Supergroups?

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unlimitedsigh

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Anyone have any knowledge of any local supergroup (think ACO-lite, sans a hospital) recent formations? Particularly with POs that have transitioned via a vertical integration (where previously no financial integration existed), or even existing PO's that were already financially and/or clinically integrated.

* Messenger-model preferred
* Spearheaded by PO and/or independent providers (as opposed to hospitals or carriers) preferred

Any state is fine, I am just interested in name/location, but details (size, costs, problems) would help. (names of organizations, city/state, staff associations, attorneys used, etc.) - anything is beneficial really.

Note: this isn't for marketing purposes (it seems peculiar posts are scrutinized for possible gain for the poster here, perhaps rightfully so...), I can explain the 5 W's in PMs for any with pertinent info.

Thanks in advance /shot in the dark
 
Yes, this is a shot in the dark.

There is a big difference between PPO's and ACO's

I don't really know what you are asking?
 
PO (physician's organization), not PPO.

Supergroups are like a foundational ACO, but do not include a hospital typically - amongst other differences (antitrust regs, quality requirements, covered lives requirements, details of savings programs...). Hence ACO-lite (over-generalization)

Both are viable options for physician's groups and other providers (surgery centers, specialists, rehab facilities, other groups) to navigate the terrain moving forward and be profitable and compliant (like EMR implementation, 'Dr Fix' on the horizon, and so on...). ACOs are also costly and fairly complicated.

Relative to ACOs, supergroups are somewhat rare. ACO formation has received the lion's share of the news. A 'supergroup' is a viable, lesser-known alternative. Being able to show this would help tremendously.




OK, that said, that distinction made - anyone here know of any? None of you health guys run in MGMA circles, or know PO directors, or have talked with carrier reps - anything, that would alert you to a giant formation as such?

THAT is why this is a shot in the dark. Other, more appropriate/direct means are already being pursued. I just figured a national network/forum of ins providers might be able to pleasantly surprise me in this regard...
 
I have never even hear the term used before.

Your best bet is to contact a someone who is involved with network negotiations on the carrier side. Look at a carrier with a national network.

They will know if these supergroups exist.
 
ABC said:
I have never even hear the term used before.

Your best bet is to contact a someone who is involved with network negotiations on the carrier side. Look at a carrier with a national network.

They will know if these supergroups exist.
Click to expand...

Thanks.

However, they do exist (I know of a couple, but am looking for more [for my interested party]) - if interested, just try googling "medical + supergroup" or "aco + supergroup" for the limited information. Like I mentioned, traditional means are already being pursued. You would be surprised in the number of healthcare attorneys that aren't even familiarized with them, and slightly less well-versed in ACO formation. The rockstars that do - their services are not cheap. Even one that is retained is limited to only knowing of a handful personally, so she is recommending compiling a list (to help sell to a PO's board), and for their experiences. Free legwork/DD is always a bit helpful before the inevitable consultant is brought in.

As for contacting the carriers.... well, they have a love-hate with ACO-like structures (instant access to a large group of patients in what amounts to a geographical monopoly is a plus - they will NEED the ACO if they want that market, but that monopoly has group bargaining power, and can really eat into their [goal] fee schedule/rates. Because antitrust is non-issue, providers could know what other providers are getting for their rates.... read more here: Will Health Plans Want to Contract with ACOs? Maybe, Maybe Not. | e-CareManagement )

That is to say, there may be no incentive in a carrier assisting an ACO or similar (monopoly/union) in getting formed. I know my party has/is reaching out, but informally in regular contract nego meetings.

It's a good thought, possibly.
 
I now understand what you are are talking about.

The hospitals are buying up every medical practice they can. I have had multiple clients sell out. One client had 34 employees.

I would think it would be cheaper to sell out than spend the money on attorneys to build a so called supergroup. Even with a supergroup there is no way you are going to have leverage with a national network.


You have a tough sale.
 
ABC said:
I now understand what you are are talking about.

The hospitals are buying up every medical practice they can. I have had multiple clients sell out. One client had 34 employees.

I would think it would be cheaper to sell out than spend the money on attorneys to build a so called supergroup. Even with a supergroup there is no way you are going to have leverage with a national network.


You have a tough sale.
Click to expand...

You are correct about the providers selling out - many cannot afford NOT to (certainly with the... well, uncertainty moving forward, and the high costs of compliance and EMR).

However, it isn't the best thing in all cases, obviously. Some physicians DON'T want to be forced to have to work hospital rotations. MOST like their independence. Then, there's always the minor fact that many thought they would be able to run a business for a profit - but they are feeling the squeeze. You have some that were putting off retiring simply deciding to retire early rather than deal with some of this stuff.

Then, there's the hospitals as dictators. Even the so-called 'non-profits'. Here's an interesting bit - often a hospital will hire a physician on an 18-24 month contract.... what do you think will happen to the salary offered when that is up? Most do not know that a new-hire physician('s practice) COSTS a hospital a net of 50-60k/yr, even in today's market. Is it in the hospitals best interest to keep paying the honeymoon salaries?

It looks like more and more will be hospital employed. Now, what happens when the doc fix/medicare rate cuts come down the pipeline? Can the physicians quite simply go back to independent practices? Would the language in their contracts even allow them to?

Selling Practices to Hospitals - Boon or Burden?

It's all the same cyclical garbage in healthcare. Deja vu all over again.



Re: leverage. You'd be surprised. It's the same with ACOs. Basically, with or without a hospital. It's really the whole point, the leverage (well, that and the cost-containment from being under one roof), so I'm not sure why you think that would be an issue. Again, market penetration for the networks is important - they will be forced to play ball. At the very least, they won't be able to undercut independents...

The numbers work. Economies of scale/streamlining and all that. Even considering the high startup costs. It isn't really a sale at this point as much as it is continual fact-finding. The interest is there...
 
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