New York supplier group, insurer partner on a new integrated delivery system

Community Care Physicians and Capital District Physicians’ Health Plan have joined forces to create a new management services organization with the goal of outsourcing the administrative operations of the group of independent multispecialty providers while maintaining its independence.

The physician-owned medical group employs 420 clinicians in 70 counties in and around Albany, New York, where the two companies are headquartered. The nonprofit insurer covers 400,000 people in 29 northern counties in the group, personal and public sector markets. The partnership is expected to close by the end of the year, subject to approval by state regulators, the companies announced last week.

Community care physicians, who did not respond to interview requests, will remain independent when the management services organization is in place. The medical group will retain contracts with other payers and outsource its revenue cycle, human resources and technology operations to the Capital District Physicians’ Health Plan.

A growing number of providers are looking to integrate their transactions more closely with payers in order to accept more of the risk for patients. Almost 60% of health systems plan to adopt risk-based Medicare Advantage payment models next year, with at least 30% following the community care physician model and partnering with payers to strengthen the ‘data integrity, reporting and technological capabilities, depending on survey results. Healthcare Financial Management Association released this month.

Many of these ventures are involved in regional nonprofit insurance companies, said Capital District Physician Health Plan chief executive Dr. John Bennett. Together, the partners will engage in risk-sharing agreements and merge their functions into an integrated system.

“We want to improve the health of our patients and we know this will lead to cost savings,” Bennett said. “But our intention is to allow doctors to be doctors, to let them practice and be with their patients.”

Fewer physicians than ever have their own practices, according to a recent survey by Avalere Health. Many remaining independent physicians are looking for alternatives to business ownership, such as joining nonprofit regional health plans or contracts with physician empowerment startups such as Agilon Health that allow them to ‘Outsource the administrative functions of their businesses,’ said Rick Kes, a healthcare partner at consulting firm RSM.

“A lot of times if you ask the doctors, they’ll say, ‘I think the best option is for us to remain independent and provide the care that these patients have received before without any interruptions. “” Kes said. “Now that there are tools, technologies, and companies that can do this, there is more interest in these physician offices. ”


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