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Are Bigger MD Groups Better Prepared for Population Health?

June 2, 2015
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As population health and accountable care initiatives move forward and ramp up, the leaders of larger physician groups are helping to lay the groundwork for transformational change in the new healthcare

It was fascinating to interview Donald W. Fisher, Ph.D., the president of the Alexandria, Va.-based American Medical Group Association (AMGA), earlier this spring, as I researched and reported our May/June cover story on population health and data analytics. For one thing, Dr. Fisher has been in the trenches in supporting the management of larger medical groups in the U.S. for decades now, so his perspectives are weighted with many years’ experience and understanding of the healthcare system at the physician group management level.

What’s more, anyone familiar with AMGA knows that the leaders of its member medical groups have been at the forefront of healthcare delivery and payment innovation for years now. It was in fact the participation of a number of a number of AMGA member medical groups whose involvement and learnings in several different Medicare-facilitated primary care and care management initiatives helped convince senior CMS (Centers for Medicare and Medicaid Services) officials to move forward to the go-live of the Pioneer ACO Program a few years ago.

And it has been not only in the Medicare accountable care organization sphere that the leaders of large medical groups have been trailblazers; large medical groups have been pioneers, with a “small p,” in private-sector ACOs, collaborating in very innovative ways with private health insurers nationwide.

So what has been learned? Among other things, as Dr. Fisher told me this spring, and as was revealed in our extended interview published this week, one key challenge remains that, as he put it, “Some medical groups still have gaps in their primary care base; and if you’re going to do population health, you need a very good primary care base. So some are still struggling in that area. And then,” he added, “there is the cultural piece, which encompasses reimbursement-related goals related to this. You can try to change your culture, but if you’re still being paid fee-for-service, and still mostly paying your doctors fee-for service, you need to change that, and that is something they’re trying to get over pretty quickly.”

Beyond those issues, there is this issue that Dr. Fisher brought up in our interview, and which I think goes to the heart of the question of how the leaders of larger medical groups are turbocharging their learning process around accountable care and population health: “The thing is,” he told me, “that you have to go beyond the data; you have to reengineer the care process. The way it is today, it’s a reactive kind of care process. If you’re using predictive analytics and data sets, you’ve got to be proactive, and reach out to patients in advance. And that requires different skill sets, different providers; it’s a very, very big job to work these data sets and predictive analytics, but,” he added, “it can make a very big difference in patients’ lives; patients are just doing so much better as a result.”

And therein lies one of the keys to unlocking the secret of population health and accountable care success—the interplay between the harnessing of data analytics and the continuous process change work that needs to undergird everything.

In other words, at the same time that the leaders of a medical group—or, for that matter, any patient care organization—are collecting data, analyzing that data, making determinations of how to act on their analyses, and moving forward to make changes based on those analyses, they need to be engaged in continuous clinical and operational performance improvement, whether using methodologies like Lean management, Six Sigma, and Toyota Production System for healthcare, or any combination of those or other methodologies, or developing their own.

It’s all about a virtuous cycle or “blessed cycle,” as some are calling it, in which process change and analytics work are all intelligently and strategically combined. Now, here’s a legitimate question: what size medical group might do this best?

Of course, every physician group has a different organizational structure, specialty and clinician composition, history, culture, and set of IT and other tools, at its disposal. And it goes without saying that every medical organization has a different set of personalities. But, given sufficient leadership capability, and the taking on of personal-professional risk on the part of leaders in an organization committed to transformational change, anything is possible. But it does seem that larger medical groups—those with enough management skill individuation that they have not only a chief medical officer but also probably a CMIO, as well as someone who serves as a chief quality officer, and with each of those leaders having some team with at least part-time responsibility to participate in robust change management—it does seem that larger medical groups are more fully advantaged in the context of this kind of work.