and care coordination tools to treat upstream health conditions without cost to the members. The organization is paid by savings generated from the contracts with payers when their patients are kept out of the hospital or exempted from unnecessary lab work or procedures. Their work upstream results in savings on the back end, which are shared with the physicians and the payers in PIP’s network. Made up of physician owners, the network exists in seven states and have saved Medicare $100 million over the last several years.
Naseem’s focus on independent physicians comes from that fact that most of healthcare is directed by large health systems and payers. “Their mission is very simple,” Naseem says. “They want to make money, and care is directed by people whose interests are not to provide the best care, but to achieve financial gain.”
Similar to other independent physician networks like Catalyst Health Group and Genesis Physicians, Premier is looking to congregate independent physicians in North Texas, where about 50 percent of physicians are not employed by a large system. The network created a quality alliance, and developed value-based contracts with Medicare Advantage payers where physicians were evaluated on their outcomes, and rewarded accordingly, rather than the old model of fee for service, or paying for inputs into the system without knowing the outcomes. “Fee for service is a failed model,” he says. “It has failed our nation.”
When physicians remain independent and enter into these contracts, they are incentivized to keep quality high and costs low, while also remaining in charge of their schedule, workload, and the overall quality of care. By contrast, Naseem says that in large systems, “The custodians of patient care are physicians and nurses, but they have had no say of decision making in the system.”
PIP already has value-based care contracts through Medicare Advantage with Humana and Aetna for 10,000 patients, and the system works well for physicians and patients, Naseem says. “The patients are happy, but the hospital systems are not happy because they are not doing as many procedures or admitting patients as much as they are used to.”
Naseem also would like to see the ability for patients to make a choice about where they receive care based on data rather than network availability, their friend’s recommendation, or location.
Naseem believes patients should be able to go online, look at results and outcomes for their doctor or surgeon, and make decisions based on results. Quality and pricing tools are more common, but they are not part of the regular decision-making process for most patients. “Providers should be forced to prove our outcomes and publish our data,” Naseem says. “You should be allowed to see how many complications and patient complaints I had. Not to penalize physicians, but to give patients the ability to pick and choose.”
Naseem would like to see the system move closer to patients being able to pick and choose their providers based on their results, holding providers accountable for their work. The technology is available, and certain specialties already do so. Cardiothorassic surgeons, for example, already publish all their data. “It rewards care and prevention rather than treating everyone in a hospital bed.”
Comprehensive patient surveys should also be available for other patients to see when choosing their physician, he says. “There are surveys at every car wash, restaurant, and bank. Why can’t we do that with our providers?”
But what about doctors who choose to go into underserved communities, treating sicker patients? Would they be penalized in such a system for taking on more difficult patients and perhaps not having the rates of success of a doctor who treats healthier patients?
Much like teachers in Dallas ISD are paid extra to work in schools that are lower achieving, Naseem sees a system where differences in patient populations are accounted for so that physicians are only compared to others working in similar environments and are rewarded for taking on more difficult populations. Looking at patient data could help physicians determine what actions need to be taken, what success looks like, and how to best manage the care. PIP, like other networks, has a care coordination team that checks in on patients and makes sure they are getting what they need and staying out of the emergency room.
Telemedicine is another change brought about by COVID-19 that was a long time coming. Naseem says resistance came from both sides of the healthcare equation. “It should have happened 10 years ago, but was systematic failure,” he says. “Hospital systems want everyone to walk in the ER and pay $20,000, and payers don’t want patients to see anybody,” he says. Telemedicine, in theory, keeps patients out of the emergency rooms while allowing easier access to care.
That said, many hospital and health insurance companies have their own version of telemedicine that did well before the pandemic.
For his network, PIP installed telehealth in a week as elective procedures were canceled and doctors offices closed during the pandemic. It allowed for increased access to those stuck at home, and a more robust program to coordinate care.
Naseem hopes to see value-based models move from the Medicare Advantage world into the employer and commercial market here in North Texas. Amazon and Berkshire Hathaway are working on value-based care, and there are a number of direct primary care practices in North Texas delivering similar care to patients, some of which have direct contracts with employers. “The care will be shifted to prevention and treatment in outpatient settings,” he says.
“My hope is that we move toward a value-based model that looks better than fee-for-service,” he says. “We don’t have time or the opportunity to do so over years. I hope we will keep that and robustly grow it.”